Paul Smits

Evaluation of a postgraduate educational programme for occupational physicians on work rehabilitation guidelines for patients with low back pain

OBJECTIVES The postgraduate educational programme for occupational physicians on guidelines for work rehabilitation of patients with low back pain was evaluated as to what extent did knowledge of the guidelines increase, and did the workers improve their performance at work. METHODS An experimental group (n=25) attended an educational programme and a reference group did so (n=20) 6 months later. Knowledge and performance were assessed for both groups, before and after education of the experimental group. Knowledge was assessed for the reference group after education. RESULTS Knowledge increased significantly more in the experimental group. The reference groups score increased further after education. The experimental groups adjusted gain score for performance indicators was significantly positive. Analysis of covariance also showed a significant effect for the experimental group for increased performance score. CONCLUSIONS The educational programme improved the quality of care because knowledge and performance of occupational physicians improved and complied better with practice guidelines.

Factors predictive of successful learning in postgraduate medical education.

Purpose  To establish which personal and contextual factors are predictive of successful outcomes in postgraduate medical education.

Case-based e-learning to improve the attitude of medical students towards occupational health, a randomised controlled trial.

Objectives Undergraduate medical teaching in occupational health (OH) is a challenge in universities around the world. Case-based e-learning with an attractive clinical context could improve the attitude of medical students towards OH. The study question is whether case-based e-learning for medical students is more effective in improving knowledge, satisfaction and a positive attitude towards OH than non-case-based textbook learning. Methods Participants, 141 second year medical students, were randomised to either case-based e-learning or text-based learning. Outcome measures were knowledge, satisfaction and attitude towards OH, measured at baseline, directly after the intervention, after 1 week and at 3-month follow-up. Results Of the 141 participants, 130 (92%) completed the questionnaires at short-term follow-up and 41 (29%) at 3-month follow-up. At short-term follow-up, intervention and control groups did not show a significant difference in knowledge nor satisfaction but attitude towards OH was significantly more negative in the intervention group (F=4.041, p=0.047). At 3-month follow-up, there were no significant differences between intervention and control groups for knowledge, satisfaction and attitude. Conclusions We found a significant decrease in favourable attitude during the internship in the experimental group compared with the control group. There were no significant differences in knowledge or satisfaction between case-based e-learning and text-based learning. The attitude towards OH should be further investigated as an outcome of educational programmes.

Annual incidence of occupational diseases in economic sectors in The Netherlands

Objective To report the annual incidence of occupational diseases (ODs) in economic sectors in The Netherlands. Methods In a 5-year prospective cohort study (2009–2013), occupational physicians were asked to participate in a sentinel surveillance system for OD notification. The inclusion criteria for participation were (1) covering a population of employees, (2) reporting the economic sectors and the size of their employee population and (3) willingness to report all diagnosed ODs. In this study, an OD was defined as a disease with a specific clinical diagnosis that was predominantly caused by work-related factors. The economic sectors (n=21) were defined according the NACE (Nomenclature des Activités Économiques dans la Communauté Européenne) classification. Results In a total working population of 514 590 employees, 1782 ODs were reported over 12 months in 2009. The estimated annual incidence for any OD was 346 (95% CI 330 to 362) per 100 000 worker-years. Of all the ODs, mental diseases were reported most frequently (41%), followed by musculoskeletal (39%), hearing (11%), infectious (4%), skin (3%), neurological (2%) and respiratory (2%) diseases. The four economic sectors with the highest annual incidences per 100 000 workers were construction (1127; 95% CI 1002 to 1253), mining and quarrying (888; 95% CI 110 to 1667), water and waste processing (832; 95% CI 518 to 1146) and transport and storage (608; 95% CI 526 to 690). Conclusion ODs are reported in all economic sectors in The Netherlands. Up to 91% of all ODs are mental, musculoskeletal and hearing diseases. Efforts to increase the effective assessment of ODs and compliance in reporting activities enhance the usability of incidence figures for the government, employers and workers.

