Designing tailored Web-based instruction to improve practicing physicians' preventive practices

Linda L Casebeer, Sheryl M Strasser, Claire M Spettell, Terry C Wall, Norman Weissman, Midge N Ray, Jeroan J Allison, Linda L Casebeer, Sheryl M Strasser, Claire M Spettell, Terry C Wall, Norman Weissman, Midge N Ray, Jeroan J Allison

Abstract

Background: The 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.

Objective: Using these principles, design and develop a Web site including multimodal strategies for improving chlamydial-screening rates among primary care physicians.

Methods: We 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.

Results: In 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.

Conclusions: The 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.

Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Chlamydia module I course home page
Figure 2
Figure 2
Chlamydia module I "screening performance for my office" page

References

    1. Chu L F, Chan B K. Evolution of web site design: implications for medical education on the Internet. Comput Biol Med. 1998 Sep;28(5):459–72. doi: 10.1016/S0010-4825(98)00027-4.S0010482598000274
    1. Casebeer Linda, Bennett Nancy, Kristofco Robert, Carillo Anna, Centor Robert. Physician Internet medical information seeking and on-line continuing education use patterns. J Contin Educ Health Prof. 2002;22(1):33–42.
    1. American Medical Association, authors. AMA study: physicians' use of internet steadily rising. [2003 Sep 4]. .
    1. Sklar B. Online CME update. 2002. Dec, [2003 Sep 4]. .
    1. Davis D A, Taylor-vaisey A. Translating guidelines into practice. A systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines. CMAJ. 1997 Aug 15;157(4):408–16. .
    1. Bero L A, Grilli R, Grimshaw J M, Harvey E, Oxman A D, Thomson M A. Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. The Cochrane Effective Practice and Organization of Care Review Group. BMJ. 1998 Aug 15;317(7156):465–8. .
    1. Davis D A, Thomson M A, Oxman A D, Haynes R B. Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA. 1995 Sep 6;274(9):700–5. doi: 10.1001/jama.274.9.700.
    1. Mcguire Christine H. Handbook of Health Professions Education (Jossey-Bass Higher Education Series/Jossey-Bass Health Series) San Francisco: Proquest Info & Learning; 1983. Nov 1,
    1. Kearsley G. Exploration in learning and instruction: the theory into practice database. 2003. [2003 Sep 4]. .
    1. Spiro RJ, Feltovich PJ, Jacobson MJ, Coulson RL. Cognitive flexibility, constructivism, and hypertext: random access instruction for advanced knowledge acquisition in ill-structured domains. In: Duffy Thomas M, Jonassen David H., editors. Constructivism and the Technology of Instruction: A Conversation. Hillsdale, NJ: Lea; 1992. Oct 1,
    1. Lave Jean, Wenger Etienne. Situated Learning : Legitimate Peripheral Participation (Learning in Doing: Social, Cognitive & Computational Perspectives) Cambridge, UK: Cambridge University Press; 1991. Sep 27,
    1. Knowles Malcolm S. Self-Directed Learning: A Guide for Learners and Teachers. Cambridge, UK: Cambridge Book Company; 1983. May 1,
    1. Jonassen D, Ambruso D, Olesen J. Designing hypertext on transfusion medicine using cognitive flexibility theory. Journal of Educational Multimedia and Hypermedia. 1992;1:309–322.
    1. Moore DE, Bennett N, Knox A, Kristofco R. Participation in formal CME: factors affecting decision-making. In: Davis David, Fox RD., editors. Physician As Learner: Linking Research to Practice. Chicago: American Medical Association; 1994. Aug 1,
    1. Kantrowitz MP. Problem-based learning in continuous medical education: some critical issues. J Contin Educ Health Prof. 1991;11:11–18.
    1. Schmidt H G. Foundations of problem-based learning: some explanatory notes. Med Educ. 1993 Sep;27(5):422–32.
    1. Romiszowski A J. Designing Instructional Systems. New York: Nichols Publishing Company; 1984. Jan 1,
    1. Prochaska J O, Diclemente C C. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983 Jun;51(3):390–5. doi: 10.1037//0022-006X.51.3.390.
    1. Schön Donald A. The reflective practitioner: How professionals think in action. New York: Basic Books; 1983.
    1. Fox Robert D, Maxmanian Paul E, Putnam R Wayne. Changing and Learning in the Lives of Physicians: New York: Praeger Publishers; 1989. Oct 6,
    1. Geertsma R H, Parker R C, Whitbourne S K. How physicians view the process of change in their practice behavior. J Med Educ. 1982 Oct;57(10 Pt 1):752–61.
    1. Ward J P, Gordon J, Field M J, Lehmann H P. Communication and information technology in medical education. Lancet. 2001 Mar 10;357(9258):792–6. doi: 10.1016/S0140-6736(00)04173-8.S0140673600041738
    1. Sun X. An investigation of instructional design models for Web-based instruction [dissertation] Toledo, OH: The University of Toledo; 2001.
    1. Dick Walter, Carey Lou. The Systematic Design of Instruction. 3. New York: Scott Foresman & Co; 1990. Feb 1,
    1. Bertram D A, Brooks-bertram P A. The evaluation of continuing medical education: a literature review. Health Educ Monogr. 1977;5(4):330–62.
