Developing your curriculum and case presentation form

Two documents shape almost everything participants experience in an ECHO program: the curriculum, which tells them what they will learn and when, and the case presentation form, which brings their real-world problems into the session. Neither has to be perfect on day one. This guide walks through how hub teams build both, the shapes a curriculum can take, what a first session looks like and the trade-offs in designing a case form people will actually fill out.

Part 1: Developing your curriculum

1. Identify the experts who will create it

Start with the people who know the subject. Facilitators, program directors and subject-matter experts build the curriculum: they know the field and are the best place to start when deciding which topics the group should cover.

Program managers and coordinators work alongside them to schedule planning meetings and keep the information organized. A typical pattern is a short series of planning meetings, usually three or four, in which the hub team reviews the program’s goals, its statement of work or funded grant, and uses that as the foundation for the curriculum.

2. Align with your goals, objectives and deliverables

The curriculum should sync with the educational goals and objectives of the program, so identify and prioritize those first. A basic framework covers what to do, how to do it, when to do it and how you will know it has been achieved. That last piece ties directly into feedback and program evaluation.

From there, fill the calendar with complementary topics that build on each other. It is easiest when the hub team has been part of the process from the beginning, because they often arrive with a curriculum already outlined. If your grant names specific curriculum deliverables, the program manager usually tracks them and works with the hub team to make sure they are met.

3. Conduct a needs assessment

A needs assessment is the key to understanding who your participants are and what they want to learn. Gather as much information as you can. A common mistake is to assume that, as experts, we already know what participants want or need. We are often proved wrong.

A good assessment covers:

• The desired outcomes and expectations of the program
• Participants’ current knowledge of and confidence in the topics you plan to cover. If the curriculum is too basic or too complex, learners disengage.
• The topics that will be covered and, where possible, samples of any assessments you will use
• Data on the current state of the problem, such as high health care utilization, student scores on standardized tests or wait times for specialty care
• Learners’ perceptions, barriers and challenges, and current trends in the field

iECHO surveys are one way to run the assessment; see Conducting assessments and other surveys.

4. Look in PERL

The Project ECHO Resource Library (PERL) holds curricula and session materials from the ECHO Institute and partners around the world. Use them as examples and inspiration, and add your own curriculum when it is ready so others can learn from it.

What should your curriculum look like?

There is no single right shape. These are four common patterns, and many programs mix them.

Month-to-month planning can work too, but only with a strong hub team and consistent participation.

Your first ECHO session

The first session is usually more packed with information than any other, and the hub team does more of the talking. Here is the agenda many program teams use when they launch:

1. Welcome.
2. Introduction to the program. Explain the goals and what participants can expect. Show them where to find resources and materials, whether on your website or in iECHO announcements.
3. ECHO overview. For many people this is their first ECHO. They are used to webinars, where there is little chance to participate, so emphasize the All Teach, All Learn model. Keep it short: what ECHO is, why it started and how the model works.
4. Didactic. A normal presentation, perhaps shorter than usual given the full agenda.
5. Sample case. A colleague may be willing to present a real case, but more often the hub team presents a sample case it created or used before. Keep it simple. If the sample is too complex, participants may think their own cases are not good enough to bring. A sample case shows how a case is presented and gets people participating in the very first session.
6. Closing. Preview next session and make any announcements.

Tips

• Build a continuous feedback loop. The needs assessment helped before launch; ongoing feedback keeps you informed about the topics participants want and the ones that did not land.
• Add a “didactic on demand” or “open ECHO” slot. It gives you a place to put a requested topic without rearranging the whole curriculum.
• Use the curriculum to recruit. Put it on your website, in announcements and on flyers.
• Be flexible. Your program will evolve, and it is fine to change the original plan. It happens more often than not.

Part 2: Developing your case presentation form

Case-based learning is one of the four pillars of the ECHO Model, and participants consistently say they learn the most when discussing cases. A case invites everyone to contribute, which is All Teach, All Learn in practice. The case form is how those cases reach your session, so its design matters.

Four things to balance

Every case form balances length, the types of cases it invites, the disciplines it speaks to and its format. Comparing forms does not mean one is better than another; each is designed for its own program, and what works for one may not work for yours.

