Teaching medical students exposure therapy for phobia/panic - randomized, controlled comparison of face-to-face tutorial in small groups vs. solo computer instruction

The effects of an exposure therapy training program for pre-professionals in an intensive exposure-based summer camp

Although exposure therapy (ET) is an effective treatment for anxiety disorders and obsessive-compulsive disorder, many clinicians report not utilizing it. The present study targeted common utilization barriers by evaluating an intensive ET training experience in a relatively inexperienced sample of pre-professionals. Thirty-two individuals at the undergraduate or college graduate level without formal clinical experience participated as camp counsellors in a 5day exposure-based therapeutic summer camp for youth with anxiety disorders and/or obsessive-compulsive disorder. Participants were trained in ET through a progressive cascading model and answered questionnaires before and after camp. Repeated measure MANOVA revealed significantly increased feelings of self-efficacy conducting exposures, and significantly decreased feelings of disgust sensitivity and contamination-related disgust from pre-camp to post-camp. A subset of individuals providing data 1 month after the camp maintained a significant gain in ET self-efficacy. Regression analyses revealed that contamination-related disgust, but not disgust sensitivity, significantly predicted post-camp ET self-efficacy. These findings suggest that individuals early into their post-secondary education can learn ET, and the progressive cascading model holds promise in its utility across experience levels and warrants further investigation. Disgust may also play a role in feelings of competency conducting ET. Implications on dissemination and implementation efforts are also discussed.

Key learning aims

(1)

A randomised controlled study of face-to-face versus internet-based teaching of CBT skills for healthcare professionals in Sudan

Background

A need has been identified for affordable and scalable methods for disseminating cognitive-behavioural therapy (CBT) to countries with barriers to traditional methods of teaching.

Objective

This study evaluated the effectiveness of internet-based teaching versus face-to-face teaching in improving the CBT theory, assessment, and formulation skills of a group of mental health practitioners in Khartoum, Sudan.

Method

Participants (N = 36) were randomly assigned to (a) a 3 h live lecture, or (b) a computer-based multimedia recorded lecture of the same duration. Participants were rated before and after training for their ability to assess a simulated patient and construct a CBT formulation of the presenting difficulties. Participants also rated the feasibility and acceptability of the training they had received.

Results

Both teaching methods resulted in significant improvements in participants' abilities to carry out the assessment and formulation tasks. However, participants allocated to computer-based teaching performed better than those allocated to live teaching (between-groups effect size d = 0.26-0.74). Both teaching methods were rated as highly acceptable and feasible by participants.

Conclusions

Computer-based teaching could offer a cheaper and effective method to help disseminate CBT to countries with limited resources and expertise, replacing and supplementing other costly traditional methods such as face-to-face teaching.

Effectiveness of training methods for delivery of evidence-based psychotherapies: a systematic review

BACKGROUND

Extensive efforts have been made to train mental health providers in evidence-based psychotherapies (EBPs); there is increasing attention focused on the methods through which providers are trained to deliver EBPs. Evaluating EBP training methods is an important step in determining which methods are most effective in increasing provider skill and improving client outcomes.

METHODS

We searched MEDLINE (Ovid) and PsycINFO for randomized controlled trials published from 1990 through June 2019 that evaluated EBP training methods to determine the effectiveness of EBP training modalities on implementation (provider and cost) and client outcomes. Eligible studies (N = 28) were evaluated for risk of bias, and the overall strength of evidence was assessed for each outcome. Data was extracted by a single investigator and confirmed by a second; risk of bias and strength of evidence were independently rated by two investigators and determined by consensus.

RESULTS

Overall, EBP training improved short-term provider satisfaction, EBP knowledge, and adherence compared to no training or self-study of training materials (low to moderate strength of evidence). Training in an EBP did not increase treatment adoption compared to no training or self-study. No specific active EBP training modality was found to consistently increase provider EBP knowledge, skill acquisition/adherence, competence, adoption, or satisfaction compared to another active training modality. Findings were mixed regarding the additive benefit of post-training consultation on these outcomes. No studies evaluated changes in provider outcomes with regards to training costs and few studies reported on client outcomes.

