$B5-!!;v(J

Supercourse model for web-basededucation in health

Akira Sekikawa 1$B!K(J, Akihiko Suyama 2$B!K(J, Katsuya Yahata 3$B!K(J,
Hidehiko Tamashiro 4$B!K(J, Deborah J Aaron 1$B!K(J, Ronald E LaPorte 1$B!K(J


1) University of Pittsburgh, U.S.A., 2) Radiation Effects Research Foundation, Japan, 3) University of Occupational and Environmental Health, Japan, 4) World Health Organization, Switzerland [Correspondence to: Akira Sekikawa, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, U.S.A., akira+@pitt.edu]
$B!J869F

$B!Z(JAbstract$B![(J The Supercourse is a project on the Internet, which is composed of web-based lectures on epidemiology and global health, created and shared by 1,200 faculty members from 101 countries$B!J(Jhttp://www.pitt.edu/~super1$B!K(J. The Supercourse differs in many ways from traditional distance education on public health using the Internet. We describe four unique characteristics of the Supercourse model for web-based education here: lectures for the instructors, sharing lectures, quality control of the lectures, and being available in low bandwidth connectivity. The Supercourse model has been employed in other health fields including environment and sustainable health at http://www.who.int/peh-super/, its Japanese version at http://www.epi.med.tottori-u.ac.jp/super/, pathology, and rehabilitation science. We believe this model offers one of the ways to share the worldÕs store of health knowledge through the Internet in order to improve health in the next century.
$B!Z(JKey words$B![(JInternet, education, public health, epidemiology, distance learning
$B!!(J

Introduction

$B!!(JThe Internet has grown exponentially during the last five years and is expected to continue to grow. It is changing the way people communicate and exchange information locally as well as globally in almost all areas of society including education.
$B!!(JIn this century, life expectancy has improved in both developed and developing countries to an extent that has never been experienced in human history$B!Z#1![(J. Japan achieved the longest life expectancy in a relatively short time period and has enjoyed it for many years$B!Z#2![(J. Most of these improvements are attributed to public health and disease prevention such as sanitation, immunization, changing life styles, improved nutrition, health education, etc.$B!Z#1!A#4![(J. Even though public health has played such an important role in this century, medical and other health-related schools put little emphasis on public health and epidemiology as a basic science of public health$B!Z#5![(J. For example, on average less than ten hours are spent for lectures on epidemiology in medical schools in Japan$B!Z#6![(J. Moreover, even in the United States where there are twenty-seven public health schools, it is suggested that there is a need for at least five times as many epidemiologists as there are now$B!Z#5![(J.
$B!!(JOne of the attempts to fill this gap is an Internet-based distance-education programs for teaching public health. Several public health schools in North America offer these courses$B!J(JTable 1$B!K(J. Typically these courses are developed to meet the educational needs of local public health workers and institutions. Application and tuition are usually required. Some programs offer master of public health and require on-campus study as a part of distance education. All programs rely exclusively on faculty members of the university that provides the courses. These distance-education programs are mere extension of on-campus courses in order to meet the local needs and may not fully utilize the capabilities of the Internet.

Table 1 Public health distance-education programs using the web

Name Facility URL
Certificate program in-public health University of Washington http://www.extension.washington.edu/extinfo/certprog/pht/pht.htm
Outreach education The University of Texas-Houston-School of Public Health http://www.sph.uth.tmc.edu/outreachedu/
Distance learning University of North Carolina at-Chapel Hill, School of Public Health http://cdlhc.sph.unc.edu/
Internet-based master-of public health Johns Hopkins University School-of Hygiene and Public Health http://www.sph.jhu.edu:443/~distance/
eLearnEmory University, Rollins School-of Public Healthhttp://www.sph.emory.edu/courses/index.html
Graduate certificate-program via distance-education George Washington University, School of Public Health and Health- Services http://learn.gwumc.edu/sphhs/
Distance education-programme McGill University, Department of-Occupational Health http://www.mcgill.ca/occh/distance/masters.htm
Distance Learning Tulane University School of Public-Health and Tropical Medicine http://caeph.tulane.edu/distance_learning_deliv.htm
$B!!(JBased on the concept of the Global Health Network University$B!Z#7![(J which was proposed to provide a transnational training program in public health through the capabilities of the Internet, the Supercourse evolved in 1997$B!Z#8![(J. The Supercourse is composed of web-based lectures created and shared by the global faculty members and has been developed to provide an overview on epidemiology, global health, and the Internet$B!J(Jhttp://www.pitt.edu/~super1$B!K(J. In this paper, first, we contrast the Supercourse model to the traditional distance- education model for web-based education, then describe the current status of the Supercourse. $B!!(J

