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Cheng C, Papadakos J, Umakanthan B, Fazelzad R, Martimianakis MA(T, Ugas M, Giuliani ME. On the advantages and disadvantages of virtual continuing medical education: a scoping review. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:41-74. [PMID: 37465741 PMCID: PMC10351643 DOI: 10.36834/cmej.75681] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Introduction With the COVID-19 pandemic, most continuing medical education activities became virtual (VCME). The authors conducted a scoping review to synthesize the advantages and disadvantages of VCME to establish the impact of this approach on inequities that physicians face along the intersections of gender, race, and location of practice. Methods Guided by the methodological framework of Arksey and O'Malley, the search included six databases and was limited to studies published between January 1991 to April 2021. Eligible studies included those related to accredited/non-accredited post-certification medical education, conferences, or meetings in a virtual setting focused on physicians. Numeric and inductive thematic analyses were performed. Results 282 studies were included in the review. Salient advantages identified were convenience, favourable learning formats, collaboration opportunities, effectiveness at improving knowledge and clinical practices, and cost-effectiveness. Prominent disadvantages included technological barriers, poor design, cost, lack of sufficient technological skill, and time. Analysis of the studies showed that VCME was most common in the general/family practice specialty, in suburban settings, and held by countries in the Global North. A minority of studies reported on gender (35%) and race (4%). Discussion Most studies report advantages of VCME, but disadvantages and barriers exist that are contextual to the location of practice and medical subspecialty. VCME events are largely organized by Global North countries with suboptimized accessibility for Global South attendees. A lack of reported data on gender and race reveals a limited understanding of how VCME affects vulnerable populations, prompting potential future considerations as it evolves.
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Affiliation(s)
| | - Janet Papadakos
- Cancer Education Program, Princess Margaret Cancer Centre, Ontario, Canada
- The Institute for Education Research, University Health Network, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Ontario, Canada
| | - Ben Umakanthan
- Cancer Education Program, Princess Margaret Cancer Centre, Ontario, Canada
| | - Rouhi Fazelzad
- Library and Information Sciences, Princess Margaret Cancer Centre, Ontario, Canada
| | | | - Mohamed Ugas
- Cancer Education Program, Princess Margaret Cancer Centre, Ontario, Canada
| | - Meredith Elana Giuliani
- Cancer Education Program, Princess Margaret Cancer Centre, Ontario, Canada
- The Institute for Education Research, University Health Network, Ontario, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Ontario, Canada
- The Wilson Centre, University Health Network, Ontario, Canada
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Posada EL, Lauck KC, Tran T, Krause KJ, Nelson KC. Educational Interventions to Support Primary Care Provider Performance of Diagnostic Skin Cancer Examinations: A Systematic Literature Review. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1579-1588. [PMID: 35040018 PMCID: PMC8763425 DOI: 10.1007/s13187-021-02118-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 06/14/2023]
Abstract
To our knowledge, there is no available standardized educational curriculum designed to promote the incorporation of skin cancer examinations and procedures into general practice. To explore the contemporary training landscape, we conducted a systematic review of educational interventions designed to support skin cancer diagnostic examinations by primary care providers (PCPs). Our review uniquely encompasses all PCPs, including practicing physicians, residents, and advanced practice practitioners (APPs). The objective of this study is to review and synthesize worldwide data on educational interventions addressing PCP performance of skin cancer diagnostic examinations. A systematic review was performed in MEDLINE, Cochrane, EMBASE, and Scopus for English language articles worldwide published from 2000 onwards. Articles were screened for eligibility, and possibly overlapping datasets were resolved. Data extracted included curriculum content, delivery format, and educational outcomes. This review followed the PRISMA guidelines. A total of 63 studies were selected for data inclusion with one addressing training for resident physicians, 4 for APPs, and the remainder for practicing physicians. Educational interventions included in this review reflect the pre-SARS-CoV-2 pandemic educational environment: half provided live/synchronous instruction of about 5-h duration on average, and a quarter featured interactive components. Less than a quarter of interventions included practice change as a specific reported outcome. Without sustainable practice change, the anticipated long-term benefits of early cancer detection in patients remain limited. Previous and existing educational interventions designed to support skin cancer detection by PCPs demonstrate heterogeneous curriculum content, delivery methods, and educational outcomes. An ideal intervention would teach consensus-derived clinical competencies, provide meaningful learner feedback, and measure outcomes, such as knowledge/competency, confidence/attitudes, and practice change, using validated instruments.