LIMITATIONS

The majority of included studies had a moderate risk of bias and strength of evidence for the outcomes of interest was generally low or insufficient. Few studies reported effect sizes. The ability to identify the most effective EBP training methods was limited by low strength of evidence for the outcomes of interest and substantial heterogeneity among studies.

CONCLUSIONS

EBP training may have increased short-term provider satisfaction, EBP knowledge, and adherence though not adoption. Evidence was insufficient on training costs and client outcomes. Future research is needed on EBP training methods, implementation, sustainability, client outcomes, and costs to ensure efforts to train providers in EBPs are effective, efficient, and durable.

TRIAL REGISTRATION

The protocol for this review is registered in PROSPERO (CRD42018093381).

Using Technology to Train Clinicians in Evidence-Based Treatment: A Systematic Review

OBJECTIVE

There is a critical shortage of clinicians trained in evidence-based treatments (EBTs). New technologies, such as Internet-based training, video conferences, and mobile applications, can increase accessibility to specialized training and enhance traditional face-to-face training. A systematic review was conducted to identify and summarize research on the use of technology to train clinicians in EBTs.

METHODS

An electronic database search of PsycINFO, PubMed, Medline, Web of Science, CINAHL, and the Cochrane Library was conducted in June 2018. Articles were independently coded and assessed for risk of bias by two reviewers using the National Heart, Lung, and Blood Institute's Quality Assessment Tool for Controlled Intervention Studies.

RESULTS

Of the 7,767 citations initially identified, 24 articles met inclusion criteria. These articles described 21 training programs, including training for anxiety, depression, substance abuse, and eating disorder treatment. Most training programs were Internet based (N=19), and a majority of studies used a randomized controlled design (N=21). Most studies reported significant increases in clinician knowledge or skills, with small to large effect sizes. The methodological quality of studies ranged from good to poor. Many programs were limited by their use of completer analyses (i.e., only those who completed study included in analyses) and self-report measures.

CONCLUSIONS

Technology has great potential for increasing availability of training opportunities for clinicians and increasing the workforce trained in EBTs. Although technology-assisted training programs are not without limitations, overall they promise a new era of facilitative learning that promotes the adoption of new clinical practices in a dynamic and efficient manner.

Offline Digital Education for Medical Students: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration

Background

Medical schools in low- and middle-income countries are facing a shortage of staff, limited infrastructure, and restricted access to fast and reliable internet. Offline digital education may be an alternative solution for these issues, allowing medical students to learn at their own time and pace, without the need for a network connection.

Objective

The primary objective of this systematic review was to assess the effectiveness of offline digital education compared with traditional learning or a different form of offline digital education such as CD-ROM or PowerPoint presentations in improving knowledge, skills, attitudes, and satisfaction of medical students. The secondary objective was to assess the cost-effectiveness of offline digital education, changes in its accessibility or availability, and its unintended/adverse effects on students.

Methods

We carried out a systematic review of the literature by following the Cochrane methodology. We searched seven major electronic databases from January 1990 to August 2017 for randomized controlled trials (RCTs) or cluster RCTs. Two authors independently screened studies, extracted data, and assessed the risk of bias. We assessed the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations criteria.

Results

We included 36 studies with 3325 medical students, of which 33 were RCTs and three were cluster RCTs. The interventions consisted of software programs, CD-ROMs, PowerPoint presentations, computer-based videos, and other computer-based interventions. The pooled estimate of 19 studies (1717 participants) showed no significant difference between offline digital education and traditional learning groups in terms of students’ postintervention knowledge scores (standardized mean difference=0.11, 95% CI –0.11 to 0.32; small effect size; low-quality evidence). Meta-analysis of four studies found that, compared with traditional learning, offline digital education improved medical students’ postintervention skills (standardized mean difference=1.05, 95% CI 0.15-1.95; large effect size; low-quality evidence). We are uncertain about the effects of offline digital education on students’ attitudes and satisfaction due to missing or incomplete outcome data. Only four studies estimated the costs of offline digital education, and none reported changes in accessibility or availability of such education or in the adverse effects. The risk of bias was predominantly high in more than half of the included studies. The overall quality of the evidence was low (for knowledge, skills, attitudes, and satisfaction) due to the study limitations and inconsistency across the studies.