Length

• If you use the form for research or to meet grant deliverables, some questions may be required.
• Think about your participants. Will they have time to complete a long form, or will it deter them from presenting?
• Is every question necessary? Could some be asked as clarifying questions during the session instead?
• If the form covers every aspect of the case, there is little left to discuss, and engagement suffers.

Some programs run successfully with five- to seven-page forms. Others found forms that long were never completed because of time constraints. Sometimes simple is better.

Types of cases

• Person-focused cases center on an individual, such as a patient or a student. They are the most common type, especially in health care programs.
• Systems cases look at processes and how participants can improve them. They are popular in quality improvement programs. A nursing home program, for example, discussed the best protocols for letting residents go outside or interact while keeping a safe distance.

Many programs add systems cases alongside person-focused cases, and some maintain more than one form.

Multidisciplinary questions

A multidisciplinary hub team gives recommendations from many angles, and the form should give each expert what they need. A chronic pain program had around nine subject-matter experts on the call, including a neurologist, an internal medicine physician, a psychiatrist, a pharmacist and a chiropractor. Its form asked about pain management strategies already tried, screening and assessment tool scores and psychological comorbidities so that every member could contribute.

The reverse is also true: if your form is aimed heavily at one discipline but your audience is varied, part of your audience will feel the form is not for them and will not present.

Format

• PDF. Still very popular. Participants usually scan the completed form back to the program team; a few still fax.
• PowerPoint. Participants download the template, fill in the highlighted fields and send it back to present.
• Online form. The newest option, built in tools such as Microsoft Forms, REDCap or Opinio. If you collect patient information, choose a secure option.

Lessons learned

A nursing home quality improvement program started with a PowerPoint case form modeled on other QI programs. Participants did not have time to complete it and found PowerPoint too advanced. The team converted it to a simple Word outline and received a few more cases, but not many. After another look they realized they were asking too many questions. Today the form asks for presenter details and only three or four questions; everything else is discussed in the session. They also moved it online for easier access.

When our education team launched its first programs, it built student-focused forms. Within two sessions it was clear participants wanted to discuss systems cases, and that program has not had a student-focused case since.

Collecting cases

1. The participant completes the case form.
2. The case is submitted to the program team. For patient or other health care cases, make sure submission is secure.
3. The program team reviews the form and checks for protected health information. Avoid questions that could elicit identifiable information, but check every submission and redact if needed.
4. The case goes to facilitators and subject-matter experts before the session. Not every hub team wants this step, so check with yours. It lets experts arrive with resources and recommendations prepared, though it is not always possible when cases come in at the last minute.
5. The program team shares the case on screen while the participant presents. Because the team has already reviewed and redacted the form, there is no risk of protected information appearing on screen.

In iECHO, see How to add a case presenter to put the presenter on the session agenda.

Follow up with recommendations

During the discussion, one hub team member takes notes and completes a case recommendation form, which goes to the presenter after the session. This can be an online form too.

For medical cases, add a disclaimer to the recommendation form stating that the hub team does not have a provider-patient relationship with the patient and that the recommendations were made during a case consultation. Many providers add the form to the patient’s file, so this is a standard practice for the ECHO Institute’s programs. For example:

Please note that ECHO case consultations do not create or otherwise establish a provider-patient relationship between any hub team clinician and any patient whose case is being presented in an ECHO setting.

Other recommendations

• Add a follow-up form and encourage participants to bring their original cases back to report how the recommendations worked. Some programs schedule follow-ups.
• Encourage ad hoc cases. If no case was submitted or there is time left, ask the network directly whether anything has come up recently. When a question during the didactic or a discussion could be a case, the facilitator can say, “That question is an excellent example of an ad hoc case. Let’s open it up for clarifying questions and then get recommendations from the network.” It is also a great way to show what a case can look like.
• Rename it if you need to. The word “case” can be misleading or confusing outside health care programs. Be creative.
• Do not require cases to match the day’s topic. It would be tidy, but it is rarely feasible, and participants who think their case must match may not present at all.
• Check [PERL](https://projectecho.box.com/s/0md844o0fw4bnywyuy6mrl3d175w4lsi) for case form examples from other programs.
• Be flexible.