Abstract
BackgroundIn an effort to ensure that all physicians have access to valid and reliable evidence on drug effectiveness, the Italian Drug Agency sponsored a free-access e-learning system, based on Clinical Evidence, called ECCE. Doctors have access to an electronic version and related clinical vignettes. Correct answers to the interactive vignettes provide Continuing Medical Education credits. The aims of this trial are to establish whether the e-learning program (ECCE) increases physicians' basic knowledge about common clinical scenarios, and whether ECCE is superior to the passive diffusion of information through the printed version of Clinical Evidence.DesignAll Italian doctors naïve to ECCE will be randomised to three groups. Group one will have access to ECCE for Clinical Evidence chapters and vignettes lot A and will provide control data for Clinical Evidence chapters and vignettes lot B; group two vice versa; group three will receive the concise printed version of Clinical Evidence. There are in fact two designs: a before and after pragmatic trial utilising a two by two incomplete block design (group one versus group two) and a classical design (group one and two versus group three). The primary outcome will be the retention of Clinical Evidence contents assessed from the scores for clinical vignettes selected from ECCE at least six months after the intervention. To avoid test-retest effects, we will randomly select vignettes out of lot A and lot B, avoiding repetitions. In order to preserve the comparability of lots, we will select vignettes with similar, optimal psychometric characteristics.Trial registrationISRCTN27453314
Highlights
In an effort to ensure that all physicians have access to valid and reliable evidence on drug effectiveness, the Italian Drug Agency sponsored a free-access e-learning system, based on Clinical Evidence, called ECCE
Two principles underlie Continuing Medical Education (CME): professional development is a process of lifelong learning in practice, and professionals must be able to demonstrate they are clinically competent in certain roles
ECCE has four components: 1) the Clinical Evidence chapter; 2) a clinical vignette from the Clinical Evidence chapter that presents a plausible medical scenario (e.g., Margaret says to her family doctor: "This time I didn't come for me, but to talk about Rachel, my 25-yearold daughter....); 3) questions addressing the recall of Clinical Evidence facts or their application to the medical scenario, from which the doctor is to select the correct answer; 4) the potential answers; and 5) instructions on what to do (e.g., "more than one answer may be correct")
Summary
Continuing Medical Education for health professionals In the last decade many countries have legislated within their health systems the revalidation and recertification of medical practitioners [1]. The potential role of e-learning from transferring information to modifying clinical practice Several conceptual models have been developed for assessing knowledge and competence. The stages of development have been slightly changed to better reflect the different components and skills targeted by educational interventions focusing on EBM: 1) factual knowledge or basic learning: knowing the benefits and risks of different interventions (e.g., in patients with unstable angina, aspirin is beneficial); 2) deep learning or competence: posing structured clinical questions considering patients, treatment, comparison, and outcomes and understanding quantitative aspects (relative or absolute risk reduction, number needed to treat); 3) point-of-care ability or performance: the incorporation of EB information into practice, with the adoption of proven treatments and interventions that can potentially improve patients' health. The secondary hypotheses are: Does ECCE modify physicians' attitudes to EB behaviours in a simulated realistic clinical scenario?
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