Does spaced education improve clinical knowledge among Family Medicine residents? A cluster randomized controlled trial.
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ABSTRACT: Method
We conducted a cluster randomized controlled trial to empirically and pragmatically test spaced education using two versions of the Family Medicine Study Guide mobile app. 12 residency training programs in Canada agreed to participate. At six intervention sites, we consented 335 of the 654 (51%) eligible residents. Residents in the intervention group were sent alerts through the app to encourage the answering of questions linked to clinical cases. At six control sites, 299 of 586 (51%) residents consented. Residents in the control group received the same app but with no alerts. Incidence rates of case completion between trial arms were compared using repeated measures analysis. We linked residents in both trial arms to their knowledge scores on the certification examination of the College of Family Physicians of Canada.Results
Over 67 weeks, there was no statistically significant difference in the completion of clinical cases by participants. The difference in mean exam scores and the associated confidence interval did not exceed the pre-defined limit of 4 percentage points.Conclusion
Further research is recommended before deploying spaced educational interventions in the Family Medicine residency to improve knowledge.
SUBMITTER: Grad R
PROVIDER: S-EPMC8338813 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundSpaced education is a novel method that improves medical education through online repetition of core principles often paired with multiple-choice questions. This model is a proven teaching tool for medical students, but its effect on resident learning is less established. We hypothesized that repetition of key clinical concepts in a "Clinical Pearls" format would improve knowledge retention in medical residents.MethodsThis study investigated spaced education with particular emphasis on using a novel, email-based reinforcement program, and a randomized, self-matched design, in which residents were quizzed on medical knowledge that was either reinforced or not with electronically-administered spaced education. Both reinforced and non-reinforced knowledge was later tested with four quizzes.ResultsOverall, respondents incorrectly answered 395 of 1008 questions (0.39; 95% CI, 0.36-0.42). Incorrect response rates varied by quiz (range 0.34-0.49; p = 0.02), but not significantly by post-graduate year (PGY1 0.44, PGY2 0.33, PGY3 0.38; p = 0.08). Although there was no evidence of benefit among residents (RR = 1.01; 95% CI, 0.83-1.22; p = 0.95), we observed a significantly lower risk of incorrect responses to reinforced material among interns (RR = 0.83, 95% CI, 0.70-0.99, p = 0.04).ConclusionsOverall, repetition of Clinical Pearls did not statistically improve test scores amongst junior and senior residents. However, among interns, repetition of the Clinical Pearls was associated with significantly higher test scores, perhaps reflecting their greater attendance at didactic sessions and engagement with Clinical Pearls. Although the study was limited by a low response rate, we employed test and control questions within the same quiz, limiting the potential for selection bias. Further work is needed to determine the optimal spacing and content load of Clinical Pearls to maximize retention amongst medical residents. This particular protocol of spaced education, however, was unique and readily reproducible suggesting its potential efficacy for intern education within a large residency program.
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Project description:BACKGROUND: Internists commonly perform invasive procedures, but serious deficiencies exist in procedure training during residency. OBJECTIVE: Evaluate a comprehensive, inpatient procedure service rotation (MPS) to improve Internal Medicine residents' comfort and self-perceived knowledge in performing lumbar puncture, abdominal paracentesis, thoracentesis, arthrocentesis, and central venous catheterization (CVC). DESIGN: The MPS comprised 1 faculty physician and 1-3 residents rotating for 2 weeks. It incorporated lectures, a textbook, instructional videos, supervised practice on mannequins, and inpatient procedures directly supervised by the faculty physician. We measured MPS impact using pre- and post-MPS rotation surveys, and surveyed all residents at academic year-end. MEASUREMENTS AND MAIN RESULTS: Thirty-nine categorical Internal Medicine residents completed the required rotation and surveys over the 2004-2005 academic year, performing 325 procedures. Post-MPS, the percentage of residents reporting comfort performing procedures rose 15-36% (p < .05 except for arthrocentesis, and CVC via internal jugular and femoral veins). The fraction desiring more training fell 26-51% (all p < .05). After the MPS rotation, self-rated knowledge increased in all surveyed aspects of the procedures. The year-end survey showed that improvements persisted. Comfort at year-end, for all procedures except abdominal paracentesis, was significantly higher among residents who rotated through the MPS than among those who had not. Self-reported compliance with recommended antiseptic measures was 75% for residents who completed the MPS, and 28% for those who had not (p < 0.001). CONCLUSIONS: A comprehensive procedure service rotation of 2 weeks duration substantially improved residents' comfort and self-perceived knowledge in performing invasive procedures. These benefits persisted at least to the end of the academic year.