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Affiliation(s)
- Eliza L Posada
- The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kyle C Lauck
- Department of Internal Medicine, The University of Texas Health Science Center, Houston, TX, USA
| | - Tiffaney Tran
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kate J Krause
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly C Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Gonna N, Tran T, Bassett RL, Farris DP, Nelson KC. Sensitivity and Specificity for Skin Cancer Diagnosis in Primary Care Providers: a Systematic Literature Review and Meta-analysis of Educational Interventions and Diagnostic Algorithms. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1563-1572. [PMID: 35834156 DOI: 10.1007/s13187-022-02194-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In areas without convenient access to dermatology care, primary care providers (PCPs) serve as an important patient resource for early skin cancer detection. To determine the most effective strategy for skin cancer detection training in PCPs, we conducted a systematic review of educational interventions and performed a meta-analysis on sensitivity and specificity outcomes in PCPs. OBJECTIVES To summarize data on skin cancer sensitivity and specificity outcomes for PCP-targeted training programs and diagnostic algorithms. Our PCP cohort included practicing physicians, trainee physicians, and advanced practice practitioners. METHODS A literature search was performed in MEDLINE, Embase, Web of Science, and the Cochrane Library for relevant English-language articles published worldwide from 2000 onward. Results were screened for eligibility, and overlapping datasets were reconciled. Data extracted included the educational intervention, diagnostic algorithm, and outcomes of interest (sensitivity and specificity). Outcomes were pooled across interventions that taught the same diagnostic algorithm. A bivariate model was fit to compare different interventions/algorithms. This review followed the PRISMA guidelines. RESULTS In total, 21 articles were included in this review, encompassing over 58,610 assessments of skin lesions by about 1529 participants worldwide. Training programs that implemented the triage-amalgamated dermoscopic algorithm (TADA) demonstrated high pooled sensitivity (91.7%) and high pooled specificity (81.4%) among PCPs. CONCLUSIONS AND RELEVANCE Overall, this systematic review and meta-analysis showed that dermoscopy training in PCPs was generally associated with gains in skin cancer sensitivity without loss of specificity. Clinically, this correlates with fewer skin cancers overlooked by PCPs and fewer excisions of benign lesions.
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Affiliation(s)
- Nadeen Gonna
- John P. and Kathrine G. McGovern Medical School, Houston, TX, USA
| | - Tiffaney Tran
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1452, Houston, TX, 77030, USA
| | - Roland L Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David P Farris
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly C Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1452, Houston, TX, 77030, USA.
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Jawade SA, Waghmare LS, Madke BS, Singh AB, Jawade SS. Learning gain in web (internet) sourced seminars versus textbook sourced seminars in postgraduate medical students. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:162. [PMID: 35847146 PMCID: PMC9277746 DOI: 10.4103/jehp.jehp_1263_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In the past, textbook or printed material was the only source of information for medical students or post-graduate students. After the introduction of internet, knowledge can be accessed easily which is updated with various aids such as animation, videos which improve the learning efficiency. This study was conducted to compare the learning efficiency between textbook-based seminar to that of internet-based seminar in postgraduate students of the department of dermatology. MATERIALS AND METHODS It was a non-randamized controlled study. The postgraduate students in the department of dermatology, Jawaharlal Nehru Medical college, DMIMS(DU),Sawangi (Meghe), Wardha, Maharashtra, India were divided into two equal groups by simple randomization method by flipping the coin. Totally 20 seminar topics were divided into two groups (A and B) consisting of 10 seminars in each group. Postgraduate students assigned in group A were asked to prepare seminar solely from textbooks while in group B, students were asked to prepare seminar by referring internet. Feedback form which consists of 7 points, i.e. appearance, completeness of preparation, clarity of presentation, appropriate use of audio visual aids, understanding of subject, ability to answer questions, and overall performance were filled up from faculties and postgraduate students after completion of each seminar. Pretest and post-test were filled up from postgraduate students before and after each seminar respectively. Learning gain was calculated by comparing the scores of pretest and posttest. Paired t-test was used to compare results in the group and unpaired t-test was used to compare results between the two groups. RESULTS Faculties' feedback on overall performance was higher (4.59 ± 0.15) in web-based seminars as compared to in textbook-based seminars (3.85 ± 0.1) with significant P = 0.008. Furthermore, postgraduate students' feedback showed statistical significant value of 0.02 in web-based seminars (4.65 ± 0.06) compared to textbook-based seminars (3.2 ± 0.06). Learning gain was significantly higher in web-based seminar compared to textbook-based seminar with P = 0.02. CONCLUSION It can be concluded that web-based learning can improve the learning efficiency in postgraduate medical students.
