In Japan, the laws and regulations for the nurses who perform medical auxiliary acts (see details) are revised. The training course of those nurses must be consisted of three parts:

(1) the lecture or e-learning for knowledge acquisition,

(2) practice including simulation for skills training

(3) on-the-job training.

There are two objectives in this study:

(1) to design and develop the knowledge acquisition part with e-learning

(2) to start the trial course and evaluate for formative evaluation of the e-learning contents

（１）Development of e-Learning

There were 10 course on trial formative evaluation.

• 4 were required category : pharmacology, pathophysiology, clinical inference and medical safety
• 4 were elective category : nursing for elderly care (acute period, terminal phase, dementia) and discharge support 
• 2 were auxiliary acts category : medication for blood glucose and medication for psychiatry

All courses and materials were developed and managed by moodle ( moodle is Learning Management System). Figures show the e-learning course of "Clinical Inference and Physical Assessment".

In each course, there are following materials for self-directed learning:

• Introduction items such as syllabus and assessment criteria of final report
• Around 10 sections about the theme
  • ​reference information
  • lecture videos
  • pdf files of powerpoint
  • quizzes : learners have to finish all quizzes to pass the course
• ​Some case analysis as a final report

(2) Formative Evaluation

There were 17 questions for formative evaluation in each course. 16 items were based on ARCS model ( see details ) to survey learners' motivation to the contents. 1 item was free-text comments. 

The survey was done in the same moodle and the results was counted automatically. The graph shows the part of the evaluation result of "clinical inference and physical assessment" couse.

As a result of ten courses evaluation, most courses were interesting and relevant to learners' daily work. However, some contents were a little difficult for learners as a self-directed learning and it was lost their confidence. 

From free-text comments showed some points of improvement. Here are some comments from learner:

• Videos
  • It is a little hard to listen some videos because the voice was a little small.
  • Some teachers just read powerpoint slides. It was less interesting. It would be better to add some additional explanation about slides. 
• Quizzes
  • Not only to tell the correct answer but also the short explanation about the wrong answer should be added.​​
  • The questions beyond the texts or lecture videos should not be on the test.

In addition, some learners found a little difficult to learn online because they do not have enough experience about e-learning. To teach how to study effectively online (such as online learner competency) and to teach basic information and media literacy are also needed for effective and efficienct e-learning course management.

Moreover, support contents such as "moodle FAQ" or forum system should be needed.

• Motivational Design for Learning and Performance: The ARCS Model Approach. John M. Keller. Springer, 2010.
• Moodle   https://moodle.org/
• Online Learner Competencies    http://ibstpi.org/online-learner-competencies/
• JNA(Japanese Nursing Association) News Release  2014 Aug, vol.15
  http://www.nurse.or.jp/jna/english/news/pdf/2014nr_15.pdf