Tools, Technologies and Training for Healthcare Laboratories


Education and Training in Analytical Quality Management, Part Two: Developing Internet Courses

You may not know this (we hope you do), but Westgard QC offers several online courses for education and training. How do we do this? Here's a behind-the-scenes discussion of how we develop "just-in-time" courses for college courses, workshops, seminars, and continuing education courses for clinical chemists and clinical laboratory scientists.


In part 1 of this series on education and training, I discussed the implications of new educational technology and distance education for laboratory education and training, particularly the possibility of delivering "just-in-time" training to anyone, anywhere, anytime, and at low cost. I also indicated that a goal of Westgard Web was to develop a "lesson-base" for training and education in analytical quality management. With such a lesson-base, we could then start to provide internet courses that could be widely available.
View Education and Training in Analytical Quality Management, Part I: Developing a "Lesson-Base."

In part 2, I want to discuss how internet courses can be organized and structured to address a variety of educational and training needs. Some real examples are provided to demonstrate how this can be done to provide continuing education courses for clinical chemists and clinical laboratory scientists, a college course for clinical laboratory science students, and laboratory training for pathologists in residence and practice.


Those of you who are teachers or trainers often encounter the following kind of situation which will help you understand the potential of internet education and training. When asked to present a lecture, seminar, or workshop on a particular subject, we may go to our collection of slides and start to select, sort, and organize those slides to provide the backbone or structure of what needs to be covered and discussed. The slides selected and the organization of those slides will depend on the target audience, thus the presentation will be somewhat different when talking to clinical chemists, clinical laboratory scientists, pathologists, or laboratory managers. The individual slides are building blocks that are used to outline, structure, and customize the presentation for the intended audience.

Now think about having bigger building blocks to work with - lessons instead of slides. With the development of the "lesson-base" for analytical quality management on this website, we can select and organize lessons to build whole courses. We can customize these courses to target specific audiences and to serve different educational purposes and training needs. And it's relatively quick and easy to do, as least compared to more traditional courses that utilize hardcopy materials.

Example courses

The current lesson-base on this website will support teaching and training in laboratory QC practices (basic statistical QC) and the planning or selection of QC procedures (a more advanced topic). To demonstrate how these materials can be used to develop educational courses, here are links to four different internet courses that make use of some of these materials.

  • Quality Control Planning was a continuing education course that offered for 15 ACCENT credits by the American Association for Clinical Chemistry (AACC). Over 130 professionals in more than 30 countries participated. This course will be replaced by the forthcoming Basic Quality Planning course.
  • Basic QC Practices is a continuing education course that is currently under development in cooperation with the American Society for Clinical Laboratory Science (ASCLS).
  • Pathology 520 was a University of Wisconsin-Madison course for senior students majoring in Clinical Laboratory Science. Online materials were available for two-thirds of this course - the sections dealing with basic QC and QC planning. This course evolved into the Basic Method Validation online course.
  • QC Planning for Pathologists in Residence and Training was a Clinical Pathology training course under development at the University of Wisconsin Hospital and Clinics. This course utilizes many of the same lessons as the AACC Quality Control Planning course, but there are some major differences in the orientation of the course and the organization of the materials, as well as some options to branch and review basic QC and method validation practices.

Course structure

In developing these courses, the important elements that we have identified include a course description or "course-page", course syllabus, lesson plans, lesson-base, an electronic discussion forum, and an online exam. The course description is like the handout material that is often provided the first day of a class. The course syllabus outlines the organization of the lessons. The lesson plans provide detailed descriptions of individual lessons and provide references to the materials in the lesson-base. The lesson-base is the like the textbook and reference materials for the course. The electronic discussion forum allows the instructor and the students to interact, ask and answer questions, and provide feedback or advice about the course. The online exam provides an assessment of the proficiency and skills learned and a measure of the success of the course.

Course description

Think of this as the home-page of the course, or the "course-page." We typically include an introduction that is intended to tell the target audience why this course will be useful to them, followed by information about the instructors, the purpose of the course, the educational goals to be accomplished, the course materials that will be used, interactive opportunities for the students, the contents and description of the lessons, and finally how the student and the course will be evaluated. This course description might be provided on Westgard Web as well as on the websites of professional organizations or other educational institutions.

In situations where continuing education is being offered through a professional organization, a link is provided for the student to connect to the website of the professional organization and register for the course. The professional organization can then give the student a password and the link to the course syllabus. For an example, see the course descriptions for the AACC Quality Control Planning course with its link to the AACC website. We expect to handle the ASCLS course on Basic QC in a similar way.

Course syllabus

This is a brief document that lists the individual lessons included in the course and provides links to the individual lesson plans. We also provide a schedule form that can be used as a plan for completion of the lessons and the course. Typically, the student would "bookmark" the syllabus and use it as the starting point to access a new lesson. The AACC Quality Planning Course and the ASCLS Basic QC course are examples where the professional organization provides the link to the course syllabus.

