Introduction:
Teaching asynchronous courses to midwives, and other clinicians, from around the world can be challenging for several reasons including: i) clinical workplace responsibilities (students’ issue), ii) being able to collaboratively work together (peers’ issue), and iii) ensuring a high integrity of learning (teachers’ issue). The aim was therefore to design an asynchronous course that could be flexible for students, but ensure high course integrity and learning.

Material and Methods:
Participants included: i) master-level sexual and reproductive health students from around the world, ii) clinical professionals, including midwives, from around the world, and iii) midwives from four sub-Saharan African nations who took part in a capacity building program. For three years, these three groups of participants were tested using the learning model. The learning model included a flipped classroom, where students could watch pre-recorded lectures at their leisure before meeting at the end of the week to discuss and apply the material to their clinical setting. In addition, project-based learning was a central tenant of the course, where each student should design their own improvement project and apply that weeks’ course materials to their actual improvement project. Students then completed three rounds of peer review on each others’ improvement projects. By peer reviewing, students i) received feedback to strengthen their own project, ii) could demonstrate a critical reflection of course concepts on others’ projects, and iii) become inspired by other improvement project ideas that they could adapt into their own methodologies.

Results:
Consistently, student evaluations showed that they enjoyed the flexibility of the course, allowing them to juggle their work life with the course, often integrating the two together via the applied improvement project (students’ issue). Despite time differences in geography, students could learn about improvement projects in different parts of the world and were given enough time (one week) to peer review each others’ papers. Moreover, by the third peer review round, they had read all of their peer’s improvement projects, and thus gained a deeper insight into additional improvement ideas (peers’ issue). Lastly, by having to apply their learned knowledge to real world settings, they had to demonstrate a high level of learning and thus course integrity could be assured (teachers’ issue). A further result is that students often reported that their direct supervisor and/or clinic greatly appreciated their improvement project, often further benefitting patient outcomes. A few students further reported publishing their improvement project, while others spread their improvement ideas to other clinics.

Conclusions:
Designing courses that force students to apply their learned knowledge creates a deeper learning experience for students, while having engaging weekly meetings and peer reviews, helps students feel like they are part of a class and can form meaningful relationships with their peers, even when learning asynchronously. Furthermore, applied courses can also benefit the workplace. Future teaching models should further explore how to make more classes use an applied teaching framework.