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      An Interactive Internet-Based Continuing Education Course on Sexually Transmitted Diseases for Physicians and Midwives in Peru

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          Abstract

          Background

          Clinicians in developing countries have had limited access to continuing education (CE) outside major cities, and CE strategies have had limited impact on sustainable change in performance. New educational tools could improve CE accessibility and effectiveness.

          Methodology/Principal Findings

          The objective of this study was to evaluate an interactive Internet-based CE course on Sexually Transmitted Diseases (STDs) management for clinicians in Peru. Participants included physicians and midwives in private practice drawn from a census of 10 Peruvian cities. The CE included a three-hour workshop for improving Internet skills, followed by a 22-hour online course on STD-syndrome-management, with subsequent educational support. The course used case-based clinical vignettes tailored to local STD problems. Knowledge and reported practices on STD management were assessed before, immediately after and at four months after completion of the course. Statistical analysis included parametric tests-linear regression multivariate analysis, paired t-test and repeated measures ANOVA using SPSS 14.0. Of 1,071 eligible clinicians, 510 agreed to participate, as did an additional 132 public sector clinicians. Of these 642 participants, 619 (96.4%) completed the course, and 596 (96.3%) took the four-month follow-up evaluation. Physician and midwife scores improved from 64.2% correct answers on the pre-test to 77.9% correct on the four-month follow-up test (p<0.001). Most participants (95%) found the online course useful for their work needs. Self reported STD management practices did not change.

          Conclusions/Significance

          Among physicians and midwives in Peru, an Internet-based CE course was feasible, acceptable with high participation rates, and led to sustained improvement in knowledge at four months. Further studies are needed to test it as a model for improving the training of physicians, midwives, and other health care providers.

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          Comparison of the instructional efficacy of Internet-based CME with live interactive CME workshops: a randomized controlled trial.

          H Schneider, Michael Fordis, Christine E. King … (2005)
          Despite evidence that a variety of continuing medical education (CME) techniques can foster physician behavioral change, there have been no randomized trials comparing performance outcomes for physicians participating in Internet-based CME with physicians participating in a live CME intervention using approaches documented to be effective. To determine if Internet-based CME can produce changes comparable to those produced via live, small-group, interactive CME with respect to physician knowledge and behaviors that have an impact on patient care. Randomized controlled trial conducted from August 2001 to July 2002. Participants were 97 primary care physicians drawn from 21 practice sites in Houston, Tex, including 7 community health centers and 14 private group practices. A control group of 18 physicians from these same sites received no intervention. Physicians were randomly assigned to an Internet-based CME intervention that could be completed in multiple sessions over 2 weeks, or to a single live, small-group, interactive CME workshop. Both incorporated similar multifaceted instructional approaches demonstrated to be effective in live settings. Content was based on the National Institutes of Health National Cholesterol Education Program--Adult Treatment Panel III guidelines. Knowledge was assessed immediately before the intervention, immediately after the intervention, and 12 weeks later. The percentage of high-risk patients who had appropriate lipid panel screening and pharmacotherapeutic treatment according to guidelines was documented with chart audits conducted over a 5-month period before intervention and a 5-month period after intervention. Both interventions produced similar and significant immediate and 12-week knowledge gains, representing large increases in percentage of items correct (pretest to posttest: 31.0% [95% confidence interval {CI}, 27.0%-35.0%]; pretest to 12 weeks: 36.4% [95% CI, 32.2%-40.6%]; P or =93%) with no significant postintervention change. However, the Internet-based intervention was associated with a significant increase in the percentage of high-risk patients treated with pharmacotherapeutics according to guidelines (preintervention, 85.3%; postintervention, 90.3%; P = .04). Appropriately designed, evidence-based online CME can produce objectively measured changes in behavior as well as sustained gains in knowledge that are comparable or superior to those realized from effective live activities.
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            A review of evaluation outcomes of web-based continuing medical education.

            Jamie L. Fleet, V Curran (2005)
            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. A search of Medline was undertaken and the level of evaluative outcomes reported was categorised using Kirkpatrick's model for levels of summative evaluation. 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. 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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              What do we mean by web-based learning? A systematic review of the variability of interventions.

              Denise M Dupras, Bruce Cook, A Levinson … (2010)
              Educators often speak of web-based learning (WBL) as a single entity or a cluster of similar activities with homogeneous effects. Yet a recent systematic review demonstrated large heterogeneity among results from individual studies. Our purpose is to describe the variation in configurations, instructional methods and presentation formats in WBL. We systematically searched MEDLINE, EMBASE, ERIC, CINAHL and other databases (last search November 2008) for studies comparing a WBL intervention with no intervention or another educational activity. From eligible studies we abstracted information on course participants, topic, configuration and instructional methods. We summarised this information and then purposively selected and described several WBL interventions that illustrate specific technologies and design features. We identified 266 eligible studies. Nearly all courses (89%) used written text and most (55%) used multimedia. A total of 32% used online communication via e-mail, threaded discussion, chat or videoconferencing, and 9% implemented synchronous components. Overall, 24% blended web-based and non-computer-based instruction. Most web-based courses (77%) employed specific instructional methods, other than text alone, to enhance the learning process. The most common instructional methods (each used in nearly 50% of courses) were patient cases, self-assessment questions and feedback. We describe several studies to illustrate the range of instructional designs. Educators and researchers cannot treat WBL as a single entity. Many different configurations and instructional methods are available for WBL instructors. Researchers should study when to use specific WBL designs and how to use them effectively.
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                Author and article information

                Contributors
                : Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Electronic): 1932-6203
                Publication date Collection: 2011
                Publication date (Electronic): 9 May 2011
                Volume: 6
                Issue: 5
                Electronic Location Identifier: e19318
                Affiliations
                [1 ]School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
                [2 ]Departments of Global Health and Epidemiology, University of Washington, Seattle, Washington, United States of America
                [3 ]Center for AIDS and STD, University of Washington, Seattle, Washington, United States of America
                [4 ]Department of Medicine, University of Washington, Seattle, Washington, United States of America
                University of Pittsburgh Medical Center, United States of America
                Author notes

                Conceived and designed the experiments: FAC PJG KKH. Performed the experiments: FAC. Analyzed the data: FAC PJG KKH SSG. Contributed reagents/materials/analysis tools: FAC. Wrote the paper: FAC PJG KKH SSG.

                Article
                Publisher ID: 10-PONE-RA-17795
                DOI: 10.1371/journal.pone.0019318
                PMC ID: 3090386
                PubMed ID: 21573054
                SO-VID: b23f73f9-f1df-4c81-8861-f292d198095d
                Copyright © Canchihuaman et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                History
                Date received : 9 April 2010
                Date accepted : 31 March 2011
                Page count
                Pages: 8
                Categories
                Subject: Research Article
                Subject: Medicine
                Subject: Global Health
                Subject: Infectious Diseases
                Subject: Sexually Transmitted Diseases
                Subject: Non-Clinical Medicine
                Subject: Health Care Providers
                Subject: Health Informatics
                Subject: Medical Education

                ScienceOpen disciplines: Uncategorized
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                ScienceOpen disciplines: Uncategorized

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