Evaluation of a workshop on evidence-based medicine for social insurance physicians

BACKGROUND Evidence-based medicine (EBM), a comprehensive method to support clinical decision making by using evidence, has been instrumental in clinical specialties but not yet in insurance medicine. AIMS We developed and evaluated a workshop on EBM for Dutch social insurance physicians who perform disability evaluations. METHODS Sixty-six social insurance physicians followed a 1-day introductory workshop that focused on teaching two EBM core skills: to ask answerable questions and to search for the best evidence. All outcomes were measured before, immediately after and 3 months after the workshop by means of self-assessment. The primary outcomes were knowledge, skills, attitude and intention to apply EBM in practice. The secondary outcomes were social influence, self-efficacy and behaviour. RESULTS Immediately after the workshop, a marked and significant improvement was seen in self-assessed skills (mean difference 4.2, 95% CI 3.7-4.6) and in self-efficacy to apply EBM (mean difference 0.7, 95% CI 0.6-0.8). For attitude, knowledge and intention, the improvements were small. Three months after the workshop, the improvements in skills (mean difference 2.3, 95% CI 1.8-2.9) and self-efficacy (mean difference 0.5, 95% CI 0.3-0.6) remained significant. CONCLUSIONS The workshop improved self-assessed EBM skills and self-efficacy both in the short and long term. The workshop also resulted in limited short-term improvements in self-assessed knowledge and in the intention to apply EBM in practice. The EBM approach can be successfully taught to social insurance physicians working in the field of disability evaluation.

A Clinically Integrated Post-Graduate Training Programme in Evidence-Based Medicine versus ‘No Intervention’ for Improving Disability Evaluations: A Cluster Randomised Clinical Trial

Background Although several studies have shown that teaching EBM is effective in improving knowledge, at present, there is no convincing evidence that teaching EBM also changes professional behaviour in practice. Therefore, the primary aim of this study was to evaluate the effectiveness of a clinically integrated post-graduate training programme in EBM on evidence-based disability evaluation. Methods and Findings In a cluster randomised controlled trial, fifty-four case-based learning groups consisting of 132 physicians and 1680 patients were randomly assigned to the intervention or control groups. A clinically integrated, post-graduate, 5-day training programme in evidence-based medicine, consisting of (home) assignments, peer teaching, interactive training in searching databases, lectures and brainstorming sessions was provided to the intervention group. The control group received no training. The primary outcome was evidence-based disability evaluation, as indicated by the frequency in use of evidence of sufficient quality in disability evaluation reports. There are no general EBM behaviour outcome measures available. Therefore, we followed general guidelines for constructing performance indicators and defined an a priori cut-off for determination of sufficient quality as recommended for evaluating EB training. Physicians trained in EBM performed more evidence-based disability evaluations compared to physicians in the control group (difference in absolute proportion 9.7%, 95% CI 3.5 to 15.9). The primary outcome differences between groups remained significant after both cluster-adjusted analysis and additional sensitivity analyses accounting for subjects lost to follow-up. Conclusions A EBM programme successfully improved the use of evidence in a non-hospital based medical specialty. Our findings support the general recommendations to use multiple educational methods to change physician behaviour. In addition, it appeared important that the professional context of the intervention was very supportive in the sense that searches in databases, using and applying guidelines and other forms of evidence are considered standard practice and are encouraged by colleagues and management.

Development and evaluation of a new occupational medicine teaching module to advance self-efficacy and knowledge among medical students.