Alternatively, we may provide schedule information and links to lessons directly on the course-page, as illustrated in the Pathology 520 course for Clinical Laboratory Science students at the University of Wisconsin-Madison and the QC Planning for Pathologists in Residency and Practice course. With the pathology resident training course, we leave the scheduling completely up to the residents because we know they will have to sandwich in time for this training between other assignments.

Lesson Plans

The lesson plans provide a brief statement of what each lesson is about, a list of specific learning objectives for the lesson, links to the web materials to be used, a list of things to do, and some self-assessment questions. These lesson plans are the key component for customizing the course objectives to a target audience, selecting the materials to be used, identifying the learning activities appropriate for those participants, and providing appropriate assessment exercises that are relevant to their needs.

A good example of a lesson plan that has been customized to an audience can be found in the pathology resident course, where the OPSpecs chart is introduced through an analogy with maps in Lesson 6. In the AACC quality planning course, the lessons introduce and develop the theory of power functions and critical-error graphs first, to provide a mathematical basis for the OPSpecs chart. This same information is made available in the resident training course as optional material for more in-depth study in Lesson 8.

The course for CLS students provides another good example of the instructional approach and the ability to use color graphics liberally to enhance the materials. The definitions and applications of different quality control rules in multirule QC procedures, as well as the original multirule paper in PDF format (which requires the Adobe Acrobat Reader), are provided via the materials available in Lesson 11. These same materials can be accessed in the resident training course through the option to review basic QC practices via the "QC - The Practice" application available in Lesson 3.


The lesson-base represents the totality of the materials that can be accessed for use in the course. For example, the "archives" link on the Westgard Web homepage provides you with a list of the materials that are currently available. In concept, the lesson-base can be thought of as a textbook from which individual chapters can be selected as needed. Currently these materials represent essays, lessons, applications, tables of reference information (such as quality requirements), web calculator tools, and other computer tools available via download from the web. In principle, it should also be possible to select materials from other lesson-bases, just like professors often assign chapters from a variety of available textbooks.

Electronic discussion forum

Our experience with the AACC course in Quality Control Planning was helpful in identifying the electronic discussion forum as an important component for providing interactions between students and instructors. Because students are likely to work through an internet course at their own pace and on their own individual schedules, i.e., "asynchronous learning", the discussion is best organized by lesson number. That way the student can participate in a discussion that is relevant to the background they have accumulated up to whatever point they are in the course.

It seems desirable to require password access to these course discussions in order to limit participation to those students who are officially enrolled. That makes it easier for the instructor to pay attention to the questions from the participants. Otherwise, the questions and discussion may get off-track if others join in who aren't following the lesson plans and accumulating the same background as the course participants.

On a personal note, I have been pleasantly surprised to find that I enjoy this type of electronic forum. Maybe it just fits my style. I find its useful to have some time to think about these questions and to formulate the responses, particularly in continuing education courses where the participants often have a tremendous base of personal experience and can ask some pretty penetrating and difficult questions.

In the absence of an electronic discussion forum, simple e-mail exchanges between the students and instructors will be useful, though not as efficient or as effective. It will also be desirable that participants in internet courses identify a mentor (or another participant) who they can periodically meet with to discuss what they're learning. Ideally, a mentor would also be able to provide access to real applications in the laboratory and in that way make the learning more relevant.

Online exam

The student should be able to assess their new skills and mastery of the course materials online. This presents some problems, however, because internet exam software is not yet widely available and the exam will often require special programming. With the Basic QC Practices course, ASCLS has provided an online exam that is evaluated by computer; within a minute or two, a grade is returned along with feedback on any questions they may have missed. Three different exams are actually available so that the participants have up to three try's to pass the exam and obtain continuing education credits.

Process perspective on this approach

This approach is a chemist's solution to a real problem. One lesson I learned early in my career was the importance of focusing on the problem before committing to a solution. That was fundamental in my training as an analytical chemist and has been perhaps the single most important principle for focusing my efforts as a clinical chemist. The second important principle has been to formulate the solution in terms of a process that can be adapted to provide additional answers for similar kinds of problems. What I have outlined here is really a process for providing the education and training in the area of analytical quality management.

As shown in the accompanying figure, this process begins by identifying a target audience, its needs for training, and the educational goals to be achieved. A rough course description is then drafted to describe the purpose, objectives, necessary contents, and expected study plan. With this information, we can then assess what course materials are needed, whether they are available in our existing "lesson-base", whether they can be obtained from another lesson-base, or whether new materials have to be prepared. Once we know where the course materials are coming from, we can create the lesson plans that define specific objectives, the materials to be used, activities to perform, and assessment exercises. These lesson plans are then organized by preparing a syllabus that will link the student to the individual lessons. Then we can finalize the course description based on the lesson plans and materials that have now been organized. The course description is given a link to the registration process, which in turn provides the enrolled student with a password and a link to the course syllabus. What remains is to facilitate the electronic discussion forum, offer online examinations, and then implement, administer, monitor, evaluate, and improve the ongoing course.

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