Conclusions

Our findings suggest that offline digital education is as effective as traditional learning in terms of medical students’ knowledge and may be more effective than traditional learning in terms of medical students’ skills. However, there is a need to further investigate students’ attitudes and satisfaction with offline digital education as well as its cost-effectiveness, changes in its accessibility or availability, and any resulting unintended/adverse effects.

The Economic Benefits of Mobile Apps for Mental Health and Telepsychiatry Services When Used by Adolescents

This article describes the benefits resulting from the use of mobile applications for mental health and telepsychiatry. Potential direct benefits include substitution for other forms of care, prevention of higher-acuity illness, higher rate of psychiatrist use, increased competition of services driving lower treatment costs, lower operating costs for psychiatrists, fewer missed appointments, and revenue for application developers. Potential indirect benefits include improved physical health, enhanced current and future productivity, and reduced demands on caregivers. A return on investment analysis framework is then presented as a generalized means for evaluating the return on investment of specific health care interventions.

Self-directed learning can outperform direct instruction in the course of a modern German medical curriculum - results of a mixed methods trial

BACKGROUND

Modernised medical curricula in Germany (so called "reformed study programs") rely increasingly on alternative self-instructed learning forms such as e-learning and curriculum-guided self-study. However, there is a lack of evidence that these methods can outperform conventional teaching methods such as lectures and seminars. This study was conducted in order to compare extant traditional teaching methods with new instruction forms in terms of learning effect and student satisfaction.

METHODS

In a randomised trial, 244 students of medicine in their third academic year were assigned to one of four study branches representing self-instructed learning forms (e-learning and curriculum-based self-study) and instructed learning forms (lectures and seminars). All groups participated in their respective learning module with standardised materials and instructions. Learning effect was measured with pre-test and post-test multiple-choice questionnaires. Student satisfaction and learning style were examined via self-assessment.

RESULTS

Of 244 initial participants, 223 completed the respective module and were included in the study. In the pre-test, the groups showed relatively homogenous scores. All students showed notable improvements compared with the pre-test results. Participants in the non-self-instructed learning groups reached scores of 14.71 (seminar) and 14.37 (lecture), while the groups of self-instructed learners reached higher scores with 17.23 (e-learning) and 15.81 (self-study). All groups improved significantly (p < .001) in the post-test regarding their self-assessment, led by the e-learning group, whose self-assessment improved by 2.36.

CONCLUSIONS

The study shows that students in modern study curricula learn better through modern self-instructed methods than through conventional methods. These methods should be used more, as they also show good levels of student acceptance and higher scores in personal self-assessment of knowledge.

What Is the Efficacy of Teaching Psychotherapy to Psychiatry Residents and Medical Students?

OBJECTIVE

Because there are no formal reviews, the authors set out to identify and evaluate studies on teaching psychotherapy to psychiatry residents and medical students.

METHOD

PubMed, Embase, and PsycINFO were searched for papers with outcomes on teaching psychotherapy. Search terms included psychotherapy, teaching, residents, medical students, supportive, psychodynamic, cognitive, behavioral, learning, training, skills, competency, and mentalization.

RESULTS

Nine studies were found that met inclusion criteria. There were seven studies of psychiatry residents and two of medical students. Only two of the research designs had comparison groups, and these were both randomized controlled trials, while seven of the other designs were pretest and posttest. Teaching methods, course content, and outcome measures varied widely across studies. Common methodological problems included a lack of control, low numbers of subjects as learners, and a lack of validity of the outcome measures. Only one of the studies was judged to be methodologically rigorous.

CONCLUSIONS

These findings establish a priority for undertaking additional rigorously designed studies in evaluating the teaching of psychotherapy to psychiatry residents and medical students.