Supercourse model for web-based education

$B!!(JFour unique characteristics of the Supercourse model for web-based education were described here: lectures for the instructors, sharing lectures, quality control of the lectures, and being available in low bandwidth connectivity. The primary target of the lectures on the Supercourse is the faculty at health-related facilities, not the students that are the typical target in the traditional distance education. While distance education means a separation between the teachers and the students, in the Supercourse model, there is no separation in that the classroom teachers do the teaching. The only difference for the classroom teachers is that they will have much better educational materials that they can pull from a library of lectures on the Internet. For example, when a classroom teacher in developing countries wants to teach mercury and environmental health because of his concern for possible mercury pollution in his country, he can use lectures written by Dr. Takizawa$B!J(Jhttp://www.pitt.edu/~super1/lecture/lec0321/ index.htm$B!K(J, the Director General of National Institute of Minamata Disease from the Supercourse.We believe that lecture quality depends almost exclusively on its content. Improving content of lectures is perhaps the easiest means to improve higher education. The best lectures of a teacher created after many years of professional and educational experiences are typically presented only once a year to a small number of students. In the Supercourse model, global faculty members develop and share their best lectures free of charge. For example, Dr. Bennett provided his best lecture - Epidemiology of type $B#2(J diabetes$B!J(Jhttp://www.pitt.edu/~super1/lecture/lec0461/index.htm$B!K(J, as he is one of the top researchers as well as teachers on this topic in the world. When a teacher at a medical or other health-related school in Japan wants to teach epidemiology of diabetes, he can prepare his class using lectures written by Dr. Bennett and by Dr. Fujimoto, who is one of the top researchers in epidemiology of type $B#2(J diabetes among Japanese Americans$B!J(Jhttp://www.pitt.edu/~super1/lecture/lec0451/index.htm$B!K(J. Distance-education courses rely on faculty members of the university that provides the courses, and their lectures are typically not shared with other faculty.
$B!!(JIt is necessary to develop and maintain high quality. In the Supercourse, therefore, open evaluation and revision of lecture materials on the web are being conducted. These procedures are built into the Supercourse based on the concept of the quality control$B!Z#8![(J. At the end of each lecture, there is a Òpeer review of the lectureÓ page, which allows the faculty members to submit their ratings and comments on the lecture with their identity. The author is then asked to update and revise the lecture based on the comments from the reviewers. To our best knowledge, this kind of quality control process has never been applied to distance-education course materials.
Many distance-education programs on public health require streaming audio/video which needs a stable Internet connection and may not run smoothly in low bandwidth connection which is typically true in many developing countries and in fact in many rural areas in developed countries. In order to share lecture materials on the web with low bandwidth users, every effort has been made to reduce the size of the web page in kilobyte $B!J(JKB$B!K(J in the Supercourse. As a result, the average size of the web page of the Supercourse lecture is less than 10 KB. In addition, one can obtain the entire copy of the Supercourse and set up a mirror server free of charge in order to improve the access time for the local users.$B!!(J

Current status

$B!!(JTo develop the Supercourse model, it is necessary to nurture such a global network among people who are interested in sharing their best lectures, reviewing lectures, or employing lectures for teaching their students. In October 1997, we announced the Supercourse via e-mail to identify faculty for the Supercourse. Since then, recruitment of the faculty has been a continuous effort. As of October 1999, there were approximately 1,200 faculty members from 101 countries and international organizations such as the World Health Organization $B!J(JWHO$B!K(J, the World Bank, and others. More than 50$B!s(J of faculty members are from North America or Europe, 18$B!s(J from South America, 15$B!s(J from Asia, $B#5!s(J from Africa, $B#4!s(J from Oceania, and $B#3!s(J from Middle East.
$B!!(JAs of October 1999, there are 80 lectures in the Supercourse$B!J(Jhttp://www. pitt. edu/~super1/main/index. htm$B!K(J. It is notable that more than 15$B!s(J of the lectures are from developing countries. Lectures cover the topics of epidemiology in general, epidemiology of specific diseases or conditions, biostatistics$B!J(Jhttp://www.pitt.edu/~super1/main/epi.htm $B!K(J, application of the Internet to public health and global health in relation to specific diseases or conditions$B!J(Jhttp://www.pitt.edu/~super1/main/int.htm $B!K(J. Some of the lectures are translated into other languages: Chinese$B!J(JBig $B#5!K(J, French, Germany, Japanese, Russian, Spanish, and Turkish. Currently five lectures are available in Japanese$B!J(JTable 2$B!K(J.

