text: This step aims to embed the specific training needs of targeted learners and identify specific stakeholders for the curriculum development, implementation, and evaluation. AGMT engaged with the nurse professors/lecturers, recent graduates, and the Global Research Nurses forum to identify specific needs of the nursing community. An article was published on the Global Health Nurses portal (https://globalresearchnurses.tghn.org/articles/preparing-genomic-medicine-nurse-training-africa/) which summarized existing nurse training and highlighted the role of nurses in Africa. In a similar fashion to the ISCB strategy developed for a Bioinformatics curriculum, four nurse personas were created to make explicit the nurses' current roles and their training needs and targeted outcomes in genomic medicine (Table 1). Nurses at different professional levels developed the initial personas and their roles based on the common nurse specializations in Africa. We had a professor in nursing who has worked and trained nurses from several different African countries. The team agreed to work with four personas as they were a convenient number that was perceived to be sufficient to capture common nurse roles in different contexts across the continent. Although the effectiveness of the four personas in informing the curriculum might need to be probed the future, it is believed that convenient sampling used, that is small in scale and purposively selected on the basis of crucial criteria, was deemed appropriate by the team and allowed us to focus on our purpose (Punch, 2005). Based on roles of nurses highlighted by the nurse personas and feedback from nurses it became clear that the course needed to emphasize practical application of content into students' current settings and roles using problem-based learning with clinical case studies relevant to Africa. This strategy was critical to highlight the relevance of the course to current clinical practice and increase uptake. In addition, skills in genetic counseling, community engagement, ethical conduct in research, inclusion of genetics and genomics in patient care, and development of health promotion material which included relevant genetics/genomic material were also found to be required. There was also a need to address stigmas and misconceptions of genetics and genomics commonly found in African communities.
  In general, the course aims to support improved genetics and genomics knowledge, attitudes and skills for: research nurses in the biomedical field or those aspiring to be research nurses; specialist nurses working in the genomics/genetics field and general nurse practitioners in their day to day duties, or recent graduates. The overall objectives for the nurse personas were to develop and implement a plan of care for patients that incorporates genetic and genomics knowledge and is sensitive to individual and cultural preferences, practices and norms by offering basic genetic counseling to patients and families, and conducting genomics research that is ethical and appropriate to the nurses' context.
  Competencies were adapted from the ISCC competency portal (https://genomicseducation.net/competency) to suit the needs of the African continent and these were mapped to the nurse personas in one face to face workshop, Google documents, and several online meetings. The mapping of ISCC to the AGMT nurse competencies were not retained due to numerous rounds of editing. The AGMT competency mapping team was split into three groups to review the personas and map competencies. Two personas were reviewed by two groups only instead of three. Consensus was agreed during monthly meetings, after face to face discussions and via Google docs. Once the targeted competencies had been established, the Bloom's taxonomy was used to determine the most appropriate level for a specific nurse by several competency mapping teams (see Table 2) for each persona. The final recommended competency to target is indicated in the last column in Table 2 and was arrived upon after the three competency mapping teams (each team's competency level mapping is colour coded in Table 2) had reached a consensus.
  This step involves planning the content to be taught and the educational methods to be used. Content was mainly adapted from a genomic medicine curriculum developed by Health Education England to upskill United Kingdom's National Health Service healthcare professionals, in readiness for the implementation of genomic approaches through the 100k Genomes project (https://www.genomicseducation.hee.nhs.uk/; https://www.genomicsengland.co.uk/about-genomics-england/the-100000-genomes-project/). Assessments were adapted to align to the specific competencies identified in step 3. Table 3 provides a brief description of the final course modules, full details are available on the AGMT website (https://training.h3abionet.org/AGMC_2016/). The four modules varied in length depending on the number of classes they had. Each class was allocated 1 week with contact sessions which lasted around 2 h. Student centered approaches that encourages integration of prior and current experiences were deemed most suitable to facilitate learning for working adults. By selectively drawing on elements of problem-based and project-based learning this enabled the use of real-life questions, a challenge or problem as educational strategies to facilitate the development of knowledge (Lennon et al., 2019). Therefore, several case studies relevant to African health were sourced from the various working group members and embedded in the course material and class assessments. These types of teaching methods are often used for training of health-care professionals as they get students to engage with self-directed learning and offer opportunities for facilitation by the instructor (Kaufman and Holmes, 1996; Kaufman and Holmes 1998).