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Affiliation(s)
- Sugat A. Jawade
- Department of Dermatology, Jawaharlal Nehru Medical College, DMIMS (DU), Wardha, Maharashtra, India
| | - Lalit S. Waghmare
- Department of Physiology, Jawaharlal Nehru Medical College, DMIMS (DU), Wardha, Maharashtra, India
| | - Bhushan S. Madke
- Department of Dermatology, Jawaharlal Nehru Medical College, DMIMS (DU), Wardha, Maharashtra, India
| | - Adarshlata B. Singh
- Department of Dermatology, Jawaharlal Nehru Medical College, DMIMS (DU), Wardha, Maharashtra, India
| | - Swapna S. Jawade
- Department of Musculoskeletol, Ravi Nair Physiotherapy College, DMIMS (DU), Wardha, Maharashtra, India
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Abstract
BACKGROUND General practitioners (GPs) play a key role in early melanoma detection. To help GPs deal with suspicious skin lesions, melanoma diagnostic training programmes have been developed. However, it is unclear whether these programmes guarantee the acquisition of skills that will be applied by GPs in their daily clinical practice and maintained over time. OBJECTIVES This scoping review aimed to examine and compare educational programmes designed to train GPs in melanoma diagnosis using clinical (naked eye) examination alone or dermoscopy±clinical examination, and sought to inform on the long-term sustainability of the GPs' acquired skills. ELIGIBILITY CRITERIA Studies eligible for inclusion evaluated educational programmes for teaching diagnosis of melanoma to GPs. MEDLINE, EMBASE and Cochrane databases were searched for relevant articles from 1995 to May 2020. RESULTS Forty-five relevant articles were found assessing 31 educational programmes. Most programmes that improved the diagnostic accuracy and long-term performances of the GPs, that is, increase in confidence, decrease in dermatologist referral for benign skin lesions and improvement in the benign/malignant ratio of excised skin lesions, trained the GPs in clinical diagnosis, followed by dermoscopy. To maintain long-term performances, these programmes provided refresher training material. CONCLUSION This review shows that studies generally report positive outcomes from the training of GPs in melanoma diagnosis. However, refresher training material seemed necessary to maintain the acquired skills. The optimal form and ideal frequency for these updates have yet to be defined.
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Affiliation(s)
- Evelyne Harkemanne
- Service de dermatologie, Cliniques universitaires Saint-Luc, Bruxelles, Belgique
- Pôle de pneumologie et dermatologie, Institut de Recherche Expérimentale et Clinique, UCLouvain, Bruxelles, Belgique
| | - Marie Baeck
- Service de dermatologie, Cliniques universitaires Saint-Luc, Bruxelles, Belgique
- Pôle de pneumologie et dermatologie, Institut de Recherche Expérimentale et Clinique, UCLouvain, Bruxelles, Belgique
| | - Isabelle Tromme
- Service de dermatologie, Cliniques universitaires Saint-Luc, Bruxelles, Belgique
- Clinique du mélanome, Institut Roi Albert II, Cliniques universitaires Saint-Luc, Bruxelles, Belgique
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Verville L, Dc PC, Grondin D, Mior S, Moodley K, Kay R, Taylor-Vaisey A. Using technology-based educational interventions to improve knowledge about clinical practice guidelines. THE JOURNAL OF CHIROPRACTIC EDUCATION 2021; 35:149-157. [PMID: 32931558 PMCID: PMC7958655 DOI: 10.7899/jce-19-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/13/2019] [Accepted: 03/04/2020] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To describe the best evidence on the effectiveness of technology-based learning tools designed to improve knowledge of health care providers about clinical practice guidelines (CPGs). METHODS We conducted a systematic review, searching MEDLINE, Embase, and CINAHL from inception to July 2018. Included studies investigated the effectiveness of any technology-based learning tools developed to improve knowledge of health care providers about CPGs. We used a 2-phase screening process to determine eligibility. Pairs of reviewers critically appraised relevant studies using the Scottish Intercollegiate Guidelines Network checklist for randomized controlled trials or the National Institutes of Health checklist for pre- and postintervention trials. Evidence from internally valid studies was described using a best-evidence summary. We conducted a sensitivity analysis to determine whether results varied according to methodological quality. RESULTS Twenty-five of 8321 articles met our selection criteria. Six studies had a low risk of bias and were included in this review. Spaced education was associated with improvement in knowledge; however, its effectiveness relative to other interventions is unknown. Module-based online educational interventions were associated with improvement in knowledge of CPGs; however, they may not be more effective than paper-based self-learning or in-person workshops. The sensitivity analysis determined that the evidence was similar between the high and low risk of bias studies. CONCLUSION Module-based- and spaced-education interventions may be beneficial for improving health care providers' knowledge of CPGs; however, much of the evidence toward their use is preliminary.