Table 2 Lectures on the Supercourse available in Japanese
Introduction to the Supercourse http://www.pitt.edu/~super1/lecture/lec0012/J/index.htm
Epidemiologic Transition http://www.pitt.edu/~super1/lecture/lec0022/index.htm
Monitoring Disease in the Population http://www.pitt.edu/~super1/lecture/lec0032/J/index.htm
Epidemiology of Insulin Dependent-Diabetes Mellitus http://www.pitt.edu/~super1/lecture/lec0042/J/index.htm
Toxic Oil Syndrome http://www.pitt.edu/~super1/lecture/lec0062/J/index.htm


$B!!(JHealth-related institutions can obtain the entire copy of the Supercourse free of charge. As of October 1999, there are 24 mirrored sites in $B#6(J continents including ministries of health in Cuba and China$B!J(Ja list of mirrored sites is available at http://www.pitt.edu/~super1/mirror/index./htm$B!K(J. $B!!(J
$B!!(JThe Supercourse model has been employed in other health fields as well. Dr. Tamashiro at the WHO is developing the Supercourse: Health, Environment, and Sustainable Development$B!J(Jhttp://www.who.int/peh-super/$B!K!Z#9![(J. This is a joint effort by the WHO and the Global Health Network. There are about 20 lectures available at this course. Dr. Suyama started the Japanese version of the Supercourse at http://www.epi.med.tottori-u.ac.jp/super/. Recently two other groups have started their Supercourse: the World Association of Societies of Pathology and Laboratory Science$B!J(Jhttp://www.dokkyomed.ac.jp/dep-k/cli-path/WASP-Glo.html$B!K(J and School of Health and Rehabilitation Science at the University of Pittsburgh$B!J(Jhttp://www.shrs.upmc.edu/supercourse/index.html$B!K(J.
$B!!(JThe latest survey for the Supercourse faculty members conducted September 1999 revealed that 29 faculty members have already utilized the lecture on the Supercourse for their teaching and 122 faculty members indicated that they would use the lecture during the next 12 months.$B!!(J

Conclusions

$B!!(JDr. Nakajima, the former Director General of the WHO commented that sharing the worldÕs store of health knowledge through information technologies is a keystone to international health development in the next century$B!Z(J10$B![(J. We believe that the Supercourse model for web-based education is one of the most feasible ways to achieve this goal. We argued that health information flowing into developing countries should come not only from Britain and the United States, by which the approaches towards public health have been dominated in this century, but also from countries with better health indicators and successful public health programs, which disproportionately provide less information than these two countries$B!Z#2![(J. In this sense, Japan cam make substantial contributions into international health in the next century.

References

$B!Z#1![(JThe World Bank. Overview. In World Development Report 1993. Oxford University Press. Oxford. p.1 - 16, 1993.

$B!Z#2![(JA. Sekikawa, R.E. LaPorte, T. Satoh, G. Ochi :
Health workers need information from countries with better health indicators than Britain and the US {letter} Brit Med J 314: 1418, 1997. http://www.bmj.com/cgi/content/full/314/7091/1418

$B!Z#3![(JR. Beaglehole, R. Bonita :
Global Health: past and present challenges. In Public Health at the Crossroads. Cambridge University Press. Cambridge, New York, p.13 - 43, 1997.

$B!Z#4![(JT. McKeown :
Determinants of Health. In NationÕs Health. Eds. Lee PR, Estes CL. Jones and Bartlett Publishers. Boston, p. 6 - 13, 1994.

$B!Z#5![(JK.L. White :
Healing the Schism. Epidemiology, medicine, and the publicÕs health. New York. Springer, 1991.

