E-learning course on COVID-19: an example of educational preparedness and quick response
On Saturday 22nd February 2020, the Italian National Federation of the Associations of Doctors, Surgeons and Dentists (FNOMCeO) has made available free of charge on the FadInMed technology platform the course "COVID-19, the disease from the new coronavirus (SARS-CoV-2)" to all Italian physicians.  The release of this CME course took place a few hours after the confirmation of the first case of local transmission in Italy and in the meantime clusters of cases were being reported in Lombardy and Veneto.
The educational project had been started approximately 2 weeks before, to provide Italian physicians with timely and trustworthy scientific information in a constantly evolving scenario and counteracting the sustained crowding of information and misinformation, that WHO has defined as “infodemia”.  The course is updated on a fortnightly scheduled basis or, in addition, in real time whenever relevant national or international documents are published, therefore it has now reached its seventh edition.
Thirty-five days after the release, 36,057 physicians (approximately 12% of all Italian practicing physicians) participated in the course and 33,695 passed. Over 99.5% of participants considered the contents of high quality, relevant and appropriate for their immediate educational needs.
The Italian Ministry of Health has included the course among the recommended resources to get good quality information on COVID-19. 
Based on the proven efficacy of the e-learning for health professionals, [4,5] the FadInMed project has trained more than 450,000 physicians over ten years, but this is the first e-learning project with continuous updating of contents.
A similar course for Italian pharmacists, always free of charge and supported by the Federation of Italian Pharmacists Associations (Federazione Ordini Farmacisti Italiani, FOFI) has registered the attendance of more than 7,000 professionals. 
As far as epidemics are concerned, the experience gathered with TELL ME Project (Transparent communication in Epidemics: Learning Lessons from experience, delivering effective Messages, providing Evidence) funded by the European Union’s Seventh Framework Programme support the adoption of an e-learning approach to rapidly and effectively disseminate and update critical information necessary to efficiently react to infectious disease emergencies in Europe. 
In fact, during epidemics or pandemics, e-learning can overcome many challenges, allowing all health workers to be similarly trained, without requiring the physical attendance and the grouping of people.
Moreover, it can be carried out at any time, offering a response to the intensive involvement on the field of the health professionals for most of the day.
Moreover, a version in plain language of the online course has been developed in collaboration with ANPAS (Pubbliche Assistenze, Italian Associations that aid to the general populatio, currently representing 880 associations) for all volunteers engaged in the COVID-19 emergency. [8 A further promising option could be to release a version of a plain language version of the e-learning course for the general public.
As confirmation of the validity of the training proposal, WHO has developed, several multilingual e-learning courses dealing with various aspects of COVID-19/SARS-CoV-2, among which the course about preparedness and response (currently more than 177,000 participants in all the world).  Also the National Institute of Health (Istituto Superiore di Sanità, ISS) has made available on its technology platform EduISS an e-learning course released in 3 modules since 28th February (134,000 participants). 
A ten point guideline for the development of effective learning courses in case of epidemics/pandemics by healthcare public is proposed:
1. Choosing e-learning as educational tool, to prevent close contacts and transfers
2. Being prompt and responsive, to provide health professionals with adequate information on time
3. Developing brief courses tailored to the participants, to optimize the shortage of time available to health professional
4. Using e-learning platforms that do not require broadband (especially in low resource countries), to facilitate participation
5. Offering the course free of charge, to promote participation
6. Providing information on regulatory sources, to standardize professional behaviors
7. Referring to evidence-based scientific literature, to ensure high quality of information and education
8. Including a section on risk communication in epidemics/pandemics, to make health professionals competent in answering to people's questions and needs
9. Listing institutional websites, to counteract fake news
10. Continuously updating the educational contents, to follow the evolution of the situation and the progression of the scientific knowledge.
Fabrizio Pregliasco 1, Maria Rosa Valetto 2, Roberto Stella †3, Nicoletta Scarpa 2, Pietro Dri P 2.
1 Section of Infectious Diseases, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
2 Zadig ltd, CME national provider, Milan, Italy.
3 Italian Federation of Medical Professional Associations (FNOMCeO), Rome, Italy
†Deceased March 11th 2020, after SARS-CoV-2 infection contracted during the medical profession as general practitioner.
The authors declare no competing interests.
Acknowledgments Raffaella Daghini 2, Christian Deligant 2, Donatella Sghedoni 2.
1. FaInMed, e-learning platform for physicians, dentists, and nurses. https://www.fadinmed.it/
2. World Health Organization (WHO). Novel Coronavirus(2019-nCoV). Situation Report-13, 2nd February 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/2...
3. Italian Ministry of Health. Covid-19, formazione a distanza per i medici. http://www.salute.gov.it/portale/nuovocoronavirus/dettaglioNotizieNuovoC...
4. Cook DA, Levinson AJ, et al. Internet-based learning in the health professions. A meta-analysis. JAMA 2008;300:1181-96.
5. Cervero RM, Gaines JK. The impact of CME on physician performance and patient health outcomes: an updated synthesis of systematic reviews. J Contin Educ Health Prof 2015;35:131-8.
6. Saepe, e-learning platform for health care professionals. https://www.saepe.it/
7. TELL ME project (Transparent communication in Epidemics: Learning Lessons from experience, delivering effective Messages, providing Evidence) Deliverable 2.4 - Technical, Legal and Scientific Feasibility of an Online Course for Primary Care Staff https://www.tellmeproject.eu/content/d24-technical-legal-and-scientific-...
8. Formars. e-learning platform for the general population. https://www.formars.it/
9. OpenWHO Online course “COVID-19: Operational Planning Guidelines and COVID-19 Partners Platform to support country preparedness and response” https://openwho.org/courses/UNCT-COVID19-preparedness-and-response-EN/it...
10. EduISS, formazione a distanza dell’Istituto Superiore di Sanità (ISS). https://www.eduiss.it/index.php?redirect=0
Competing interests: No competing interests