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Harris JM, Sun H. A randomized trial of two e-learning strategies for teaching substance abuse management skills to physicians. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2013; 88:1357-1362. [PMID: 23887001 PMCID: PMC3769087 DOI: 10.1097/acm.0b013e31829e7ec6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To compare the educational effectiveness of two virtual patient (VP)-based e-learning strategies, versus no training, in improving physicians' substance abuse management knowledge, attitudes, self-reported behaviors, and decision making. METHOD The 2011-2012 study was a posttest-only, three-arm, randomized controlled trial in 90 resident and 30 faculty physicians from five adult medicine primary care training programs. The intervention was one of two 2-hour VP-based e-learning programs, designed by national experts to teach structured screening, brief interventions, referral, and treatment skills. One used traditional problem solving with feedback (unworked example), and the other incorporated an expert demonstration first, followed by problem solving with feedback (worked example). The main outcome measure was performance on the Physicians' Competence in Substance Abuse Test (P-CSAT, maximum score = 315), a self-administered, previously validated measure of physicians' competence in managing substance abuse. The survey was completed at the outset of the study and two months later. RESULTS Overall P-CSAT scores were virtually identical (202-211, P > .05) between both intervention groups and the no-training control group at both times. Average faculty P-CSAT scores (221.9, 224.6) were significantly higher (P < .01) than resident scores (203.7, 202.5) at both times. CONCLUSIONS This study did not provide evidence that a brief, worked example, VP-based e-learning program or a traditional, unworked, VP-based e-learning program was superior to no training in improving physicians' substance abuse management skills. The study did provide additional evidence that the P-CSAT distinguishes between physicians who should possess different levels of substance abuse management skills.
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Affiliation(s)
- John M Harris
- University of Arizona College of Medicine, Tucson, AZ 85724-5121, USA.
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Lazzari MA. Can Continuing Medical Education Courses Supplied by the Clinical Laboratory Alter Provider Test-Ordering Practice? Lab Med 2012. [DOI: 10.1309/lmlwcdrbwbf6yrvf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Dolev JC, O'Sullivan P, Berger T. The eDerm online curriculum: A randomized study of effective skin cancer teaching to medical students. J Am Acad Dermatol 2011; 65:e165-71. [DOI: 10.1016/j.jaad.2010.07.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 06/22/2010] [Accepted: 07/20/2010] [Indexed: 11/28/2022]
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Goulart JM, Quigley EA, Dusza S, Jewell ST, Alexander G, Asgari MM, Eide MJ, Fletcher SW, Geller AC, Marghoob AA, Weinstock MA, Halpern AC. Skin cancer education for primary care physicians: a systematic review of published evaluated interventions. J Gen Intern Med 2011; 26:1027-35. [PMID: 21472502 PMCID: PMC3157536 DOI: 10.1007/s11606-011-1692-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2010] [Revised: 02/14/2011] [Accepted: 03/02/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Early detection of melanoma may provide an opportunity to positively impact melanoma mortality. Numerous skin cancer educational interventions have been developed for primary care physicians (PCPs) to improve diagnostic accuracy. Standardized training is also a prerequisite for formal testing of melanoma screening in the primary care setting. OBJECTIVE We conducted a systematic review to determine the extent of evaluated interventions designed to educate PCPs about skin cancer, including melanoma. DESIGN Relevant studies in the English language were identified through systemic searches performed in MEDLINE, EMBASE, BIOSIS, and Cochrane through December 2010. Supplementary information was obtained from corresponding authors of the included studies when necessary. APPROACH Studies eligible for inclusion formally evaluated skin cancer education interventions and were designed primarily for PCPs. Excluded studies lacked a specified training intervention, used decision-making software, focused solely on risk factor identification, or did not directly educate or assess participants. Twenty studies met the selection criteria. Data were extracted according to intervention content and delivery format, and study outcomes. KEY RESULTS All interventions included instructions about skin cancer diagnosis, but otherwise varied in content. Curricula utilized six distinct educational techniques, usually incorporating more than one. Intervention duration varied from 12 min to over 6 h. Eight