Designing Tailored Web-Based Instruction to Improve Practicing Physicians' Preventive Practices

Abstract

BackgroundThe 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.ObjectiveUsing these principles, design and develop a Web site including multimodal strategies for improving chlamydial-screening rates among primary care physicians.MethodsWe 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.ResultsIn 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.ConclusionsThe 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.

A framework for enhancing continuing medical education for rural physicians: A summary of the literature

“…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 MDcme.ca, an Internet-based CME portal which provides College of Family Physicians of Canada (CFPC) accredited online CME courses .…”

Comparison of the Instructional Efficacy of Internet-Based CME With Live Interactive CME Workshops

“…These approaches are emphasized in adult learning theories such as constructivism, 19 derived cognitive flexibility theory, 20 andragogy, 21 and situated learning, 22 which are relevant to online CME design. 23,24 Despite a growing body of literature on Web-based health professional education, [25][26][27] few rigorous studies of Web-based CME have been reported. These have included self-controlled trials, [28][29][30] controlled trials, [31][32][33] and randomized controlled trials (RCTs).…”

The Effect of Physician Continuing Medical Education on Patient-Reported Outcomes for Identifying and Optimally Managing Obstructive Sleep Apnea

“…20,21 Tailoring educational content to readiness to adopt a performance change is also likely to play a key role. [22][23][24][25] The Transtheoretical Model (TTM) is an integrative model that describes behavior change as a progression through a series of five stages of readiness: (1) Precontemplation: not intending to adopt the best practices, (2) Contemplation: intending to adopt the best practices in the next six months, (3) Preparation: intending to adopt the best practices in the next 30 days, (4) Action: adopted the best practices less than six months ago, and (5) Maintenance: adopted the best practices more than six months ago. The TTM could provide a useful framework for tailoring CME content in that leveraging the principles of the TTM permits the inclusion of behavior change statements to ensure activities meet the needs of all physicians, even those who are not prepared to adopt the desired performance.…”