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Project description:BACKGROUND: Several studies have documented that physical examination knowledge and skills are limited among medical trainees. OBJECTIVES: The objective of the study is to investigate the efficacy and acceptability of a novel online educational methodology termed 'interactive spaced-education' (ISE) as a method to teach the physical examination. DESIGN: The design of the study is randomized controlled trial. PARTICIPANTS: All 170 second-year students in the physical examination course at Harvard Medical School were eligible to enroll. MEASUREMENTS: Spaced-education items (questions and explanations) were developed on core physical examination topics and were content-validated by two experts. Based on pilot-test data, 36 items were selected for inclusion. Students were randomized to start the 18-week program in November 2006 or 12 weeks later. Students were sent 6 spaced-education e-mails each week for 6 weeks (cycle 1) which were then repeated in two subsequent 6-week cycles (cycles 2 and 3). Students submitted answers to the questions online and received immediate feedback. An online end-of-program survey was administered. RESULTS: One-hundred twenty students enrolled in the trial. Cycles 1, 2, and 3 were completed by 88%, 76%, and 71% of students, respectively. Under an intent-to-treat analysis, cycle 3 scores for cohort A students [mean 74.0 (SD 13.5)] were significantly higher than cycle 1 scores for cohort B students [controls; mean 59.0 (SD 10.5); P < .001], corresponding to a Cohen's effect size of 1.43. Eighty-five percent of participants (102 of 120) recommended the ISE program for students the following year. CONCLUSIONS: ISE can generate significant improvements in knowledge of the physical examination and is very well-accepted by students.
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Project description:BACKGROUND:This study aimed to determine the current state of oncology education in Canadian family medicine postgraduate medical education programs (FM PGME) and examine opinions regarding optimal oncology education in these programs. METHODS:A survey was designed to evaluate ideal and current oncology teaching, educational topics, objectives, and competencies in FM PGMEs. The survey was sent to Canadian family medicine (FM) residents and program directors (PDs). RESULTS:In total, 150 residents and 17 PDs affiliated with 16 of 17 Canadian medical schools completed the survey. The majority indicated their programs do not have a mandatory clinical rotation in oncology (79% residents, 88% PDs). Low rates of residents (7%) and PDs (13%) reported FM residents being adequately prepared for their role in caring for cancer patients (p?=?0.03). Residents and PDs believed the most optimal method of teaching oncology is through clinical exposure (65% residents, 80% PDs). Residents and PDs agreed the most important topics to learn (rated ?4.7 on 5-point Likert scale) were: performing pap smears, cancer screening/prevention, breaking bad news, and approach to patient with increased cancer risk. According to residents, other important topics such as appropriate cancer patient referrals, managing cancer complications and post-treatment surveillance were only taught at frequencies of 52, 40 and 36%, respectively. CONCLUSIONS:Current FM PGME oncology education is suboptimal, although the degree differs in the opinion of residents and PDs. This study identified topics and methods of education which could be focussed upon to improve FM oncology education.
