Lisa Fleet

A review of evaluation outcomes of web-based continuing medical education

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.

Academic administrators' attitudes towards interprofessional education in Canadian schools of health professional education.

Interprofessional education is an approach to educating and training students and practitioners from different health professions to work in a collaborative manner in providing client and/or patient-centred care. The introduction and successful implementation of this educational approach is dependent on a variety of factors, including the attitudes of students, faculty, senior academic administrators (e.g., deans and directors) and practitioners. The purpose of this study was to examine attitudes towards interprofessional teamwork and interprofessional education amongst academic administrators of post-secondary health professional education programs in Canada. A web-based questionnaire in English and French was distributed via e-mail messaging during January 2004 to academic administrators in Canada representing medicine, nursing, pharmacy, social work, occupational therapy and physiotherapy post-secondary educational programs. Responses were sought on attitudes towards interprofessional teamwork and interprofessional education, as well as opinions regarding barriers to interprofessional education and subject areas that lend themselves to interprofessional education. In general, academic administrators responding to the survey hold overall positive attitudes towards interprofessional teamwork and interprofessional education practices, and the results indicate there were no significant differences between professions in relation to these attitudinal perspectives. The main barriers to interprofessional education were problems with scheduling/calendar, rigid curriculum, turf battles and lack of perceived value. The main pre-clinical subject areas which respondents believed would lend themselves to interprofessional education included community health/prevention, ethics, communications, critical appraisal, and epidemiology. The results of this study suggest that a favourable perception of both interprofessional teamwork and interprofessional education exists amongst academic administrators of Canadian health professional education programs. If this is the case, the post-secondary system in Canada is primed for the introduction of interprofessional education initiatives which support the development of client and patient-centred collaborative practice competencies.

Evaluation of learning outcomes in Web-based continuing medical education.

Background There has been significant growth in use of Web-based continuing medical education (CME) by physicians. A number of evaluation and metareview studies have examined the effectiveness of Web-based CME to varying degrees. One of the main limitations of this literature has been the lack of systematic evaluation across different clinical subject matter areas using standardized Web-based CME learning formats. Method One group of pretest–postest designs were used to evaluate knowledge and self-reported confidence change across multiple Web-based courses using a standardized instructional format but comprising distinct clinical subject matter. Participants also completed a participant satisfaction survey and a self-reported retrospective skill/ability change survey. Results The majority of courses evaluated demonstrated significant pre to post knowledge and confidence effect size change, as well as significant self-reported retrospective practice change. Conclusions A Web-based CME instructional format comprising multimedia-enhanced learning tutorials supplemented by asynchronous computer-mediated conferencing for case-based discussions was found to be effective in enhancing knowledge, confidence, and self-reported practice change outcomes across a variety of clinical subject matter areas.

A comparative evaluation of the effect of internet-based CME delivery format on satisfaction, knowledge and confidence

BackgroundInternet-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.MethodsEvaluative 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.ResultsParticipants 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.ConclusionsThe findings support the instructional benefits of a scheduled delivery format and facilitated asynchronous discussion in Internet-based CME.

The transition from face-to-face to online CME facilitation

This study examines the experiences of nine medical teachers who transitioned from face-to-face teaching to facilitating a course in an online environment. The authors examined the reasons why the teachers agreed to facilitate an online course, the challenges they encountered and their practical solutions, and the advantages and disadvantages they perceived to this teaching environment. Thirty-minute phone interviews were conducted. An iterative process was used to develop the themes and sub-themes for coding. Teachers reported being attracted to the novelty of the new instructional format and saw online learning as an opportunity to reach different learners. They described two facets to the transition associated with the technical and facilitation aspects of online facilitation. They had to adapt their usual teaching materials and determine how they could make the ‘classroom’ user friendly. They had to determine ways to encourage interaction and facilitate learning. Lack of participation was frustrating for most. This study has implications for those intending to develop online courses. Teacher selection is important as teachers must invest time in course development and teaching and encourage participation. Teacher support is critical for course design, site navigation and mentoring to ensure teachers facilitate online discussion. Practice points•Online interactive continuing medical education is a new format for physician-teachers.•Facilitators are drawn to online CME by the novelty of teaching with this new medium and the opportunity to reach new learners.•Facilitators faced two challenges in their transition from face-to-face teaching: the technical aspects associated with the medium and the skills of facilitating in a different environment.•Organizations beginning to develop interactive online learning programs need to pay attention to the selection of teachers who are prepared to invest the time and energy into learning and thinking about the technology and their facilitation skills.•Facilitators recognize and appreciate instructional design support for course construction, navigation tips and facilitation guidance.

A Responsive Evaluation of an Aboriginal Nursing Education Access Program

Nursing education access programs have been introduced in a number of countries to address the shortage of healthcare providers of Aboriginal descent. An evaluation study of a nursing education access program in Labrador, Canada, was undertaken using a Responsive Evaluation approach. Interviews and focus groups with program stakeholders were conducted. Program effectiveness was influenced by culturally relevant curriculum, experiential and authentic learning opportunities, academic and social support, and the need for partnership building between stakeholders. The authors report key findings resulting from the Responsive Evaluation.