of the 20 studies were randomized trials. Most studies (18/20, 90%) found a significant improvement in at least one of the following five outcome categories: knowledge, competence, confidence, diagnostic performance, or systems outcomes. Competence was most commonly measured; no study evaluated all categories. Variability in study design, interventions, and outcome measures prevented correlation of outcomes with intervention characteristics. CONCLUSIONS Despite the development of many isolated educational interventions, few have been tested rigorously or evaluated under sufficient standardized conditions to allow for quantitative comparison. Improved and rigorously tested skin cancer educational interventions for PCPs with outcome measures focusing on changes in performance are needed.
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Affiliation(s)
- Jacqueline M Goulart
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 07920, USA
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Puljak L, Sapunar D. Web-based elective courses for medical students: an example in pain. PAIN MEDICINE 2011; 12:854-63. [PMID: 21481172 DOI: 10.1111/j.1526-4637.2011.01104.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Online learning is an efficient new educational method that is able to link teachers with geographically dispersed students and capture the interest of students with interactive materials. Our objective was to describe curricula of new Web-based electives about pain for undergraduate medical education. DESIGN We created three interactive Web-based elective courses about pain targeted to medical and dental students. "The Puzzle of Pain" course introduced basic concepts of pain and neurobiology of pain. The humanities-based curriculum of "Empathy and Pain" taught students about emotional aspects of pain and empathetic responses. "The Cochrane Library and Pain" course introduced students to the concept of evidence-based medicine, critical appraisal of the literature, and the hierarchy of evidence in medicine. OUTCOME MEASURES We measured program effectiveness with a pretest/posttest instrument and student satisfaction survey. RESULTS Mean knowledge scores increased significantly after the program and overall evaluations were positive. CONCLUSIONS Delivering the pain electives for medical students in an online format was an efficient educational method, with high student satisfaction scores. Medical educators should consider online electives for medical students in pain studies as well as in other content areas.
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Affiliation(s)
- Livia Puljak
- Department of Anatomy, University of Split School of Medicine, Split, Croatia.
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Alford DP, Richardson JM, Chapman SE, Dubé CE, Schadt RW, Saitz R. A web-based Alcohol Clinical Training (ACT) curriculum: is in-person faculty development necessary to affect teaching? BMC MEDICAL EDUCATION 2008; 8:11. [PMID: 18325102 PMCID: PMC2329623 DOI: 10.1186/1472-6920-8-11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Accepted: 03/06/2008] [Indexed: 05/08/2023]
Abstract
BACKGROUND Physicians receive little education about unhealthy alcohol use and as a result patients often do not receive efficacious interventions. The objective of this study is to evaluate whether a free web-based alcohol curriculum would be used by physician educators and whether in-person faculty development would increase its use, confidence in teaching and teaching itself. METHODS Subjects were physician educators who applied to attend a workshop on the use of a web-based curriculum about alcohol screening and brief intervention and cross-cultural efficacy. All physicians were provided the curriculum web address. Intervention subjects attended a 3-hour workshop including demonstration of the website, modeling of teaching, and development of a plan for using the curriculum. All subjects completed a survey prior to and 3 months after the workshop. RESULTS Of 20 intervention and 13 control subjects, 19 (95%) and 10 (77%), respectively, completed follow-up. Compared to controls, intervention subjects had greater increases in confidence in teaching alcohol screening, and in the frequency of two teaching practices - teaching about screening and eliciting patient health beliefs. Teaching confidence and teaching practices improved significantly in 9 of 10 comparisons for intervention, and in 0 comparisons for control subjects. At follow-up 79% of intervention but only 50% of control subjects reported using any part of the curriculum (p = 0.20). CONCLUSION In-person training for physician educators on the use of a web-based alcohol curriculum can increase teaching confidence and practices. Although the web is frequently used for dissemination, in-person training may be preferable to effect widespread teaching of clinical skills like alcohol screening and brief intervention.