    1. Dixon J. Evaluation criteria in studies of continuing education in the health professions: a critical review and a suggested strategy. Eval Health Prof. 1978;1(2):47–65.
    1. Stross J K, Harlan W R. The impact of mandatory continuing medical education. JAMA. 1978 Jun 23;239(25):2663–6. doi: 10.1001/jama.239.25.2663.
    1. Haynes R B, Davis D A, Mckibbon A, Tugwell P. A critical appraisal of the efficacy of continuing medical education. JAMA. 1984 Jan 6;251(1):61–4. doi: 10.1001/jama.251.1.61.
    1. Davis D, O'brien M A, Freemantle N, Wolf F M, Mazmanian P, Taylor-vaisey A. Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? JAMA. 1999 Sep 1;282(9):867–74. doi: 10.1001/jama.282.9.867.jrv90027
    1. Oxman AD, Sackett DL, Guyatt GH. User guide to the medical literature: how to get started. JAMA. 1993;(270):2093–2095. doi: 10.1001/jama.270.17.2093.
    1. Oxman A D, Thomson M A, Davis D A, Haynes R B. No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. CMAJ. 1995 Nov 15;153(10):1423–31.
    1. Thomson O'brien M A, Oxman A D, Davis D A, Haynes R B, Freemantle N, Harvey E L. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2000;(2):CD000409.CD000409
    1. Davis D, O'brien M A, Freemantle N, Wolf F M, Mazmanian P, Taylor-vaisey A. Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? JAMA. 1999 Sep 1;282(9):867–74. doi: 10.1001/jama.282.9.867.jrv90027
    1. Peloso P M, Stakiw K J. Small-group format for continuing medical education: a report from the field. J Contin Educ Health Prof. 2000;20(1):27–32. doi: 10.1002/chp.1340200106.
    1. Grilli R, Lomas J. Evaluating the message: the relationship between compliance rate and the subject of a practice guideline. Med Care. 1994 Mar;32(3):202–13.
    1. Gross P A, Greenfield S, Cretin S, Ferguson J, Grimshaw J, Grol R, Klazinga N, Lorenz W, Meyer G S, Riccobono C, Schoenbaum S C, Schyve P, Shaw C. Optimal methods for guideline implementation: conclusions from Leeds Castle meeting. Med Care. 2001 Aug;39(8 Suppl 2):II85–92.
    1. Hulscher MEJL, Wensing M, van der Weijden R, Grol R. The Cochrane Library, Issue 3. Oxford: Update Software Ltd; 2002. Interventions to implement prevention in primary care.
    1. Hayes R P, Ballard D J. Review: feedback about practice patterns for measurable improvements in quality of care--a challenge for PROs under the Health Care Quality Improvement Program. Clin Perform Qual Health Care. 1995;3(1):15–22.
    1. Goebel L J. A peer review feedback method of promoting compliance with preventive care guidelines in a resident ambulatory care clinic. Jt Comm J Qual Improv. 1997 Apr;23(4):196–202.
    1. Donabedian Avedis MD. Definition of Quality and Approaches to Its Assessment (Explorations in Quality Assessment and Monitoring) Vol. 1. Ann Arbor, MI: Health Administration Press; 1980. Jun 1,
    1. Donabedian A. The role of outcomes in quality assessment and assurance. QRB Qual Rev Bull. 1992 Nov;18(11):356–60.
    1. Donabedian A. Evaluating the quality of medical care. Milbank Mem Fund Q. 1966 Jul;44(3):Suppl:166–206.
    1. Thomson-O'Brien MA, Oxman AD, Davis DA, Haynes RB, Freemantle N, Harvey EL. The Cochrane Library. Oxford: Update Software Ltd; 1997. Educational outreach visits: effects on professional practice and health care outcomes.
    1. Horn K D, Sholehvar D, Nine J, Gilbertson J, Hatton C, Richert C, Becich M J. Continuing medical education on the World Wide Web (WWW). Interactive pathology case studies on the Internet. Arch Pathol Lab Med. 1997 Jun;121(6):641–5.
    1. Curran V R, Hoekman T, Gulliver W, Landells I, Hatcher L. Web-based continuing medical education. (II): Evaluation study of computer-mediated continuing medical education. J Contin Educ Health Prof. 2000;20(2):106–19. doi: 10.1002/chp.1340200207.
    1. Bell D S, Mangione C M. Design and analysis of a Web-based guideline tutorial system that emphasizes clinical trial evidence. Proc AMIA Symp. 2000:56–60. .D200870
    1. Agius R M, Bagnall G. Development and evaluation of the use of the Internet as an educational tool in occupational and environmental health and medicine. Occup Med (Lond) 1998 Jul;48(5):337–43.
    1. Berry E, Parker-jones C, Jones R G, Harkin P J, Horsfall H O, Nicholls J A, Cook N J. Systematic assessment of World Wide Web materials for medical education: online, cooperative peer review. J Am Med Inform Assoc. 1998;5(4):382–9.
    1. Farrell David W, Olevitch Laura, Brennan Laura K. In: Tailoring Health Messages: Customizing Communication With Computer Technology (Lea's Communication (Paperback)) Kreuter Matthew., editor. Mahwah, NJ: Lea; 1999. Oct 1,
    1. Anderson JG, Casebeer LL, Kristofco RE, Carillo A. Using Web-enabled technology to promote the adoption of practice guidelines. In: Eder Lauren B., editor. Managing Healthcare Information Systems with Web-Enabled Technologies. Hershey, PA: Idea Group Publishing; 2000.
    1. Nelson H D, Helfand M. Screening for chlamydial infection. Am J Prev Med. 2001 Apr;20(3 Suppl):95–107. doi: 10.1016/S0749-3797(01)00253-7.S0749379701002537

Source: PubMed

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