Designing Tailored Web-Based Instruction to Improve Practicing Physicians' Preventive Practices

Division of Continuing Medical Education, University of Alabama School of Medicine, Birmingham, AL 35294-4551, USA.
Journal of Medical Internet Research (Impact Factor: 3.43). 09/2003; 5(3):e20. DOI: 10.2196/jmir.5.3.e20
Source: PubMed

ABSTRACT The World Wide Web has led to the rapid growth of medical information and continuing medical educational offerings. Ease of access and availability at any time are advantages of the World Wide Web. Existing physician-education sites have often been designed and developed without systematic application of evidence and cognitive-educational theories; little rigorous evaluation has been conducted to determine which design factors are most effective in facilitating improvements in physician performance and patient-health outcomes that might occur as a result of physician participation in Web-based education. Theory and evidence-based Web design principles include the use of: needs assessment, multimodal strategies, interactivity, clinical cases, tailoring, credible evidence-based content, audit and feedback, and patient-education materials. Ease of use and design to support the lowest common technology denominator are also important.
Using these principles, design and develop a Web site including multimodal strategies for improving chlamydial-screening rates among primary care physicians.
We used office-practice data in needs assessment and as an audit/feedback tool. In the intervention introduced in 4 phases over 11 months, we provided a series of interactive, tailored, case vignettes with feedback on peer answers. We included a quality-improvement toolbox including clinical practice guidelines and printable patient education materials.
In the formative evaluation of the first 2 chlamydia modules, data regarding the recruitment, enrollment, participation, and reminders have been examined. Preliminary evaluation data from a randomized, controlled trial has tested the effectiveness of this intervention in improving chlamydia screening rates with a significant increase in intervention physicians' chlamydia knowledge, attitude, and skills compared to those of a control group.
The application of theory in the development and evaluation of a Web-based continuing medical education intervention offers valuable insight into World Wide Web technology's influence on physician performance and the quality of medical care.

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    • "Internet-based learning has become an increasingly popular approach to medical education (Casebeer et al. 2002; Curran & Fleet 2005; Fordis et al. 2005; Bergeron 2006; Cook et al. 2008), and on-line CME/CPD has grown steadily in the recent past (Olson & Shershneva 2004; Wearne 2008). The Internet has expanded opportunities for the provision of a flexible, convenient , and interactive form of CME/CPD for busy practitioners who have difficulty attending formal education sessions (Casebeer et al. 2003; Sly et al. 2006). A consortium of the Canadian medical school CME/CPD departments has developed, "
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    ABSTRACT: Recruitment and retention of rural physicians is vital for rural health care. A key deterrent to rural practice has been identified as professional isolation and access to continuing medical education/continuing professional development (CME/CPD). The purpose of this article is to review and synthesize key themes from the literature related to CME/CPD and rural physicians to facilitate CME/CPD planning. A search of the peer-reviewed English language literature and a review of relevant grey literature (e.g., reports, conference proceedings) was conducted. There is robust evidence demonstrating that the CME/CPD needs of rural physicians are unique. Promising practices in regional CME/CPD outreach and advanced procedural skills training and other up-skilling areas have been reported. Distance learning initiatives have been particularly helpful in increasing access to CME/CPD. The quality of evidence supporting the overall effect of these different strategies on recruitment and retention is variable. Supporting the professional careers of rural physicians requires the provision of integrated educational programs that focus on specific information and skills. Future research should examine the linkage between enhanced CME/CPD access and its effect on factors related to retention of physicians in rural communities. A proposed framework is described to aid in developing CME/CPD for rural practitioners.
    Medical Teacher 11/2010; 32(11):e501-8. DOI:10.3109/0142159X.2010.519065 · 1.68 Impact Factor
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    • "As we extracted our data, we noted further candidate theories and proceeded to test these as well. Additional candidate theories that we attempted to tested included: Vygotski [29], Danchak [30], Schon [31], Garrison [32,33], Dewey and Brookfield [33], Kolb [34], Moshman [35], Eraut [36], Boettcher [37], Wenger [38], Koschmann [39], Nahapiet and Ghoshal [40], Socrates [41] Problem Based Learning [31,42-48], Constructivism [29-31,33-35,37,44,45,49-57] and adult learning theory/principles [31,32,47,50,53,54,58-70]. "
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    ABSTRACT: Educational courses for doctors and medical students are increasingly offered via the Internet. Despite much research, course developers remain unsure about what (if anything) to offer online and how. Prospective learners lack evidence-based guidance on how to choose between the options on offer. We aimed to produce theory driven criteria to guide the development and evaluation of Internet-based medical courses. Realist review - a qualitative systematic review method whose goal is to identify and explain the interaction between context, mechanism and outcome. We searched 15 electronic databases and references of included articles, seeking to identify theoretical models of how the Internet might support learning from empirical studies which (a) used the Internet to support learning, (b) involved doctors or medical students; and (c) reported a formal evaluation. All study designs and outcomes were considered. Using immersion and interpretation, we tested theories by considering how well they explained the different outcomes achieved in different educational contexts. 249 papers met our inclusion criteria. We identified two main theories of the course-in-context that explained variation in learners' satisfaction and outcomes: Davis's Technology Acceptance Model and Laurillard's model of interactive dialogue. Learners were more likely to accept a course if it offered a perceived advantage over available non-Internet alternatives, was easy to use technically, and compatible with their values and norms. 'Interactivity' led to effective learning only if learners were able to enter into a dialogue - with a tutor, fellow students or virtual tutorials - and gain formative feedback. Different modes of course delivery suit different learners in different contexts. When designing or choosing an Internet-based course, attention must be given to the fit between its technical attributes and learners' needs and priorities; and to ways of providing meaningful interaction. We offer a preliminary set of questions to aid course developers and learners consider these issues.
    BMC Medical Education 02/2010; 10(12):12. DOI:10.1186/1472-6920-10-12 · 1.22 Impact Factor
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    • "Internet-based learning has become an increasingly popular approach to medical education [4-6] and Internet-based continuing medical education (CME) has grown steadily in the recent past [7,8]. The Internet has expanded opportunities for the provision of a flexible, convenient and interactive form of CME that has fulfilled the requirements of busy practitioners who have difficulty attending formal education sessions [9,10]. "
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    ABSTRACT: Internet-based instruction in continuing medical education (CME) has been associated with favorable outcomes. However, more direct comparative studies of different Internet-based interventions, instructional methods, presentation formats, and approaches to implementation are needed. The purpose of this study was to conduct a comparative evaluation of two Internet-based CME delivery formats and the effect on satisfaction, knowledge and confidence outcomes. Evaluative outcomes of two differing formats of an Internet-based CME course with identical subject matter were compared. A Scheduled Group Learning format involved case-based asynchronous discussions with peers and a facilitator over a scheduled 3-week delivery period. An eCME On Demand format did not include facilitated discussion and was not based on a schedule; participants could start and finish at any time. A retrospective, pre-post evaluation study design comparing identical satisfaction, knowledge and confidence outcome measures was conducted. Participants in the Scheduled Group Learning format reported significantly higher mean satisfaction ratings in some areas, performed significantly higher on a post-knowledge assessment and reported significantly higher post-confidence scores than participants in the eCME On Demand format that was not scheduled and did not include facilitated discussion activity. The findings support the instructional benefits of a scheduled delivery format and facilitated asynchronous discussion in Internet-based CME.
    BMC Medical Education 01/2010; 10(1):10. DOI:10.1186/1472-6920-10-10 · 1.22 Impact Factor
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