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Affiliation(s)
- Daniel P Alford
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Jessica M Richardson
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Sheila E Chapman
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Catherine E Dubé
- Department of Community Health, Brown University, Providence, RI, USA
| | - Robert W Schadt
- Department of Educational Technology, Boston University School of Public Health, Boston, MA, USA
| | - Richard Saitz
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
- Youth Alcohol Prevention Center, Boston University School of Public Health, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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Harris JM, Fulginiti JV, Gordon PR, Elliott TE, Davis BE, Chabal C, Kutob RM. KnowPain-50: a tool for assessing physician pain management education. PAIN MEDICINE 2008; 9:542-54. [PMID: 18266812 DOI: 10.1111/j.1526-4637.2007.00398.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite a need for better physician pain management education, there are no widely accepted assessment or outcome measures to support this work. OBJECTIVE Create a self-assessment tool to measure physician educational needs and the effectiveness of chronic pain educational programs. DESIGN We used expert consensus to draft a 142-item survey that covered essential areas of chronic pain management. We tested the survey in 106 physicians, including 22 pain management experts and used predefined psychometric criteria to eliminate 70 items. We then eliminated 22 remaining items that did not correlate with the management of a standardized chronic pain patient by 27 academic physicians. We evaluated internal consistency using Cronbach's alpha. RESULTS The final 50-item survey assessed physician knowledge, attitudes, and beliefs in: 1) initial pain assessment; 2) defining goals and expectations; 3) development of a treatment plan; 4) implementation of a treatment plan; 5) reassessment and management of longitudinal care; and 6) management of environmental issues. The survey demonstrated good internal consistency in all physician populations studied (alpha = 0.77-0.85). Average scores in 84 "pilot" physician users of a CME Website (135.8-138.5) were significantly lower (P < 0.01) than scores in 27 academic physicians (150.0), or 22 pain experts (177.5). CONCLUSIONS This survey, the KnowPain-50, has good psychometric properties, correlates with clinical behaviors, and appears to distinguish between physicians with different levels of pain management expertise. It may be a useful measure of the effectiveness of physician pain management education programs.
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Harris JM, Elliott TE, Davis BE, Chabal C, Fulginiti JV, Fine PG. Educating generalist physicians about chronic pain: live experts and online education can provide durable benefits. PAIN MEDICINE 2008; 9:555-63. [PMID: 18266811 DOI: 10.1111/j.1526-4637.2007.00399.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Determine whether lectures by national experts and a publicly available online program with similar educational objectives can improve knowledge, attitudes, and beliefs (KAB) important to chronic pain management. DESIGN A pretest-posttest randomized design with two active educational interventions in two different physician groups and a third physician group that received live education on a different topic to control for outside influences, including retesting effects, on our evaluation. PARTICIPANTS A total of 136 community-based primary care physicians met eligibility criteria. All physicians attended the educational program to which they were assigned. Ninety-five physicians (70%) provided complete data for evaluation. MEASUREMENTS Physician responses to a standardized 50-item pain management KAB survey before, immediately after, and 3 months following the interventions. RESULTS The study groups and the 41 physicians not providing outcomes information were similar with respect to age, sex, race, percent engaged in primary care, and number of patients seen per week. Physician survey scores improved immediately following both pain education programs (live: 138.0-->150.6, P < 0.001; online: 143.6-->150.4, P = 0.007), but did not change appreciably in the control group (139.2-->142.5, P > 0.05). Findings persisted at 3 months. Satisfaction measures were high (4.00-4.72 on 1-5 scale) and not significantly different (P = 0.072-0.893) between groups. CONCLUSIONS When used under similar conditions, national speakers and a publicly available online CME program were associated with improved pain management KAB in physicians. The benefits lasted for 3 months. These findings support the continued use of these pain education strategies.
