Massive open online courses in health sciences from Latin American institutions: A need for improvement?

Background: Massive open online courses (MOOCs) have undergone exponential growth over the past few years, offering free and worldwide access to high-quality education. We identified the characteristics of MOOCs in the health sciences offered by Latin American institutions (LAIs). Methods: We screened the eight leading MOOCs platforms to gather their list of offerings. The MOOCs were classified by region and subject. Then, we obtained the following information: Scopus H-index for each institution and course instructor, QS World University Ranking® 2015/16 of LAI, and official language of the course. Results: Our search identified 4170 MOOCs worldwide. From them, 205 MOOCs were offered by LAIs, and six MOOCs were health sciences related. Most of these courses (n = 115) were offered through Coursera. One health science MOOC was taught by three instructors, of which only one was registered in Scopus (H-index = 0). The remaining five health science MOOCs had solely one instructor (H-index = 4 [0–17]). The Latin American country with the highest participation was Brazil (n = 11). Conclusion: The contribution of LAI to MOOCs in the health sciences is low.

. Categorical variables were summarized using frequencies and percentages, and numeric variables were summarized using median and range.

Results
The search identified 4170 MOOCs offered by educational institutions worldwide. LAI offered 205 MOOCs (4.91%). Table 1 summarizes the results of each platform.
Only six (2.93%) of these courses were in health sciences; one by Coursera®, two by Miriada X®, and three by edX®. One of the health science MOOCs was taught by three instructors, only one of whom was registered on Scopus and had an H-index of zero. The other five health science MOOCs offered by a LAI had only one instructor, and the median H-index was four (range, 0-17).
The top-five LAIs with the most MOOCs in the platforms were Monterrey Institute of Technology and Higher Education,

Discussion
The number of MOOCs offered by LAIs was low compared with other regions. They represented almost the 5% of the MOOCs offered by educational institutions worldwide, in contrast with US institutions that offers most of these courses among several platforms 1 .

Brazil and Mexico offer the most available MOOCs from Latin
America. This could be due to the higher demand for MOOCs in these countries, especially in Brazil, which is related with a broad multidisciplinary research culture that can foster a high user demand among undergraduates 10 .
Additionally, there was a low number of health sciences MOOCs offered by LAIs. Mexico offered the largest number of MOOCs in health sciences, which may be attributed to the cutting-edge educational strategies and individuals with high academic degrees available 11 . It is worth mentioning that some organizations, like World Medical Association and the Internet Medical Society, are establishing agreements with some LAIs to develop high quality MOOCs for the benefit of the medical community that works in rural areas.
Even in developed countries, educational institutions that offer MOOCs want to achieve academic and scientific excellence. The currently offered MOOCs by LAIs are provided by instructors who have low H-indices, which may indirectly influence the quality of MOOCs 12 . This may be due to a low level of training of the faculties and deans of health sciences schools in LAIs, and lack of incentives for undertaking teaching and research activities in these institutions 13 .
This study has some limitations, such as the lack of data concerning instructors in some platforms, and the incomplete coverage of all available platforms. However, the covered platforms represent only 75% of worldwide MOOC, to the best of our knowledge, this is the first study with greater coverage in the scientific community 5 . Despite the limitations that the H-index has, it´s the only indirect quality measure available for notifying the expertise of the instructors 14 .

Conclusion
The contribution of LAIs to health science MOOCs is low. LAIs should invest, develop, and promote this type of educational strategy, which offers huge potential for continuing medical education in this century, and promote access to these technologies, particularly in rural and remote areas. It is a good research idea and a thoroughly done research but that being said, I am not sure if this is relevant to the scope of this website. It will be interesting to see how the quality of MOOC in Latin America compare with the rest of the world though.

If applicable, is the statistical analysis and its interpretation appropriate? Yes
Are all the source data underlying the results available to ensure full reproducibility? Yes

Are the conclusions drawn adequately supported by the results? Yes
No competing interests were disclosed.

Competing Interests:
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