Objectives: Self-efficacy is defined as a persons beliefs in his or her abilities to successfully complete a task, and has been shown to influence student motivation and academic achievement. The purpose of this study was to evaluate the impact of a new European teaching module in occupational medicine on undergraduate students’ self-efficacy and knowledge in the subject matter. Methods: Pre-, in-between, and posttraining tests were used to assess self-efficacy and knowledge building of 261 third-year medical students on occupational health issues. Determinants of self-efficacy and knowledge were also identified. Repeated measurement data were analyzed with multilevel statistical procedures. Results: The level of self-efficacy and knowledge in occupational medicine increased after the training. Students who frequently attended the lectures scored significantly higher than sporadic attendees. There was no relation between the level of self-efficacy and the final knowledge score. Conclusions: Teaching with the new occupational medicine module was effective. Lecture attendance is an important determinant of self-efficacy and performance. Self-efficacy was not associated with knowledge score. Encouraging classroom participation may enhance student achievement.

Improved quality and more attractive work by applying EBM in disability evaluations: a qualitative survey

BackgroundThe uptake of evidence in practice by physicians, even if they are trained in the systematic method of evidence-based medicine (EBM), remains difficult to improve. The aim of this study was to explore perceptions and experiences of physicians doing disability evaluations regarding motivators and preconditions for the implementation of EBM in daily practice.MethodsThis qualitative study was nested in a cluster randomized controlled trial (Trial registration NTR1767; 20-apr-2009) evaluating the effects of training in EBM. The 45 physicians that participated received a comprehensive 6-months training program in EBM of which the last course day included audio-recorded interviews in groups. During these interviews participating physicians discussed perceptions and experiences regarding EBM application in daily practice. In an iterative process we searched for common motivators or preconditions for the implementation of EBM.ResultsThree main concepts or themes emerged after analyzing the transcriptions of the discussions: 1) improved quality of physicians’ actions, such as clients benefiting from the application of EBM; 2) improved work attractiveness of physicians; and 3) preconditions that have to be met in order to work in an evidence-based manner including professional competence, facilitating material conditions and organizational support and demands.ConclusionsPhysicians trained in EBM are motivated to use EBM because they perceive it as a factor improving the quality of their work and making their work more attractive. In addition to personal investments and gains, organizational support should further facilitate the uptake of evidence in practice.

Betere beoordeling van beroepsziekten

Samenvatting‘Het diagnosticeren en melden van werkgerelateerde aandoeningen behoort tot de expertise van de bedrijfsarts, daarover is weinig verschil van mening.’1 Dat dit in de beroepsgroep wordt ondersteund, blijkt uit de grote deelname van bedrijfsartsen aan het Peilstation Intensief Melden (PIM). Vanaf 1 januari 2009 doen 181 bedrijfsartsen mee aan het project. Onderdeel van dit project is een scholingsprogramma. De scholing wil van bedrijfsartsen beroepsziekteexperts maken. Naar verwachting melden zij meer beroepsziekten en zijn de meldingen van betere kwaliteit.2 In dit artikel beschrijven we de doelen van het PIM-scholingsprogramma en hoe het is opgezet. Daarnaast bespreken we gegevens van een vragenlijstonderzoek onder de deelnemers bij de start van PIM.

Evidence-based verzekeringsgeneeskunde: een evaluatie van een EBM-workshop

SamenvattingIn dit onderzoek is een evidence-based medicine (EBM-)workshop voor verzekeringsartsen geëvalueerd. Uitkomstmaten voor dit onderzoek waren kennis en vaardigheden in EBM, attitude ten aanzien van EBM, intentie om EBM toe te passen, sociale invloed op gebruik van EBM, ervaren bekwaamheid in EBM-gebruik en daadwerkelijk EBM-gebruik. Na de workshop werd een significante verbetering van zelfgerapporteerde vaardigheden en ervaren bekwaamheid in EBM gevonden. Drie maanden na de workshop waren deze verbeteringen nog steeds significant. Verzekeringsartsen hadden vooral prognostische vragen rondom de gevalsbehandeling. Wij concluderen dat een eendaagse inleidende EBM-workshop effectief is voor verzekeringsartsen om kennis te maken met EBM, en dat de EBM-methodiek aansluit bij de bestaande praktijk.