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Dubner SJ, Moss AJ, Schapachnik ES, Levine PA, Perez Riera AR, Camm J, Zareba W. Web-based virtual cardiac symposia: a new approach for worldwide professional medical education. Ann Noninvasive Electrocardiol 2007; 12:165-70. [PMID: 17593186 PMCID: PMC6932499 DOI: 10.1111/j.1542-474x.2007.00156.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIM The Internet is an extremely powerful tool for the transmission of data and knowledge, and the question is whether this technology can be used effectively in continuing medical education. We present our experience with worldwide, web-based virtual symposia for practicing physicians. METHODS The International Society for Holter and Noninvasive Electrocardiography (ISHNE) decided four years ago to conduct a series of cardiology-related educational activities for physicians utilizing a web-based approach. Six educational events under the format of virtual symposia were held on the Internet during the years 2002 to 2006. These Internet events included symposia on Brugada syndrome (2002), the long QT syndrome (2004), arrhythmogenic right ventricular dysplasia (2005), atrial fibrillation (2005), heart failure (2006), and sudden cardiac death (2006). RESULTS During the past four years, there has been a dramatic and progressive increase in the number of physician registrants, the number of countries represented, and the number of lectures downloaded with each subsequent virtual symposium. For example, during the month of October 2006, the Internet-based sudden cardiac death symposium involved 14,087 physician registrants from 120 countries with 64,939 lectures downloaded. The top lecture was downloaded 11,251 times, and over 200 e-mail questions and replies were exchanged. The average time per visit to the web site was 12.5 minutes. CONCLUSION The progressively increasing numbers of physician registrants from around the world who participated in these web-based, virtual symposia suggest that this approach is answering an unmet professional educational need. This Internet approach adds an important, new, low-cost dimension to continuing medical education.
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Affiliation(s)
| | - Arthur J. Moss
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | | | | | | | - John Camm
- St. George University of London, London, United Kingdom
| | - Wojciech Zareba
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, NY
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Clarke RSJ. Ulster connections with Nelson and Trafalgar. THE ULSTER MEDICAL JOURNAL 2006; 75:80-4. [PMID: 16457409 PMCID: PMC1891793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- R S J Clarke
- Office of Archives, Royal Victoria Hospital, Belfast.
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Wall TC, Mian MAH, Ray MN, Casebeer L, Collins BC, Kiefe CI, Weissman N, Allison JJ. Improving physician performance through Internet-based interventions: who will participate? J Med Internet Res 2005; 7:e48. [PMID: 16236700 PMCID: PMC1550676 DOI: 10.2196/jmir.7.4.e48] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Revised: 07/22/2005] [Accepted: 07/29/2005] [Indexed: 12/03/2022] Open
Abstract
Background The availability of Internet-based continuing medical education is rapidly increasing, but little is known about recruitment of physicians to these interventions. Objective The purpose of this study was to examine predictors of physician participation in an Internet intervention designed to increase screening of young women at risk for chlamydiosis. Methods Eligibility was based on administrative claims data, and eligible physicians received recruitment letters via fax and/or courier. Recruited offices had at least one physician who agreed to participate in the study by providing an email address. After one physician from an office was recruited, intensive recruitment of that office ceased. Email messages reminded individual physicians to participate by logging on to the Internet site. Results Of the eligible offices, 325 (33.2%) were recruited, from which 207 physicians (52.8%) participated. Recruited versus nonrecruited offices had more eligible patients (mean number of eligible patients per office: 44.1 vs 33.6; P < .001), more eligible physicians (mean number of eligible physicians per office: 6.2 vs 4.1; P < .001), and fewer doctors of osteopathy (mean percent of eligible physicians per office who were doctors of osteopathy: 20.5% vs 26.4%; P = .02). Multivariable analysis revealed that the odds of recruiting at least one physician from an office were greater if the office had more eligible patients and more eligible physicians. More participating versus nonparticipating physicians were female (mean percent of female recruited physicians: 39.1% vs 27.0%; P = .01); fewer participating physicians were doctors of osteopathy (mean percent of recruited physicians who were doctors of osteopathy: 15.5% vs 23.9%; P = .04) or international medical graduates (mean percent of recruited physicians who were international graduates: 12.3% vs 23.8%; P = .003). Multivariable analysis revealed that the odds of a physician participating were greater if the physician was older than 55 years (OR = 2.31; 95% CI = 1.09–4.93) and was from an office with a higher Chlamydia screening rate in the upper tertile (OR = 2.26; 95% CI = 1.23–4.16). Conclusions Physician participation in an Internet continuing medical education intervention varied significantly by physician and office characteristics.