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Project description:IntroductionThe Advisory Committee on Immunization Practices updated its pneumococcal vaccination guidelines in September 2014 and provided an additional recommendation in February 2016. We perceived a knowledge gap related to these guidelines among residents who serve as primary care physicians during postgraduate training. Our research team confirmed the presence of this knowledge gap and designed a curriculum focused on the current guidelines for pneumococcal vaccination.MethodsThis curriculum consists of a preeducation quiz and survey, as well as an educational video, pocket card, and poster. The educational materials were then disseminated over a 7-week period and included a short video, handouts (laminated pocket cards), and summaries of guideline recommendations in electronic format.ResultsThe quiz, which includes eight clinical vignette selected-response items, revealed a knowledge deficiency. For example, only a minority of residents (31.2%) correctly chose the appropriate pneumococcal vaccination schedule for an elderly patient with multiple comorbid and chronic medical ailments. A postintervention survey showed that a majority of residents (87.5%) found the educational tools effective in improving understanding and implementation of vaccine guidelines.DiscussionThis novel educational strategy is designed to increase resident knowledge of pneumococcal vaccination guidelines with eventual translation to actual clinical practice.
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Project description:BACKGROUNDMetabolic health in people with obesity is determined by body composition. In this study, we examined the influence of a combined strength exercise and motivational programme -embedded in the school curriculum- on adolescents body composition and daily physical activity.METHODSA total of 695 adolescents (11-15y) from nine Dutch secondary schools participated in a one year cluster randomised controlled trial (RCT). In the intervention schools, physical education teachers were instructed to spend 15-30 min of all physical education lessons (2× per week) on strength exercises. Monthly motivational lessons were given to stimulate students to be more physically active. Control schools followed their usual curriculum. The primary outcome measure was body composition assessed by the deuterium dilution technique. Daily physical activity and sedentary behaviour measured by accelerometry served as a secondary outcome.RESULTSAfter 1 year, a 1.6% fat mass difference was found in favour of the intervention group (p?=?.007). This reflected a 0.9 kg difference in fat free mass (intervention>control; p?=?.041) and 0.7 kg difference in fat mass (intervention<control; p?=?.054). Daily physical activity decreased from baseline to posttest in both groups, but less so in the intervention group (p?=?.049). After 1 year, a difference of 0.4% was found for moderate to vigorous physical activities in favour of the intervention group (p?=?.046). No differences in sedentary behaviour, or light physical activity were found between groups.CONCLUSIONIn 11-15 year olds, the combination of strength exercises plus motivational lessons contributed to an improvement in body composition and a smaller decrease in physical activity level. TRIAL REGISTRATION ID: ( NTR5676 - retrospectively registered 8 February 2016; enrolment of first participant: 2 March 2015).
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Project description:IntroductionThe last 10-15 years has seen a decline in formal undergraduate urological education throughout Canada. Given the large volume of urological presentations in family practice, trainees need to acquire the requisite urological knowledge and skills to serve their patients. The objective of this study is to determine the perceived level of urological knowledge and skills among Canadian family medicine residents.MethodsA 15-item, anonymous, online survey was distributed via email to all Canadian family medicine program directors from September to December 2018 and distributed to their residents. The survey obtained data on demographics, training, undergraduate urology experience, self-reported proficiency in interpreting urological investigations, performing common urological procedures, and managing common urological conditions. Descriptive statistics were used to summarize data.ResultsThe questionnaire was completed by 142 family medicine residents with representation from Western Canada (27.5%), Ontario (32.4%), and Quebec (40.1%); 39.4% of respondents had completed a urology rotation during medical school and only 29.1% felt that their medical training prepared them for the urological aspects of family medicine. Although the majority of respondents felt proficient in performing a digital rectal examination (58.5%) or managing urinary tract infections (97.9%), only a minority felt competent in performing male genitourinary examination (40.1%), uncomplicated male (34.5%), female (45.8%) or difficult (9.2%) urethral catheterization. Likewise, the minority of respondents felt comfortable managing erectile dysfunction (41.5%), scrotal swelling (34.7%), and scrotal pain (25.7%).ConclusionsThere are significant deficiencies in urological knowledge and skills among family medicine residents in Canada, possibly because of insufficient educational experiences during medical training.
