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Online Continuing Education in Public Health: 10 Lessons in 10 Years


I Introduction
II 10 lessons in 10 years
III Reasons to sign up

Submitted by Karen MacDougall and Elizabeth Wright, Skills Online, Skills Enhancement for Public Health, Public Health Agency of Canada

I Introduction

Skills Online is an award winning, Public Health Agency of Canada internet based continuing education program for public health professionals. Skills Online offers a comprehensive set of courses, both facilitated and self-directed, which are asynchronous and easily accessible online. Content reflects current public health practice in Canada and the Core Competencies for Public Health in Canada: Release 1.0 (Core Competencies). All courses use an experiential learning approach, where learners are encouraged to reflect on their own practice as they learn. Since 2004, Skills Online has delivered close to 21,000 courses to over 9000 unique public health professionals/learners. There are now 16 Skills Online modules available and six more under development.

II 10 lessons in 10 years

So, what have we learned?  Plenty!  More than we can share in this short article, and we’re still learning.  Here are our top ten:
1. Provide something unique. The past ten years reflects a period of rapid change in available technology and continuing education approaches. When the Skills Online program started, internet-based learning was at the leading edge of innovation. Now, there are many players and a variety of online learning options to choose from. It is important, in this new context, to offer something of unique value to public health practitioners. The Skills Online comprehensive set of courses, in both official languages, based on public health practice in Canada and mapped to the Core Competencies provides a unique continuing education opportunity. Furthermore, Skills Online does not require an arduous registration process or college or university level prerequisites, and learners do not have to meet extensive completion requirements.

2. Take “time” into account. It’s a challenge for everyone: learners, organizations and developers!  Learners consistently report that time is one of the biggest barriers for course completion and that courses “take longer than you think.”  Most learners use time at home and work to complete the courses. Some organizations offer staff “time off in lieu” for completion of a course. So, participation in the program requires not only a time commitment from the learners but also their organization. Finally, course development takes time – at least 24 months – and it should not be rushed. This timespan reflects a detailed development cycle, from needs assessment, to framework, content, design, build and launch of the final product. Every point in the cycle is subject to review and revision. It is important to remember that the time invested “up front” in development pays off when the end product is a reliable, polished and comprehensive education resource.

3. Don’t skip steps in course development. Course development is a multi-step, sequential, but iterative process that begins by establishing need. If you’re committed to the development of a high quality product, you can’t skip steps and you can’t do it alone.  We’ve learned that it is important to:

  • Engage experts early.
  • Establish and value our partnerships.
  • Invest time in developing relationships with technology partners.  
  • Orient developers, programmers and other technology experts to the program.
  • Develop a framework and commit to goals, objectives, and approach.  
  • Establish and adhere to formats and standards.
  • Reference properly and consistently, and investigate potential copyrights.  
  • Manage the process, ensure version control and document decisions – your memory and partners will appreciate it.
  • Explore options for French module development because it is more than translation.
  • Budget time and resources for internal and external review AND complete learner pilots in both languages.
  • Prof read!  Prof red!  Proof read!  This is critical.

4. Use the Core Competencies as a foundation and guide. The Core Competencies are a key component of Skills Online. Course content is based on a solid foundation of knowledge, skills, and attitudes required to carry out public health functions. All course content is mapped to the Core Competencies, and potential learners have access to this information before they enrol in any course. This allows learners to plan to enhance existing competencies or work on the development of others. Not only are the Core Competencies crucial for focused content development, but they also guide prioritization of course development and provide a consistent base for program communication and marketing. Recently, the Core Competencies were used to develop role specific learning paths – recommended groups of modules - for Community Health Nurses and Public Health Inspectors. The learning paths provide direction to help focus competency based, professional development.

5. We can’t be immediate but we must be current. Quality course development takes time, and it doesn’t stop there. As soon as new courses are released, we begin planning for updates. It is impossible to adjust the content in real time: guidelines, new practices, new evidence all appear more rapidly than we can assess and adjust our content. Instead, we commit to end-of-term updates and extensive reviews every two to three years. In terms of new course development, it is essential that content reflects current Canadian public health practice. We budget and plan ongoing review and maintenance of the courses and have learned to not be overwhelmed by every (potential) change in practice and terminology.  