Investigating bang for your training buck: a randomized controlled trial comparing three methods of training clinicians in two core strategies of dialectical behavior therapy

The present study examined the efficacy of online training (OLT), instructor-led training (ILT), and a treatment manual (TM) in training mental health clinicians in two core strategies of Dialectical Behavior Therapy (DBT): chain analysis and validation. A randomized controlled trial compared OLT, ILT, and TM among clinicians naïve to DBT (N=172) who were assessed at baseline, post-training, and 30, 60, and 90 days following training. Primary outcomes included satisfaction, self-efficacy, motivation, knowledge, clinical proficiency, and clinical use. Overall, ILT outperformed OLT and TM in satisfaction, self-efficacy, and motivation, whereas OLT was the most effective method for increasing knowledge. The conditions did not differ in observer-rated clinical proficiency or self-reported clinical use, which both increased to moderate levels after training. In addition, ILT was particularly effective at improving motivation to use chain analysis, whereas OLT was particularly effective at increasing knowledge of validation strategies. These findings suggest that these types of brief, didactic trainings may be effective methods of increasing knowledge of new treatment strategies, but may not be sufficient to enable clinicians to achieve a high level of clinical use or proficiency. Additional research examining the possible advantages of matching training methods to types of treatment strategies may help to determine a tailored, more effective approach to training clinicians in empirically supported treatments.

Exposing clinicians to exposure: a randomized controlled dissemination trial of exposure therapy for anxiety disorders

OBJECTIVE

The present study evaluated three technology-based methods of training mental health providers in exposure therapy (ET) for anxiety disorders. Training methods were designed to address common barriers to the dissemination of ET, including limited access to training, negative clinician attitudes toward ET, and lack of support during and following training.

METHOD

Clinicians naïve to ET (N=181, Mage=37.4, 71.3% female, 72.1% Caucasian) were randomly assigned to (a) an interactive, multimedia online training (OLT), (b) OLT plus a brief, computerized motivational enhancement intervention (OLT+ME), or (c) OLT+ME plus a Web-based learning community (OLT+ME+LC). Assessments were completed at baseline, posttraining, and 6 and 12weeks following training. Outcomes include satisfaction, knowledge, self-efficacy, attitudes, self-reported clinical use, and observer-rated clinical proficiency.

RESULTS

All three training methods led to large and comparable improvements in self-efficacy and clinical use of ET, indicating that OLT alone was sufficient for improving these outcomes. The addition of the ME intervention did not significantly improve outcomes in comparison to OLT alone. Supplementing the OLT with both the ME intervention and the LC significantly improved attitudes and clinical proficiency in comparison to OLT alone. The OLT+ME+LC condition was superior to both other conditions in increasing knowledge of ET.

CONCLUSIONS

Multicomponent trainings that address multiple potential barriers to dissemination appear to be most effective in improving clinician outcomes. Technology-based training methods offer a satisfactory, effective, and scalable way to train mental health providers in evidence-based treatments such as ET.

Offline eLearning for undergraduates in health professions: A systematic review of the impact on knowledge, skills, attitudes and satisfaction

BACKGROUND

The world is short of 7.2 million health-care workers and this figure is growing. The shortage of teachers is even greater, which limits traditional education modes. eLearning may help overcome this training need. Offline eLearning is useful in remote and resource-limited settings with poor internet access. To inform investments in offline eLearning, we need to establish its effectiveness in terms of gaining knowledge and skills, students' satisfaction and attitudes towards eLearning.

METHODS

We conducted a systematic review of offline eLearning for students enrolled in undergraduate, health-related university degrees. We included randomised controlled trials that compared offline eLearning to traditional learning or an alternative eLearning method. We searched the major bibliographic databases in August 2013 to identify articles that focused primarily on students' knowledge, skills, satisfaction and attitudes toward eLearning, and health economic information and adverse effects as secondary outcomes. We also searched reference lists of relevant studies. Two reviewers independently extracted data from the included studies. We synthesized the findings using a thematic summary approach.