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Affiliation(s)
- Terry C Wall
- Department of Pediatrics, University of Alabama, Birmingham, AL, USA.
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Curran VR, Fleet L. A review of evaluation outcomes of web-based continuing medical education. MEDICAL EDUCATION 2005; 39:561-7. [PMID: 15910431 DOI: 10.1111/j.1365-2929.2005.02173.x] [Citation(s) in RCA: 204] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
INTRODUCTION The Internet and worldwide web have expanded opportunities for the provision of a flexible, convenient and interactive form of continuing medical education (CME). Larger numbers of doctors are accessing and using the Internet to locate and seek medical information. It has been suggested that a significant proportion of this usage is directly related to questions that arise from patient care. A variety of Internet technologies are being used to provide both asynchronous and synchronous forms of web-based CME. Various models for designing and facilitating web-based CME learning have also been reported. The purpose of this study was to examine the nature and characteristics of the web-based CME evaluative outcomes reported in the peer-reviewed literature. METHODS A search of Medline was undertaken and the level of evaluative outcomes reported was categorised using Kirkpatrick's model for levels of summative evaluation. RESULTS The results of this analysis revealed that the majority of evaluative research on web-based CME is based on participant satisfaction data. There was limited research demonstrating performance change in clinical practices and there were no studies reported in the literature that demonstrated that web-based CME was effective in influencing patient or health outcomes. DISCUSSION The findings suggest an important need to examine in greater detail the nature and characteristics of those web-based learning technologies, environments and systems which are most effective in enhancing practice change and ultimately impacting patient and health outcomes. This is particularly important as the Internet grows in popularity as a medium for knowledge transfer.
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Affiliation(s)
- Vernon R Curran
- Academic Research and Development, Faculty of Medicine, Memorial University of Newfoundland, St John's, Canada.
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Sakata K, Beitler AL, Gibbs JF, Kraybill WG, Virgo KS, Johnson FE. How surgeon age affects surveillance strategies for extremity soft tissue sarcoma patients after potentially curative treatment. J Surg Res 2002; 108:227-34. [PMID: 12505046 DOI: 10.1006/jsre.2002.6544] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The optimal strategy for follow-up of extremity soft tissue sarcoma patients after potentially curative treatment remains unknown. We investigated whether the date of completion of formal surgical training affects choice of surveillance strategy. MATERIALS AND METHODS The 1,592 members of the Society of Surgical Oncology were asked how often they use 12 separate surveillance modalities during years 1-5 and 10 postsurgery. The motivation underlying follow-up was assessed separately. Repeated-measures analysis of variance was used to compare practice patterns by the year in which the surgeon's formal surgery training was completed, controlling for tumor grade, tumor size, and year postsurgery. RESULTS Of the 716 respondents, 318 performed surgery and also provided long-term postoperative surveillance for their patients. These respondents were considered evaluable. Erythrocyte sedimentation rate, extremity X ray, and bone scan were the follow-up tests which differed significantly among physician age groups. Surgeons who completed training more than 30 years ago ordered erythrocyte sedimentation rate more frequently (P < 0.001). Surgeons in the 21-30 year category ordered extremity X ray and bone scan more frequently (P < 0.05), but the absolute differences among age groups were quite small. Older surgeons were also significantly more likely to believe that follow-up is clinically worthwhile. CONCLUSIONS The posttreatment surveillance practice patterns of the members of the Society of Surgical Oncology caring for extremity soft tissue sarcoma patients vary only marginally with the length of time since completion of training. Postgraduate education may be one factor homogenizing surgeon behavior in this important aspect of cancer patient care.
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Affiliation(s)
- Keita Sakata
- Department of Surgery, Saint Louis University Health Science Center, Missouri 63110, USA
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