The way we do training has needed to change in 2020 - more online training brings new challenges of how to keep participants engaged when they aren’t all sitting in the same room. In this Cochrane Community Blog, Mike Clarke talks about his experience of finding new and novel ways of engaging the participants of a recent online systematic review course.

Over 25 years, Cochrane has played a key global role in preparing, maintaining and disseminating systematic reviews. However, this is not enough to ensure that reliable and robust reviews are available and used. People need to learn how to do this research, how to appraise it and how to use it when making decisions. The need was pressing even before there were 200,000 systematic reviews and more than 10,000 starting every year, by 2018. It has increased dramatically in 2020, with COVID-19 leading to an explosion in the number of people working on reviews and the number appearing in the literature. By 21 October 2020, PubMed had added its 1000th systematic review about COVID-19, just over nine months after the first cases of this single disease were reported. Contrast this with the seven years from the start of the Cochrane Collaboration to the 1000th Cochrane Review in early 2001, and those reviews covered all conditions. That was also around the time that I started teaching small group courses on systematic reviews. Over the subsequent decades, I had the privilege and pleasure to teach dozens of such face-to-face courses to thousands of participants in numerous cities around the world, including annually for the last five years, in Tromsø, Norway.

Then COVID-19 arrived, and my courses, and those being taught by tens of thousands of other people around the world, went online.

During recent months, learners have had to get used to receiving their learning out of a screen and teachers have had to get used to delivering teaching into a camera. Ideally, this should be done as live humans, reflecting on recent events, tailoring our words to the audience, answering questions straight away and conveying our enthusiasm in the moment. But even if we are live, we have lost the ability to hand things out during the course; to share physical, not online, content in real time.

Inspired by a conversation with my son, Lorcan, on the way from a supermarket where restaurants had started to sell “cook boxes” of ingredients so that customers who could no longer dine out could stay home and cook the meal for themselves, we developed a similar idea for teaching about systematic reviews.

My first opportunity to try this was a 2-day online course on Systematic Reviews for participants in Tromsø in September 2020. With the help of course organiser, Kari Lægreid, each student was posted a pack of four envelopes. These contained props to help with teaching and learning and instructions to open them only when asked to do so during the course. 

• Envelope 1: contained a piece of paper with the word “SYSTEMATIC” or “REVIEW”. This was used in the initial few minutes of the course, when students were asked to open it and spend 30 seconds thinking about what the word meant, before telling the whole group their ideas on key features of systematic reviews. 
• Envelope 2: contained a coin or a dice, which the students were asked to describe, in eight words or less, on the online class notebook so that others could experience the challenge of trying to identify something from the equivalent of a short description in a report that might be eligible for their review. The students then used their coin or dice to generate dichotomous data for each of two groups, ready for combination in RevMan, to introduce them to meta-analyses and the forest plot. 
• Envelope 3: The next envelope was used after the students had worked in small groups on the eligibility criteria for a systematic review of garlic and the common cold. They then opened envelope 3 to reveal an article reporting a potentially eligible trial and had to work independently to decide whether this should be included in the review. 
• Envelope 4: Finally, after collectively making a list of items to extract for a review of the effects of needle length on local reactions to vaccination, they opened envelope 4 and had to find and extract six key pieces of information from the article it contained.

This introduction of the cook box approach to online teaching worked well. All ten students who provided feedback on the Tromsø course said it should be used again for future online courses, with comments such as “very good idea” and “very exciting”. It gave them the type of interaction that is possible when we are all in the same room, and a hands-on sense of the challenges of being a reviewer or the consumer of other people’s reviews.

We seem certain to continue with the online experience for teachers and learners for some time, not just because of COVID-19 but also as we minimize the impact of travel on climate change. Even if opportunities for travel resume, benefits we have found from teaching remotely may mean that our BAUU (business as unusual) future will include the delivery of more teaching like this. I will be continuing with the cook box idea, adding more to the package, to “spice it up” further, if you will excuse the pun.

The COVID-19 pandemic and its associated measures is changing how we teach and learn. It has fuelled a massive need to spread knowledge, and enormous surges in the quantity of information available and the number of people reviewing it. We need to adapt our teaching to embrace this and to adopt novel methods, to find ways to deliver on ambitions such as the desire to see one million hours of new learning, and to properly evaluate and systematically review the impact of what we do.

To finish, one of the nicest complements on the idea came from one Tromsø student: “It was soo cool! I loved how active it made the course. If I ever get a chance to teach, I will try to implement something similar”.

• Explore systematic review courses

Author:
Mike Clarke
Northern Ireland Methodology Hub, Centre for Public Health, Queen’s University Belfast, ICS Block A, Royal Victoria Hospitals, Grosvenor Road, Belfast, BT12 6BJ, UK

Conflicts of interest
MC receives payments to teach about systematic reviews and other evaluations of health and social care. 

Acknowledgements
I am grateful to Kari Lægreid, Elin Evensen and Svetlana Zykova for their help in organizing this and earlier courses in Tromsø, and to Lorcan Clarke for developing the cook box idea and encouraging me to write it up.

Funding
Funding for the Tromsø course and the cook boxes for September 2020 was from the University of Tromsø (the Arctic University of Norway) and the University Hospital of North Norway.