$B!Z#6![(JR. Tokunag :
Pre-graduate education on social medicine. In White Paper on Medical Education 1994. Shinohara publishers. Tokyo. p. 81 - 85, 1994$B!J(Jin Japanese$B!K(J.

$B!Z#7![(JR.E. LaPorte, S. Akazawa, E. Boostrom, M. Campos, C. Gamboa, T. Gooch, H.K. Lee, I. Libman, E. Marler, K. Roko, F. Sauer, N. Tajima, W. Wieve :
Global Public Health and the Information Superhighway: Global Health Network University Proposed. Brit Med J 309: 736 - $B#7(J, 1994. http://www.pitt.edu/~rlaporte/ref2.html

$B!Z#8![(JSupercourse Faculty. The Global Health Network Supercourse. Telemed J$B!J(Jin Press$B!K(J.

$B!Z#9![(JH. Tamashiro, T. Oshima, S. Takahashi, R.E. LaPorte, A. Sekikawa, T. Satoh :
An Internet-based ÒdistanceÓ learning for health, environment and sustainable development Òdistance learning without a frontierÓ. Jpn J Pub Health. 46: 130 - $B#3(J, 1999.$B!J(Jin Japanese$B!K(J.

$B!Z(J10$B![(JWHO Health agenda for the 21st century. In The world health report 1998. World Health Organization, Geneva, pp 201 - 212, 1998.

$B%$%s%?!<%M%C%H$r1~MQ$7$?%0%m!<%P%k$J650i%W%m%8%'%/%H(J
$B!]%9!<%Q!<%3!<%9!](J

$B4X@n!!6G(J 1$B!K(J$B!$F+;3> 2$B!K(J$B!$H,H(>!Li(J 3$B!K(J$B!$6L>k1QI'(J 4$B!K(J$B!$(JAaron DJ 1$B!K(J$B!$(JLaPorte RE 1$B!K(J

$B#1!K%T%C%D%P!<%0Bg3X!$%"%a%j%+9g=09q!$#2!KJ| $B#3!K;:6H0e2JBg3X!$#4!K@$3&J]7r5!4X!$%9%$%9(J

$BMW!!Ls(J

$B%9!<%Q!<%3!<%9$H$O!$%$%s%?!<%M%C%H$r1~MQ$7$?!$M=KI0e3X$d1V3XEy$N%\!<%@!<%l%9$J650iB%?J(J $B$rL\E*$H$7$?%&%'%V>e$N%W%m%8%'%/%H$G$"$j!$8=:_!$(J101$B%u9q!$(J1,200$BL>$NF1J,Ln$N@lLg2H$N6(NO(J $B$G?J$a$i$l$F$$$k!J(Jhttp://www.pitt.edu/~super1$B!K!#%9!<%Q!<%3!<%9$O!$=>Mh$N%$%s%?!<%M%C%H$r(J $B1~MQ$7$?1s3V650i$H$O0[$J$C$?$b$N$G$"$j!$K\9F$G$O$=$N=EMW$J%]%$%s%H$r#4$D>R2p$7$?!#(J $B!!%9!<%Q!<%3!<%9$N7ABV$O!$$9$G$K4D6-$HJ]7r!J(Jhttp://www.who.int/peh-super $B$*$h$S$=$NF|K\8lHG(J http://www.epi.med.tottori-u.ac.jp/super/$B!K!$IBM}3X!$NW>28!::3X!J(Jhttp://www.dokkyomed.ac.jp/dep-k/cli-path/WASP-Glo.html$B!K!$%j%O%S%j%F!<%7%g%s2J3X!J(Jhttp://www.shrs.upmc.edu/supercourse/$B!K$NJ,Ln$G$b1~MQ$5$l$F$$$k!#(J21$B@$5*$K$`$1$F$N%0%m!<%P%k$J650i!$(J $BCN<1$N6&M-$N$?$a$K!$%9!<%Q!<%3!<%9$N7ABV$O$-$o$a$FM-MQ$G$"$k$H;W$o$l$?!#(J

$B!Z%-!<%o!<%I![(J $B%$%s%?!<%M%C%H!$650i!$8x=01R@8!$1V3X!$(J $B1s3V650i(J