A randomized controlled trial of an online immunization curriculum

Abstract

Introduction: Immunization education for physicians-in-training is crucial to address vaccine concerns in clinical practice. Vaccine education is not standardized across residency programs. The Collaboration for Vaccination Education and Research (CoVER) team developed an online curriculum for pediatric (Peds) and family medicine (FM) residents.

Methods: A cluster randomized controlled trial (RCT) was performed during the 2017-2018 academic year to evaluate the CoVER curriculum. A convenience sample of residency institutions were randomly allocated to the intervention or control group, with stratification by residency type. The intervention, the CoVER curriculum, consisted of four online modules and an in-person training guide. Control sites continued with their standard vaccine education. Pre-intervention and post-intervention surveys were emailed to residents in both groups. The primary outcomes compared between groups were changes in "vaccine knowledge," "vaccine attitudes/hesitancy," and "self-confidence" in immunization communication. The team assessing outcomes was unblinded to assignments. Hierarchical general linear model was used to adjust for residency type and residency year; residency site was modeled as a random effect.

Results: Overall, 1444 residents from 31 residency programs were eligible to participate (734 intervention, 710 control). The pre-intervention response rate was 730 (51%) and post-intervention was 526 (36%). Average knowledge scores increased from pre-intervention (control 53%; CoVER 53%) to post-intervention (control 58%; CoVER 60%). Increases in vaccine knowledge among FM residents were greater for CoVER compared to controls (p = 0.041). Vaccine hesitancy was more common among FM (23%) than Peds (10%) residents. In all three residency years, residents in the CoVER group showed greater increases in self-confidence in ability to discuss vaccines with parents/patients (p < 0.03) compared to control group.

Conclusion: The CoVER curriculum is an effective model to standardize immunization education of physicians-in-training. This RCT demonstrated the effectiveness of the CoVER curriculum to improve resident confidence in their ability to discuss vaccines with parents and patients.

Keywords: Family medicine; Medical education; Pediatric; Resident education; Vaccine education; Vaccine hesitancy.

Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Pahud-Investigator on trials funded by NIH, CDC, GlaxoSmithKline, Pfizer, Merck, and AstraZeneca. Has received honoraria from Pfizer, Seqirus, and Sanofi Pasteur for service on advisory boards and nonbranded presentations. Williams- Grant funding from the American Academy of Pediatrics and Pfizer Independent Grants for Learning & Change. Lee-Funded by grants from PCORI, KCALSI, and Merck. Lewis- No additional declarations of interest. Middleton- Advisory boards for Pfizer, GlaxoSmithKline, and Sanofi Pasteur, lectures for Pfizer and Seqirus, co-principal investigator for a CDC grant. Clark-No additional declarations of interest. Humiston-Consultant to Sanofi Pasteur, consultant on federal grants to The University of Rochester and UCLA, consultant to AAP and AAP chapters, Immunization Action Coalition, and Immunize Kansas Coalition. All authors are sponsored by the Pediatric Infectious Diseases Society Foundation through unrestricted educational grants from Sanofi Pasteur US, Merck & Co., Inc., Pfizer, Inc., GlaxoSmithKline, and Seqirus USA, Inc.

Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.