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Project description:IntroductionHealth literacy (HL) in infectious diseases is inadequate in China. Since the first nationwide survey of HL conducted in China, great efforts have been made. However, the rate of HL in infectious diseases was 16.06% in 2017. In contrast, with an HL rate of 15.85% in 2008, no significant effect was observed over 10 years. With an increasing number of internet users, we aim to assess the effects of WeChat-based health education for the promotion of partial HL-health knowledge in infectious diseases.Methods and analysisA total of 2160 residents aged 15-69 years old will be enrolled in this study. The primary outcome measures will be the rate of health knowledge in infectious disease. The follow-up period is 3 years.Ethics and disseminationThe study protocol was approved by the Research Ethics Committee of the First Affiliated Hospital, College of Medicine, Zhejiang University. The findings of this study will be submitted to a peer-reviewed journal.
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Project description:ContextProstate cancer screening with prostate-specific antigen (PSA) is frequently performed, counter to clinical practice guidelines.BackgroundIt was hypothesized that an e-mail-based intervention termed "spaced education" could reduce clinicians' inappropriate screening for prostate cancer.DesignThe study was conducted as an RCT.Setting/participantsThe study involved 95 primary care clinicians in eight Veterans Affairs medical centers from January 2007 to February 2009.InterventionParticipants were randomized into two cohorts: spaced education clinicians received four isomorphic cycles of nine e-mails over 36 weeks (zero to two e-mails per week), whereas control clinicians received no intervention. Each e-mail presented a clinical scenario and asked whether it was appropriate to obtain a PSA test. Participants received immediate feedback after submitting their answers.Main outcome measuresThe primary outcome was the number and percentage of inappropriate PSA screening tests ordered. Inappropriate testing was defined as use of PSA for prostate cancer screening in patients aged >76 or <40 years. Appropriateness of screening was dichotomized based on patient age at time of screening. Patients with PSA testing for non-screening reasons were excluded using a validated protocol. Logistic regression with adjustment for patient clustering by clinician was performed. Analyses were conducted in 2009.ResultsDuring the intervention period (Weeks 1-36), clinicians receiving spaced education e-mails ordered significantly fewer inappropriate PSA screening tests than control clinicians (10.5% vs 14.2%, p=0.041). Over the 72-week period following the intervention (Weeks 37-108), spaced education clinicians continued to order fewer inappropriate tests compared to controls (7.8% vs 13.1%, respectively, p=0.011), representing a 40% relative reduction in inappropriate screening.ConclusionsSpaced education durably improves the prostate cancer screening behaviors of clinicians and represents a promising new methodology to improve patient care across healthcare systems.
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Project description:BACKGROUND:At most institutions, internal medicine residents struggle with balancing clinical duties and learning opportunities, particularly during busy cardiology ward rotations. To improve learning experiences for residents, we helped develop a cardiology handbook app to supplement cardiology education. OBJECTIVE:The aim of this study was to report the development, implementation, and preliminary impact of the Krannert Cardiology Handbook app on graduate medical education. METHODS:In June 2017, 122 residents at Indiana University were invited to download the digital handbook in the Krannert app. The Krannert app featured a total of 13 chapters written by cardiology fellows and faculty at Indiana University. Residents were surveyed on their self-reported improvement in cardiology knowledge and level of satisfaction after using the Krannert app. Residents were also surveyed regarding their preference for a digital handbook app versus a paper handbook. RESULTS:Of the 122 residents, 38 trainees (31.1%) participated in survey evaluations. Among all respondents, 31 app users (82%) reported that the app helped improve their cardiology knowledge base. The app had an overall favorable response. CONCLUSIONS:The Krannert app shows promise in augmenting clinical education in cardiology with mobile learning. Future work includes adding new topics, updating the content, and comparing the app to other learning modalities.
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