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


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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    • "This suggests that education for practicing physicians on the topic of vitamin D deficiency testing, management and sun exposure is urgently needed. This paper aims to describe the development of an online CME program for GPs on vitamin D and sun health called " The ABC's of Vitamin D for GPs " using nine elements of Casebeer et al.'s [5] 12 design principles for physician-education web sites as a framework. Given online CME is a relatively recent innovation, and following Rogers Diffusion of Innovation theory [25] which proposes that individuals' perceptions of an innovation determine its rate of adoption, the paper will also report the program's usability, acceptability and perceived effectiveness as reported by the intended users of the program, GPs. "
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    ABSTRACT: Online continuing medical education (CME) offers a number of advantages for physicians including flexibility with regards to location and timing of use. In order to effect physician practices and improve patient outcomes, it is important that the development of online CME is theory and evidence-based. This paper aims to describe the development of an online CME program for practising general practitioners (GPs) on vitamin D and sun health called "The ABC's of Vitamin D for GPs" using elements of design principles for physician-education web sites as a framework. The paper will also report the program's usability and acceptability pilot test results. The ABC's of Vitamin D program was developed following nine principles: needs assessment; evidence-based content development; multimodal program and modularisation; clinical cases; tailoring and interactivity; audit and feedback; credibility of the web site host; patient education materials; ease of use and navigation. Among the 20 GPs invited, acceptability and useability was tested with 12 GPs (60%) who agreed to participate and were interviewed following use of the program. The study was conducted between 2011 and 2013. An online CME program consisting of eight modules was constructed. Of the 12 participating GPs, most (n=11) reported that the program was clear and easy to understand, logical, easy to navigate, and took a reasonable amount of time (estimated between 1 and 3h) to complete. Eleven of 12 participants said they would use the program as an accredited CME activity and all participants indicated that the program was 'very or somewhat' likely to lead to changes in the advice patients are given. This study found that a theory and evidence based approach for the development of an online CME program for GPs was acceptable to users. Further research is needed to examine whether the online CME program is effective at changing GP practices and improving patient outcomes. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    International Journal of Medical Informatics 01/2015; 84(6). DOI:10.1016/j.ijmedinf.2015.01.006 · 2.00 Impact Factor
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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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