Table 1.

Case study descriptions

	(1) Evidence-based practice: e-lectures	(2) Healthcare public health: online self-study module	(3) Pilot global health and communicable disease control: asynchronous discussions
Setting	University of Birmingham	UCL Medical School	Brighton and Sussex Medical School (BSMS)
Students	Year 3 of 5-year course (n = ∼370)	Year 4 of 6-year course (n = ∼400)	Year 4 of 5-year course (10 students volunteered to pilot the course)
Subject	Evidence-based medicine and research methods: covering study designs, interpreting data, critical appraisal, developing research questions and clinical guidelines	Principles and practice of population screening (screening policy, test characteristics, harms and benefits, evaluation)	Global health protection focussing on comparing communicable disease control in UK with impact and practice in low-income settings
Previous format and rationale for change	Five sessions, each involving a 1 h lecture, 1 h of self-directed learning and a 2 h face-to-face small group tutorial	One-hour lecture, followed by a 1 h face-to-face small group tutorial, delivered four times	A mapping exercise in 2012 revealed that the BSMS curriculum was not meeting recommended global health competences
	79% of evaluation comments on lectures were negative and student attendance at lectures was poor (<50%). Students suggested e-lectures as an alternative	Lecture feedback was mixed. Some students complained they had learnt material previously but some still had a limited grasp of basic concepts. Students suggested online formats	While a small number of core global health sessions were introduced, there were areas not covered in these sessions which are of value particularly to students with a global health interest
e-Learning approach	Live lectures were replaced by e-lectures, made available to all Year 3 students via the university's virtual learning environment. Students continued to be timetabled for a 1 h lecture, 1 h of self-directed learning and a 2 h face-to-face tutorial	Live lectures were replaced by a short online module made available to all Year 4 students 2 weeks before face-to-face teaching	A pilot module on global health and communicable disease control was developed in collaboration with People's-Uni, a charity which provides low-cost online public health education in low-income countries (www.peoples-uni.org)
	Lecturers recorded the e-lectures using PowerPoint and headphones. The lectures were similar in format to the live lectures, with activities adapted from the live lecture	Module design was informed by Mayer's principles of effective multimedia learning.12 It comprised short lecture casts, video clips, multiple-choice questions and links to external resources, with short ‘diagnostic’ quiz for students to self-assess prior knowledge and decide where to focus	The module comprised a 2-week online discussion facilitated by a tutor, simulating a ‘virtual classroom’ focussed on realistic scenarios, e.g. measuring the impact of HIV in a community, management of a measles outbreak in rural Uganda
	Questions could be raised on-line or directly with tutors in the face-to-face teaching	Students and trainee doctors created content, tested pilot versions and provided feedback	Discussions were asynchronous, rather than real time so participants' posts remain visible for the duration of the module and others can respond hours or days later. Tutors comprised three People's-uni alumni, all health professionals in low-income settings—Swaziland, Ethiopia and Papua New Guinea
		Questions could be raised online or directly with tutors in face-to-face teaching
Evaluation data	Student feedback survey: Likert scale and free text questions	Student feedback survey: Likert scale and free text questions	Focus group amongst participating students
		Site usage monitoring data	Site usage monitoring data