FINDINGS

Forty-nine studies, including 4955 students enrolled in undergraduate medical, dentistry, nursing, psychology, or physical therapy studies, met the inclusion criteria. Eleven of the 33 studies testing knowledge gains found significantly higher gains in the eLearning intervention groups compared to traditional learning, whereas 21 did not detect significant differences or found mixed results. One study did not test for differences. Eight studies detected significantly higher skill gains in the eLearning intervention groups, whilst the other 5 testing skill gains did not detect differences between groups. No study found offline eLearning as inferior. Generally no differences in attitudes or preference of eLearning over traditional learning were observed. No clear trends were found in the comparison of different modes of eLearning. Most of the studies were small and subject to several biases.

CONCLUSIONS

Our results suggest that offline eLearning is equivalent and possibly superior to traditional learning regarding knowledge, skills, attitudes and satisfaction. Although a robust conclusion cannot be drawn due to variable quality of the evidence, these results justify further investment into offline eLearning to address the global health care workforce shortage.

Computer-based teaching module design: principles derived from learning theories

CONTEXT

The computer-based teaching module (CBTM), which has recently gained prominence in medical education, is a teaching format in which a multimedia program serves as a single source for knowledge acquisition rather than playing an adjunctive role as it does in computer-assisted learning (CAL). Despite empirical validation in the past decade, there is limited research into the optimisation of CBTM design. This review aims to summarise research in classic and modern multimedia-specific learning theories applied to computer learning, and to collapse the findings into a set of design principles to guide the development of CBTMs.

METHODS

Scopus was searched for: (i) studies of classic cognitivism, constructivism and behaviourism theories (search terms: 'cognitive theory' OR 'constructivism theory' OR 'behaviourism theory' AND 'e-learning' OR 'web-based learning') and their sub-theories applied to computer learning, and (ii) recent studies of modern learning theories applied to computer learning (search terms: 'learning theory' AND 'e-learning' OR 'web-based learning') for articles published between 1990 and 2012. The first search identified 29 studies, dominated in topic by the cognitive load, elaboration and scaffolding theories. The second search identified 139 studies, with diverse topics in connectivism, discovery and technical scaffolding. Based on their relative representation in the literature, the applications of these theories were collapsed into a list of CBTM design principles.

RESULTS

Ten principles were identified and categorised into three levels of design: the global level (managing objectives, framing, minimising technical load); the rhetoric level (optimising modality, making modality explicit, scaffolding, elaboration, spaced repeating), and the detail level (managing text, managing devices).

CONCLUSIONS

This review examined the literature in the application of learning theories to CAL to develop a set of principles that guide CBTM design. Further research will enable educators to take advantage of this unique teaching format as it gains increasing importance in medical education.

Predicting adoption of exposure therapy in a randomized controlled dissemination trial

The present study examined organizational, client, and therapist characteristics as predictors of use of and proficiency in exposure therapy (ET) after training. Therapists naïve to ET (N=181) were randomized to: (1) online training (OLT), (2) OLT plus motivational enhancement (ME), or (3) OLT+ME plus a learning community. Twelve weeks after training, self-reported use of ET in clinical practice was high (87.5%) and therapists demonstrated moderate clinical proficiency. Use of ET was predicted by therapist degree, self-efficacy, and knowledge. Clinical proficiency was predicted by therapist anxiety sensitivity, attitudes, and knowledge, as well as organizational and client barriers. Several of these effects were moderated by training condition, indicating that therapists who received more comprehensive training were less impacted by barriers and showed enhanced adoption in the presence of facilitating factors. Overall, these results suggest that the primary barriers to the adoption of ET are therapist, not organizational or client, factors.

Systematic review of effectiveness of situated e-learning on medical and nursing education

OBJECTIVES

Because of the complexity of clinical situations, traditional didactic education is limited in providing opportunity for student-patient interaction. Situated e-learning can enhance learners' knowledge and associated abilities through a variety of activities. Healthcare providers who interact with virtual patients in designed situations may avoid unnecessary risks and encounters with real patients. However, the effectiveness of situated e-learning is inconsistent. The purpose of this study is to determine the effectiveness of situated e-learning in prelicensure and postlicensure medical and nursing education.

