Since 2001, the Project ECHO model has gained popularity as a modality for creating collaborative virtual learning sessions. Dr. Sanjeev Arora founded Project ECHO at the University of New Mexico, where the model was originally intended to address clinical healthcare challenges. ECHO has now been embraced by public health practitioners in recent years because of its unique and equity-driven approach to participant engagement. At the core of its proven formula for creating effective ECHO sessions is its “All Teach, All Learn” ethos. The basis of the “all teach all learn” approach is the belief that all participants can gain and share knowledge among peers in an ECHO session (Serhal et al., 2022) and that this sharing makes ECHO outcomes most effective. Instead of a conventional webinar setting where one individual or panel speaks to a silent audience, the ECHO model encourages bi-directional learning from guests and participants. This ethos embodies a mindset of collective learning and collaboration by fostering virtual learning environments where individuals of diverse experiences are applauded for their varied expertise and contributions.

Project ECHO’s “All Teach, All Learn” ethos is a set of practices that can be implemented in any setting to amplify community voice. NNPHI’s Project ECHO for Public Health team identified key practices that lead to an “All Teach, All Learn” environment in any virtual format, including perspective over positionality, hands-on learning using case studies, and agile facilitation.

Perspective over positionality: creating an environment that emphasizes the importance of varied perspectives

The ethos of ECHO encourages all stakeholders to broaden their view of expertise. Instead of relying on subject matter experts (SMEs) – who often possess specialized expertise from their professional or academic backgrounds – as the locus of knowledge, ECHO sessions recognize that public health knowledge is a collection of insight from a variety of experiences that must be valued and centered for equitable and effective public health programming. These varied perspectives promote a more well-rounded understanding of contextual information and holistic strategies for change.

Regardless of context within or outside of an ECHO project, virtual event planning teams can make perspective over positionality explicit from start to finish by:

• Building a diverse project team to ensure programming is robust and creative. In Project ECHO, having an interdisciplinary format and hub planning team is identified as an important attribute of the ECHO experience (Katzman et al., 2022).
• Prioritizing accessibility. Consider ways to ensure that all voices have a seat at the table. Common practices utilized in ECHO spaces include offering translation services, using chat and breakout room functions, providing recordings of sessions for review after the event, and issuing pre-series surveys to gather accommodation needs of potential participants.
• Inviting a variety of guests to share. Broaden the definition of SME to include individuals with lived experience. Experts in public health often come from a variety of socioeconomic, educational, and other backgrounds to offer poignant insight to help meet the objectives of an event.
• Making “All Teach, All Learn” a group norm. At the start of the event, describe the meaning of the phrase and connect with participants about how to embody it. Refer back to the phrase to encourage new voices to contribute.
• Reconsidering measures of success. In traditional training methods, knowledge change or increase is one of the measures for performance and evaluation. Considering which measures for evaluation are available to assess the level of engagement happening within the session among learners can help to further promote “all teach, all learn” in virtual training.

Hands-on Learning: using case studies to encourage collective sharing and problem-solving.

The ECHO modality is unique in integrating case studies, commonly used in healthcare training and education, into public health. As a part of each ECHO session, participants submit case studies aligned with the topic of the ECHO Series for group discussion. In this way, case studies are utilized to further demonstrate the applicability of session lectures or panel discussions using real-time problem-solving and analysis. The use of case studies has been shown to improve self-efficacy and collaboration across disciplines and provide increased buy-in from ECHO session participants (Osei-Twum et al., 2022).

NNHPI’s Project ECHO team works closely with individuals or organizations that submit a case study to prepare the case for presentation during a session. NNPHI adopted a case study model that not only asks for solutions and solicits responses from participants, but seeks to identify broader goals and analyze risks in depth. The process for soliciting and crafting a case study for an ECHO session or other training event includes key steps:

• Collect case studies that align with event topic. Inspired by the event focus, individuals or organizations submit case studies that describe unique and real-life challenges. Case studies are submitted via email or form.
• Craft a thorough case study to allow for expansive group discussion. The planning team works with the individual submitting the case study to develop critical questions for the audience to discuss. A strong case study highlights the nuances of organizations and projects to identify the different struggles they face and the outcomes they can improve the communities they serve.
• Create a collaborative space for discussion. During the case study presentation, the facilitator encourages a space of curiosity and sharing; the presenter assists the audience by answering the questions and providing insight from their lived experiences and research.

Agile Facilitation: approaching session facilitation with care, intuition, and flexibility.

Like all virtual learning spaces, the ECHO model benefits from an effective facilitator or facilitation team. Championing a “perspective over positionality” mindset and navigating real-life case studies requires confident and responsive facilitation.

In the most recent NNPHI-led ECHO series, The Vaccine Equity Project’s Guiding Principles ECHO for Public Health, Fabiola DeCaratachea’s facilitation style embodied “All Teach, All Learn.” Fabiola had a dynamic role in the series as the series facilitator, from developing agendas and discussion questions, to level-setting and creating an interactive environment that cultivated meaningful dialogue. With a caring temperament and an intuitive read of participants’ needs, Fabiola encouraged diverse participant contributions as they discussed nuanced public health challenges and solutions. Fabiola’s words speak for themselves:

“My role as a facilitator is to give the people sharing a soft place to land. I’m the water – I’ll fill any holes that need filling and encourage others to come into that space ready to engage. I know that a confident and comfortable presenter makes for a better experience for all. I try to be mindful about asking, ‘What worries you about the session? What would make you feel better?’ Letting them know we’re in partnership and my job is to make sure that they’re comfortable and feel supported in the conversation is important to me….

I try to draw people into conversation and into community with each other. Part of that is modeling participation, reading comments in the chat and asking for more information, echoing not only what presenters are sharing, but also highlight the expertise in the room and learning together. People want to share their experience, but are used to panel conversations and Q&A. The ECHO model isn’t that and I actually wish more spaces incorporated the all teach, all learn model.”

Read More Articles from the latest issue of Elevate

• Incorporating a Relational Model in Training and Technical Assistance to Promote Trust, Equity, and Collaboration
• How Public Health AmeriCorps Prepares Future Leaders in Public Health
• Preparing for the Unforeseen: Insights from the Public Health Policy & Strategy Innovation Hub Training
• Helping the Helpers: How We Can Support Public Health Training Developers
• Exploring the Ethos of Project ECHO: How “All Teach All Learn” Encourages Virtual Engagement