Comparing Performance Outcomes Research Articles

The Development and Pilot Testing of Immersive Virtual Reality Simulation Training for Prelicensure Nursing Students: A Quasi-Experimental Study

Nursing schools struggle to increase enrollments due to insufficient faculty and limitations in clinical site placements. New strategies must be employed to optimize learning, engage learners, and provide methods to ensure competency in future nursing graduates. A convenience sample of junior-level prelicensure nursing students (n = 48) were assigned to the immersive virtual reality (VR) group (n = 24) or the hospital-based group (n = 24). This mixed-methods quasi-experimental pilot study examined the effectiveness of an immersive VR simulation training program to replace pediatric clinical practice. The intervention group participated in immersive VR. The control group received the usual inpatient clinical training. Both groups then completed a traditional in-person simulation to compare performance outcomes. Performance scores for the immersive VR training group were significantly higher for total performance compared to the hospital-based training group. These preliminary results offer promise and demonstrate the potential of VR in the future of nursing education.

A Preliminary Evaluation of Students' Learning and Performance Outcomes in an Accelerated 3-Year MD Pathway Program.

Little outcome data exist on 3-year MD (3YMD) programs to guide residency program directors (PDs) in deciding whether to select these graduates for their programs. To compare performance outcomes of 3YMD and 4-year MD (4YMD) students at New York University Grossman School of Medicine. In 2020, using the Kirkpatrick 4-level evaluation model, outcomes from 3 graduating cohorts of 3YMD students (2016-2018) were compared with the 4YMD counterparts. Descriptive statistics compared outcomes among consented student cohorts: 92% (49 of 53) 3YMD, 87% (399 of 459) 4YMD-G, and 84% (367 of 437) 4YMD-S. Student survey response rates were 93% (14 of 15), 74% (14 of 19), and 89% (17 of 19) from 2016 to 2018. PDs' response rates were 58% (31 of 53, 3YMD) and 51% (225 of 441, 4YMD). Besides age, 3YMD and 4YMD cohorts did not differ significantly in admissions variables. Other than small statistically significant differences in the medicine shelf examination (3YMD mean 74.67, SD 7.81 vs 4YMD-G mean 78.18, SD 7.60; t test=3.02; P=.003) and USMLE Step 1 (3YMD mean 235.13, SD 17.61 vs 4YMD-S mean 241.70, SD 15.92; t test=2.644; P=.009 and vs 4YMD-G mean 242.39, SD 15.65; t test=2.97; P=.003) and Step 2 CK scores (3YMD mean 242.57, SD 15.58 vs 4YMD-S mean 248.55, SD 15.33; t test=2.55; P=.01 and vs 4YMD-G mean 247.83, SD 15.38; t test=2.97; P=.03), other metrics and overall intern ratings did not differ by pathway. Exploratory findings from a single institution suggest that 3YMD students performed similarly to 4YMD students in medical school and the first year of residency.

Skeletal Muscle Adaptations and Performance Outcomes Following a Step and Exponential Taper in Strength Athletes.

Before major athletic events, a taper is often prescribed to facilitate recovery and enhance performance. However, it is unknown which taper model is most effective for peaking maximal strength and positively augmenting skeletal muscle. Thus, the purpose of this study was to compare performance outcomes and skeletal muscle adaptations following a step vs. an exponential taper in strength athletes. Sixteen powerlifters (24.0 ± 4.0 years, 174.4 ± 8.2 cm, 89.8 ± 21.4 kg) participated in a 6-week training program aimed at peaking maximal strength on back squat [initial 1-repetition-maximum (1RM): 174.7 ± 33.4 kg], bench press (118.5 ± 29.9 kg), and deadlift (189.9 ± 41.2 kg). Powerlifters were matched based on relative maximal strength, and randomly assigned to either (a) 1-week overreach and 1-week step taper or (b) 1-week overreach and 3-week exponential taper. Athletes were tested pre- and post-training on measures of body composition, jumping performance, isometric squat, and 1RM. Whole muscle size was assessed at the proximal, middle, and distal vastus lateralis using ultrasonography and microbiopsies at the middle vastus lateralis site. Muscle samples (n = 15) were analyzed for fiber size, fiber type [myosin-heavy chain (MHC)-I, -IIA, -IIX, hybrid-I/IIA] using whole muscle immunohistochemistry and single fiber dot blots, gene expression, and microRNA abundance. There were significant main time effects for 1RM squat (p < 0.001), bench press (p < 0.001), and deadlift, (p = 0.024), powerlifting total (p < 0.001), Wilks Score (p < 0.001), squat jump peak-power scaled to body mass (p = 0.001), body mass (p = 0.005), fat mass (p = 0.002), and fat mass index (p = 0.002). There were significant main time effects for medial whole muscle cross-sectional area (mCSA) (p = 0.006) and averaged sites (p < 0.001). There was also a significant interaction for MHC-IIA fiber cross-sectional area (fCSA) (p = 0.014) with post hoc comparisons revealing increases following the step-taper only (p = 0.002). There were significant main time effects for single-fiber MHC-I% (p = 0.015) and MHC-IIA% (p = 0.033), as well as for MyoD (p = 0.002), MyoG (p = 0.037), and miR-499a (p = 0.033). Overall, increases in whole mCSA, fCSA, MHC-IIA fCSA, and MHC transitions appeared to favor the step taper group. An overreach followed by a step taper appears to produce a myocellular environment that enhances skeletal muscle adaptations, whereas an exponential taper may favor neuromuscular performance.