METHODS

Literature databases of PubMed, Medline, CINAHL, ERIC, and Cochrane Library were searched. The study eligibility criteria included articles published in English, which examined the effectiveness of situated e-learning on the outcomes of knowledge and performance for clinicians or students in medicine and nursing. Effect sizes were calculated with 95% confidence intervals.

RESULTS

Fourteen articles were included for meta-analysis. Situated e-learning could effectively enhance learners' knowledge and performance when the control group received no training. Compared to traditional learning, the effectiveness of situated e-learning on performance diminished but still remained significant whereas the effect become insignificant on knowledge. The subgroup analyses indicate the situated e-learning program significantly improved students' clinical performance but not for clinicians.

CONCLUSIONS

Situated e-learning is an effective method to improve novice learners' performance. The effect of situated e-learning on the improvement of cognitive ability is limited when compared to traditional learning. Situated e-learning is a useful adjunct to traditional learning for medical and nursing students.

Using Self-Guided Treatment Software (ePST) to Teach Clinicians How to Deliver Problem-Solving Treatment for Depression

Problem-solving treatment (PST) offers a promising approach to the depression care; however, few PST training opportunities exist. A computer-guided, interactive media program has been developed to deliver PST electronically (ePST), directly to patients. The program is a six-session, weekly intervention modeled on an evidence-based PST protocol. Users are guided through each session by a clinician who is presented via hundreds of branching audio and video clips. Because expert clinician behaviors are modeled in the program, not only does the ePST program have the potential to deliver PST to patients but it may also serve as a training tool to teach clinicians how to deliver PST. Thirteen social workers and trainees used ePST self-instructionally and subsequently attended a day-long workshop on PST. Participants' PST knowledge level increased significantly from baseline to post-ePST (P = .001) and did not increase significantly further after attending the subsequent workshop. Additionally, attending the workshop did not significantly increase the participants' skill at performing PST beyond the use of the ePST program. Using the ePST program appears to train novices to a sufficient level of competence to begin practicing PST under supervision. This self-instructional training method could enable PST for depression to be widely disseminated, although follow-up supervision is still required.

Therapist training in empirically supported treatments: a review of evaluation methods for short- and long-term outcomes

Therapist training efforts have been assessed using several outcomes. A model for evaluating therapist training in empirically supported treatments is presented, adapted from Kirkpatrick's (in: Craig and Bittel (eds.) Training and development handbook, 1967) training evaluation model. The adapted framework includes short-term outcomes, such as reactions to training and changes in attitude, knowledge, or skills, and longer-term outcomes, such as changes in therapist behavior in practice or client outcomes. Evaluation methods for these outcomes are reviewed, with information on their validity, reliability, and feasibility. An agenda for further research to improve therapist training evaluation is presented, with discussion of how evaluation can inform other areas of the field.

Overcoming barriers to disseminating exposure therapies for anxiety disorders: a pilot randomized controlled trial of training methods

The present study evaluated methods for training mental health providers (N=46) in exposure therapies (ETs) for anxiety disorders. A pilot randomized controlled trial compared: (1) an interactive, multimedia online training (ET OLT), (2) the ET OLT plus a brief Motivational Interviewing-based intervention (ET OLT+MI), and (3) a placebo control OLT. Assessments were completed at baseline, post-training, and one-week following training. Both ET OLT and ET OLT+MI received high satisfaction ratings and were comparably effective at increasing knowledge of ETs as well as clinicians' overt efforts to learn and use the treatment. ET OLT+MI was the most effective method for improving clinicians' attitudes toward ETs. Results indicate that OLT is effective for disseminating knowledge about ETs to clinicians, and suggest that supplementing OLT with a brief MI-based intervention may be a promising direction to address potential attitudinal barriers to adopting these highly efficacious treatments.

