Prescribing skills course: Three years' experience and lessons learnt through India's massive open online course

Studies highlighting the prevalence of inappropriate prescribing and preventable harm emphasize the need to enhance prescribing competencies. This paper describes distinctive features, launch and evaluation of massive open online course (MOOC) Prescribing Skills Course (PSC) designed for medical interns and registered medical practitioners (RMPs).

PSC development funded by Indian Council of Medical Research (ICMR), guided by national and international experts, with content aligned with the national medical curriculum and inputs from stakeholders, included video lectures with case scenarios, demonstration videos, assignments (pre- and post-course MCQ tests, prescription analysis) and structured feedback. Hosted on Government of India's online learning platform, course infrastructure enabled data collection for evaluation and analysis.

PSC having 50 modules was conducted with interns' enrolment/completion 4327/1164 (26.9%), 4098/815 (19.9%), 665/ 129 (19.4%) in 2020, 2021, 2022 and RMPs 1984/557(28.1%), 448/138 (30.8%) in 2021, 2022, respectively. Enrolment was significantly lower in regions with weaker health indices (rate ratio 0.35 with 95% CI: 0.32-0.38; P < 0.001; Poisson regression test). Participants rated course content, relevance, quality, assignment usefulness 'excellent' to 'very good'. RMPs demonstrated higher baseline scores and greater improvement (from 60% to 73.3% p < 0.001 in cycle 3) compared to interns.

The PSC- MOOC is convenient, accessible with experiential learning for large numbers. Performance of RMPs may suggest practical relevance and applicability. Module-wise performance analysis and enrolment variation provided insights for future strategy. Limitations include inability to assess the impact on prescribing practices. PSC-MOOC represents a promising, scalable educational strategy. Our experience would be useful to other countries.