The Nature of the Interaction Between Participants and Facilitators in Online Asynchronous Continuing Medical Education Learning Environments

Background: MDcme.ca offers an online asynchronous continuing medical education (CME) environment for family physicians. The nature of participation in online CME using computer-mediated conferencing (CMC) discussion systems and the characteristics of interaction between participants and facilitators is not well understood. Purpose: To examine the association between participant and facilitator participation in online asynchronous CME learning environments. Methods: We analyzed registration and participation data including participant and facilitator postings to an asynchronous CMC discussion system for CME programs offered through MDcme.ca using frequency counts. Pearson r correlation was used to assess the association between numbers of participants and participant postings, facilitator postings and participant postings, and the number of discussion items accessed and participant postings. Results: MDcme.ca offered 25 programs to 327 registrants, of whom 180 actually participated by accessing course materials and online discussion postings. Pearson r correlations showed a significant association between the number of participants and the number of postings, the number of facilitator postings and the number of participant postings, and the mean number of discussion items accessed by participants and the overall number of participant postings. Discussion: Both the number of facilitator postings and the number of discussion items accessed by participants appeared to be important determinants of the amount of interaction that will occur in asynchronous online CME. Curriculum planners and facilitators of asynchronous CME need to be aware of the importance of fostering interactive, stimulating discussions if the potential of asynchronous learning for physicians is to reach its potential in supporting higher levels of critical, reflective, practice-based learning.

Survey of Distance Learning Provision in Continuing Health Professional Education in Canada

In Canada, the trend is towards greater use of distance learning technologies in the provision of continuing professional education in the health professions. Lack of access to professional development is a common deterrent to practice in rural and remote areas. Distance learning technologies have an important role to play in addressing the professional isolation challenges experienced by rural and remote health care providers. This article examines the state of distance learning provision among Canadian providers of continuing health professional education. The survey population included academic institutions, national/provincial health professional associations and non-profit health advocacy organizations, the pharmaceutical industry, and hospital/health care authority organizations. The results provide a greater understanding of the state of distance learning provision among providers of continuing health professional education in Canada and suggest a number of means to foster distance learning opportunities for rural health care provider.

Evaluation Outcomes Resulting from an Internet-Based Continuing Professional Development (CPD) Asthma Program: Its Impact on Participants' Knowledge and Satisfaction

Introduction. Previous studies have focused on the evaluation of Internet-based continuing professional development (CPD), but few have focused on the clinical area of asthma. Our purpose was to examine the evaluation outcomes related to knowledge and satisfaction that resulted from the provision of an Internet-based CPD program focusing on this clinical area. Methods. Evaluation methodologies included a pre-/post-knowledge assessment (multiple choice) and a satisfaction survey. Completion of all assessments was voluntary, with the exception of the post-knowledge assessment for which completion was required for credit claim. Results. There were a total of N = 457 unique registrants in the course over 1 year. A total of N = 125 course participants completed both pre- and post-knowledge assessments. An overall mean pre-knowledge score of 11.54 and a post-knowledge score of 16.04 were reported. Paired samples t-test analyses indicated a significant pre- to post-knowledge gain overall and for the majority of professions; 95.8% of the N = 46 satisfaction survey respondents reported that the program addressed their learning needs; 89.1% reported that it was relevant to practice. Discussion. Recent studies focusing specifically on asthma were non-Canadian pilot studies with small sample sizes. The study findings highlight a similar initiative in Canada, which provided health professionals who care for patients with asthma access to relevant CPD with a Canadian perspective. The findings show that course participants were extremely satisfied and that they increased their knowledge in this clinical area. Further development of such Internet-based programs may encourage health professionals to improve their knowledge in a variety of therapeutic areas.

A Review of Digital, Social, and Mobile Technologies in Health Professional Education.

Introduction: Digital, social, and mobile technologies (DSMTs) can support a wide range of self-directed learning activities, providing learners with diverse resources, information, and ways to network that support their learning needs. DSMTs are increasingly used to facilitate learning across the continuum of health professional education (HPE). Given the diverse characteristics of DSMTs and the formal, informal, and nonformal nature of health professional learning, a review of the literature on DSMTs and HPE could inform more effective adoption and usage by regulatory organizations, educators, and learners. Methods: A scoping review of the literature was performed to explore the effectiveness and implications of adopting and using DSMTs across the educational continuum in HPE. A data extraction tool was used to review and analyze 125 peer-reviewed articles. Common themes were identified by thematic analysis. Results: Most articles (56.0%) related to undergraduate education; 31.2% to continuing professional development, and 52.8% to graduate/postgraduate education. The main DSMTs described include mobile phones, apps, tablets, Facebook, Twitter, and YouTube. Approximately half of the articles (49.6%) reported evaluative outcomes at a satisfaction/reaction level; 45.6% were commentaries, reporting no evaluative outcomes. Most studies reporting evaluative outcomes suggest that learners across all levels are typically satisfied with the use of DSMTs in their learning. Thematic analysis revealed three main themes: use of DSMTs across the HPE continuum; key benefits and barriers; and best practices. Discussion: Despite the positive commentary on the potential benefits and opportunities for enhancing teaching and learning in HPE with DSMTs, there is limited evidence at this time that demonstrates effectiveness of DSMTs at higher evaluative outcome levels. Further exploration of the learning benefits and effectiveness of DSMTs for teaching and learning in HPE is warranted.