Computer-aided psychotherapy for anxiety disorders: a meta-analytic review

Computer-aided psychotherapy (CP) is said to (1) be as effective as face-to-face psychotherapy, while requiring less therapist time, for anxiety disorder sufferers, (2) speed access to care, and (3) save traveling time. CP may be delivered on stand-alone or Internet-linked computers, palmtop computers, phone-interactive voice response, DVDs, and cell phones. The authors performed a meta-analysis of 23 randomised controlled studies (RCTs) that compared CP with non-CP in anxiety disorders: phobias, n = 10; panic disorder/agoraphobia, n = 9; PTSD, n = 3; obsessive-compulsive disorder, n = 1. Overall mean effect size of CP compared with non-CP was 1.08 (95% confidence interval: 0.84-1.32). CP and face-to-face psychotherapy did not differ significantly from each other (13 comparisons, d = -0.06). Much caution is needed when interpreting the findings indicating that outcome was unrelated to type of disorder, type of comparison group, mode of CP delivery (Internet, stand-alone PC, palmtop), and recency of the CP system and that effect size decreased when more therapist time was replaced by the computer. Because CP as a whole was as effective as face-to-face psychotherapy, certain forms of CP deserve to be integrated into routine practice.

Which training method works best? A randomized controlled trial comparing three methods of training clinicians in dialectical behavior therapy skills

This study evaluated the efficacy of three methods of training community mental health providers (N = 150) in Dialectical Behavior Therapy skills, including a written treatment manual; an interactive, multimedia online training (OLT); and a two-day instructor-led training workshop (ILT). A hybrid design was utilized that incorporated aspects of efficacy and effectiveness trials. Assessments were completed at baseline, post-training, and 30- and 90-days following training. The results indicate that learner satisfaction with the training was highest in OLT and ILT, and both resulted in significantly higher satisfaction ratings than the manual. OLT outperformed ILT and the manual in increasing knowledge of the treatment, whereas ILT and the manual did not differ. All three training methods resulted in comparable increases in clinicians' ability to apply course content in clinical simulations. Overall, the results provide strong support for the efficacy of technology-based OLT methods in disseminating knowledge of empirically supported treatments to community mental health providers, suggesting that OLT may be a high-quality, easily accessible, and affordable addition to traditional training methods.

Randomized controlled trial comparing lecture versus self studying by an online tool

OBJECTIVES

Since 2001, an e-learning tool has been developed for dentistry. To compare online self study with traditional lectures, a module about instrumental occlusal analysis was offered by oral lecture and by a unit in the virtual library of the e-learning tool.

METHODS

85 pre-clinical dental students were randomly divided into two groups: the computer assisted learning (CAL) group (n = 48) and the lecture group (n = 37). A pre-test was made to assess the students' basic knowledge. The first post-test and the scoring of the teaching methods were performed immediately after the lecture or the self studying by the online tool and a second post-test six weeks later.

RESULTS

The oral lecture got better educational and enjoyment values. The students prefer CAL in addition to traditional lectures. The results of the pre-tests were not different between the two groups (p = 0.706). The lecture group significantly improved their scores in the first post-test (p = 0.011), but the scores of the second post-test did not differ significantly (p = 0.157).

CONCLUSIONS

In the short term, knowledge acquisition seems to be better in oral lectures but in the long term there is no difference in knowledge retention between the two learning scenarios.

Comparison of a web-based package with tutor-based methods of teaching respiratory medicine: subjective and objective evaluations

BACKGROUND

Respiratory disease is a major cause of morbidity and mortality not only in the United Kingdom, but globally. A good understanding of respiratory disease and its treatment is essential for all medical graduates. As a result of changes in clinical practice, patients with some common respiratory illnesses are less often admitted to hospital, restricting the experience available to undergraduate students. Combined with a potential shortage of clinical teachers, this means that new methods of teaching need to be developed and appraised. The aim of this study was to establish whether a web-based package on the diagnosis of respiratory disease would be as effective and as acceptable to final year medical students as tutor-led methods of teaching the same material.

METHODS

137 out of 315 final year undergraduate students in a single medical school volunteered to take part. Each received up to two hours of tutor-lead interactive, tutor-lead didactic or electronic, Web-based teaching on the accurate diagnosis and management of respiratory disease. Post teaching performance was assessed by multiple true/false questions and data interpretation exercises, whilst students' teaching preferences were assessed by questionnaire.