  Learning activities such as quizzes, online discussions on the University of Cape Town's learning management system Vula (powered by Sakai), preclass exercises, and postclass assignments were developed in alignment with indicative content and competencies for each lesson. In addition, the range of learning activities was structured to enable students to actively engage and apply their knowledge and thus promote student-centered learning and flipped class learning (Goh and Ong, 2019). Furthermore, exercises and assessments were made relevant to the participants' context as it required participants to produce resources such as generate a list of genetics and genomics resources and services available at their institutes to make it easier for them to refer their patients.
  Classes were required to submit a collaborative research project at the end of the course. which aimed to promote collaborative development of publishable research and reviews, and the assignments could be submitted to a special collection in a specific journal. However, classes were also free to choose not to publish their work or publish in a separate journal. The initial plan was for the course to run over six months, however the formatting of class projects into manuscripts continued after the course had concluded and this exercise varied across the different classes.
  Each classroom is managed by a facilitator who ensures the lectures are played, the class is linked up to the live sessions, and facilitates the interactive activities. We had a brief three-week training for facilitators in three areas; online facilitation; face to face group facilitation; and facilitation of role plays required for genetic counseling. Trainers were asked to develop slides based on the indicative content provided and the aligned competencies and assigned levels. This was a negotiated process.
  An electronic advertisement was circulated via several mailing lists to advertise the course, see Figure 2. Almost 30 different sites applied to host a classroom for the course, however 19 classes were chosen based on their meeting the requirements to provide stable internet connectivity, a qualified facilitator in genetics and hardware that could handle hosting webinars. The coordinator advertised the training extensively via social media, the chosen class facilitators were also required to recruit participants in their areas/regions. The course was open to qualified and practising African-based nurses and it ran from April to August in 2017 with a weekly contact session every Wednesday.
  Figure 2 Flier circulated widely across various mailing list to attract the first cohort of trainees.
  A distributed blended online classroom approach, similar in structure to the Structured Training for African Researchers (STARS) Career development course which was developed through the Association of Commonwealth Universities (https://www.acu.ac.uk/focus-areas/early-careers/structured-training-for-african-researchers/) and was recently adopted and adapted by the H3ABioNet Introduction to Bioinformatics Training course (Gurwitz et al., 2017), was used for the training. For the virtual classroom approach, trainers were required to prerecord their material, which was then loaded onto a learning management system, in this case – Vula (Sakai based). Facilitators of the various classes were then required to download the course material onto local storage devices such as hard drives to avoid relying on internet connectivity during the live weekly contact sessions. The facilitators and learners watched the videos within the physical classrooms distributed across Africa before the 1-h long online contact session with the trainers. The online live sessions were made possible via a webinar platform. During these live sessions, only one connection was allowed from each class via the facilitator. The class could then pose questions via the facilitators. Figure 3 summarizes the distributed classroom approach.
  Figure 3 A summary of how the training is conducted using the distributed virtual classroom and blended learning approach. At least 7 days before the face to face sessions, participants can download videos from Vula and watch before class and do preclass exercises. During class (face to face sessions), participants engage with learning material (videos, lectures, etc) during face to face classrooms predownloaded by a facilitator. The class can then connect with the trainer virtually for a question and answer session. Participants also submit a quiz and rate the class. After class participants submit an assignment.
  All facilitators were encouraged to obtain accreditation from relevant bodies across Africa for continued professional development points (CPD). While the initial plan was to obtain accreditation from all affiliated universities for this course as a short course, this was not feasible and therefore the short course accreditation was only obtained from the University of Cape Town. During the first implementation of the project, facilitators were also tasked with marking the qualitative and face to face assessments such as role plays.