6. A good PowerPoint does not a quality online product make. Design and organization of content is key, and the online course format differs from face-to-face. There are many new applications and approaches for online learning, but we have learned that “new” is not always better. Snappy applications with appealing interactivity options are not always the best choice for Skills Online content.  We have to keep accessibility for all learners in mind when we design our courses, and content must not be obscured by a cluttered presentation style. First and foremost, the content must be of high quality.  No amount of innovative design will compensate for poor content. It is important also to be consistent, using the same logical flow for each topic, and maintaining a common look, feel and functionality for all of the courses. Learners invest time in orienting themselves to the Skills Online approach when they take their first course. This should pay off when they take additional courses – both in time and ease of course navigation. Lastly, the online format is not a “silver bullet” guaranteed to communicate all concepts with ease. Some topic areas need different approaches.

7. Consider options in delivery. Skills Online courses are either self-directed or facilitated, not instructed. (Facilitation does not equal instruction!) Facilitators are experienced public health practitioners who have completed the Skills Online facilitation training and mentoring program. The Skills Online team includes facilitator coordinators, and the program provides rubrics for course discussion forums and assignments. Many facilitators are involved every term, so the time and resources to develop and provide initial training, as well as ongoing support, are critical to the consistent delivery of the program. We have recently introduced a facilitated group learning option for groups of learners from one or two organizations and are exploring course delivery and/or content sharing with several academic programs. Although internet access has expanded exponentially since Skills Online was first introduced, there are still connectivity limitations. Access isn’t always instantaneous, the capacity of internet providers varies, and many areas of the country still lack optimal connectivity.

8. Evaluation. Evaluation is critical to the ongoing maintenance, development and sustainability of a high quality program. We have learned that while it is important to collect feedback from learners about satisfaction and immediate impact, we’ve also learned not to collect information that we won’t use. We have developed slightly thicker skins, and no longer jump to immediate action when we receive a negative comment. Our advisory group has been tremendously helpful in this respect – we take advice from experts in public health and in online learning, and we evaluate feedback before changing anything. We have also learned that program evaluation should involve more than learner post course feedback surveys. We have conducted case studies to learn more about team and organizational level impacts of the program, learner pilots during the course development phase, and program policy/delivery pilots e.g., group learner, academic use of courses and/or course content.

9. We know we are valued. Learner statistics (and feedback data) give us some indication of the utility of the program. Before the facilitated course fee was implemented, registrations for each term were at capacity. Although registration rates for facilitated courses are now lower, course completion rates have increased by 12% (from 70% to 82%) since the registration fee was introduced in January 2013. Learner feedback on course content, delivery and the learning experience is consistently positive. Over 94% of learners report that through their participation in the program they learned something new and of these, most have or are planning to apply this new learning to their work. Additional individual learner impacts include increased confidence, improved creative and problem solving ability, and higher job satisfaction. At the team and organizational levels, managers report better understanding of roles and public health work in general; an appreciation for surveillance; improved communications, willingness to collaborate and work across teams and disciplines; and increased cohesiveness. Furthermore, a successful collaboration with the Pan American Health Organization (PAHO) has yielded customized versions and independent delivery of two Skills Online courses. The Skills Online program is recognized by several professional associations, and several academic programs now include Skills Online modules and/or content. Finally, we really know that we are valued because Skills Online content shows up unacknowledged in other places.

10. We might not look like this in 10 years. Public health practice is not static, it changes over time, and it is expected that public health practitioners will have to update knowledge and skills. Continuing education will always be needed for public health practitioners. Skills Online is a primary resource for workforce capacity development for public health practitioners in Canada. Public health practice is changing, on line training is changing, and so are we. While there are new players, new delivery options, new delivery devices, and evolving learning styles the Skills Online program will continue to adapt to support the continuing education needs of public health practitioners.

III Reasons to sign up

10 reasons to sign up for Skills Online

  • Strengthen your Core (competencies)
  • Expand your knowledge about public health
  • Improve your critical thinking skills
  • Learn about other resources
  • Increase your confidence
  • Earn continuing education credit
  • Increase job satisfaction
  • Improve communication with your co-workers
  • Network and collaborate with other public health professionals
  • Improve your creativity and problem solving abilities

Additional e-learning resources

For a quick introduction to Skills Online check out our video at  

If you would like to learn more about the Skills Online program please visit or or email