RESULTS

Despite a high knowledge baseline before the study, there was a small, but statistically significant increase in knowledge score after all forms of teaching. Similarly, data interpretation skills improved in all groups, irrespective of teaching format, Although paradoxically most students expressed a preference for interactive tutor-lead teaching, spirometry interpretation in those receiving web-based teaching improved significantly more [p = 0.041] than in those in the interactive group.

CONCLUSION

Web-based teaching is at least as good as other teaching formats, but we need to overcome students' reluctance to engage with this teaching method.

Computer-aided vs. tutor-delivered teaching of exposure therapy for phobia/panic: randomized controlled trial with pre-registration nursing students

BACKGROUND

Exposure therapy is effective for phobic anxiety disorders (specific phobias, agoraphobia, social phobia) and panic disorder. Despite their high prevalence in the community, sufferers often get no treatment or if they do, it is usually after a long delay. This is largely due to the scarcity of healthcare professionals trained in exposure therapy, which is due, in part, to the high cost of training. Traditional teaching methods employed are labour intensive, being based mainly on role-play in small groups with feedback and coaching from experienced trainers. In an attempt to increase knowledge and skills in exposure therapy, there is now some interest in providing relevant teaching as part of pre-registration nurse education. Computers have been developed to teach terminology and simulate clinical scenarios for health professionals, and offer a potentially cost effective alternative to traditional teaching methods.

OBJECTIVE

To test whether student nurses would learn about exposure therapy for phobia/panic as well by computer-aided self-instruction as by face-to-face teaching, and to compare the individual and combined effects of two educational methods, traditional face-to-face teaching comprising a presentation with discussion and questions/answers by a specialist cognitive behaviour nurse therapist, and a computer-aided self-instructional programme based on a self-help programme for patients with phobia/panic called FearFighter, on students' knowledge, skills and satisfaction.

DESIGN

Randomised controlled trial, with a crossover, completed in 2 consecutive days over a period of 4h per day.

PARTICIPANTS

Ninety-two mental health pre-registration nursing students, of mixed gender, age and ethnic origin, with no previous training in cognitive behaviour therapy studying at one UK university.

RESULTS

The two teaching methods led to similar improvements in knowledge and skills, and to similar satisfaction, when used alone. Using them in tandem conferred no added benefit. Computer-aided self-instruction was more efficient as it saved teacher preparation and delivery time, and needed no specialist tutor.

CONCLUSION

Computer-aided self-instruction saved almost all preparation time and delivery effort for the expert teacher. When added to past results in medical students, the present results in nurses justify the use of computer-aided self-instruction for learning about exposure therapy and phobia/panic and of research into its value for other areas of health education.

A multi-institutional randomized controlled trial of adjuvant Web-based teaching to medical students

PURPOSE

To investigate the impact of an adjuvant Web-based teaching program on medical students' learning during clinical rotations.

METHOD

From April 2003 to May 2004, 351 students completing clinical rotations in surgery-urology at four U.S. medical schools were invited to volunteer for the study. Web-based teaching cases were developed covering four core urologic topics. Students were block randomized to receive Web-based teaching on two of the four topics. Before and after a designated duration at each institution (ranging one to three weeks), students completed a validated 28-item Web-based test (Cronbach's alpha = .76) covering all four topics. The test was also administered to a subset of students at one school at the conclusion of their third-year to measure long-term learning.

RESULTS

Eighty-one percent of all eligible students (286/351) volunteered to participate in the study, 73% of whom (210/286) completed the Web-based program. Compared to controls, Web-based teaching significantly increased test scores in the four topics at each medical school (p < .001, mixed analysis of variance), corresponding to a Cohen's d effect size of 1.52 (95% confidence interval [CI], 1.23-1.80). Learning efficiency was increased three-fold by Web-based teaching (Cohen's d effect size 1.16; 95% CI 1.13-1.19). Students who were tested a median of 4.8 months later demonstrated significantly higher scores for Web-based teaching compared to non-Web-based teaching (p = .007, paired t-test). Limited learning was noted in the absence of Web-based teaching.

CONCLUSIONS

This randomized controlled trial provides Class I evidence that Web-based teaching as an adjunct to clinical experiences can significantly and durably improve medical students' learning.