A Comparison of Student Outcomes Between Longitudinally and Traditionally Placed Advanced Pharmacy Practice Experiences

Objective. To compare performance outcomes of students completing a longitudinal pharmacy practice experience at a single site with those of students completing advanced pharmacy practice experiences (APPEs) at a variety of practice sites. Methods. Performance data and other meaningful outcomes from a cohort of students completing a six-month experience within a single health system (longitudinal group) were compared to data from a group of students completing six months of similar APPEs at multiple health systems (control group). Results. Motivators for participating in the longitudinal program varied, with students in the program identifying practice interest alignment, schedule simplification, and desire to do a residency; and students choosing to not participate in identifying schedule flexibility and experience at a variety of practice sites. The 16 longitudinal students differed from the 20 control students at baseline in grade point average and the number of scheduled community pharmacy APPEs. Performance measures for longitudinal students and control students did not differ significantly, but the difference between students' self-perceived effort and preceptor perception of student effort was significantly different for control students compared to longitudinal students. Residency match rates and number of students receiving recognition for high academic performance were similar in the two groups. Conclusion. Students participating in the longitudinal program had different motivators but comparable outcomes to students who completed similar APPEs at a variety of practice sites.

A Systematic Review of the Efficacy of Lower Body Aquatic Plyometric Training: The Development of Evidence-Based Recommendations for Practitioners

Objectives: Plyometric exercises are often prescribed for enhancing athletic performance, however, this form of training can elicit significant skeletal loading which may defer practitioners from utilizing these exercises throughout rehabilitation. Purpose: 1) complete a systematic review to critically examine the efficacy of plyometric training performed in water when compared to land for eliciting changes in musculoskeletal markers of performance, and 2) to provide evidence-based recommendations for practitioners on how best to utilize this form of training in rehabilitation and return-to-play. Methods: A systematic review was undertaken with relevant studies identified that compared changes in performance markers (e.g., strength, sprinting, and jumping) between the same aquatic- and land-based plyometric program were eligible for inclusion. Data was extracted using a standardized extraction form as confirmed by three reviewers. Data extraction included population characteristics, program design, and pre- and post- adaptations in strength, speed, and vertical jump. Results: Eight studies were included comparing performance outcomes following aquatic- and land-based plyometric training. The results of this review suggest that aquatic plyometric training is as effective as land-based plyometric training at improving lower body strength, sprint, and vertical jump performance. Conclusions: The utilization of aquatic plyometric training can be an important piece of the rehabilitation and return-to-play process in order to improve lower body strength, speed, and power while reducing the physical stress of land-based plyometric training.

Effect of Repeat Examination on Family Medicine NBME Subject Scores.

National Board of Medical Examiners (NBME) subject examinations are used by many schools to assess student clinical knowledge. Studies indicate that mean scores on NBME examinations improve as the clinical year progresses. Literature review revealed no studies investigating changes in individual student scores when end-of-block examinations were repeated at the end of the clinical year. This study investigated NBME family medicine subject examination score changes for students who opted to repeat the examination at the end of the academic year. In 2014, students on a 4-week family medicine block clerkship took the NBME subject examination at the end of their clerkship block and were offered the opportunity to repeat this examination at the end of that clinical year; 25 of 80 students voluntarily repeated the examination. Paired t-tests were used to compare performance outcomes between the exam means at the end of the clerkship blocks to the means on the exam administration at the end of the academic year. Results showed a statistically significant improvement in scores between the first and second examination administration. Examinations given immediately after the students' clinical experience yielded scaled scores ranging from 60 to 80 compared to the national mean of 71.9. Examinations given at the end of the clinical year yielded scaled scores ranging from 57 to 90 (t[24]=-2.66, P=0.0006). Repeating the NBME subject examination at the end of the year led to slightly increased scores, suggesting that time spent during clerkships influences examination performance.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters

BACKGROUND CONTEXT Major League Baseball (MLB) players are at significant risk for back injury, and back injury accounts for a significant proportion of time spent on the disabled list. MLB players that sustain back injuries are either managed conservatively or undergo operation with the goal of returning to their full level of pre-injury performance. Performance data of MLB players is a readily available method of objectively comparing performance outcomes following recovery from back inury. PURPOSE To better understand differences in performance outcomes and ability to return to play following back injury in MLB players. STUDY DESIGN/SETTING This is a retrospective cohort study comparing performance outcomes in MLB players with back injury who underwent conservative versus surgical managment. PATIENT SAMPLE Major League Baseball players that sustained a documented back injury between 2010 and 2016 as recorded in individual MLB team disabled lists. Inclusion criteria also required that players have statistical performance data available one year prior to the injury and following return to play. OUTCOME MEASURES Various outcome measures of in-game performance were measured using hitting and pitching metrics. Hitting performance was assessed using at bats, hits, batting average, home runs, RBIs, and OPS. Pitching performance was analyzed using win/loss ratio, ERA, saves, innings pitches, strike outs and WHIP. Fast ball velocity and pitch selection was also analyzed. Time on the disabled list and whether players returned to play were determined. METHODS Players who sustained back injury were identified using publically available disabled listings from MLB teams from 2011 to 2016. Conservative versus surgical treatment method was determined by using news media and team-affiliated reporting on injured players. Online statistical data on MLB players performance metrics and pitch selection was gathered for the players meeting inclusion criteria. Performance data was compared from one year prior to the injury to one year following return to play to assess change in performance. RESULTS A total of 187 players were identified who sustained back injury between 2010 and 2016. Of these, data was analyzed from 126 players who met inclusion criteria. A total of 100 and 26 players were treated with conservative and surgical management, respectively. The average age was 33. Surgeries included thoracic and lumbar fusion, and discectomy or microdiscectomy of the lumbar and cervical spine. Players undergoing surgery averaged significantly longer time on the disabled list (126days and 41days, respectively). Pitcher earned run average was increased more in the conservative treatment group than the surgical treatment group (increases of 1.15 and 0.4, respectively). Pitcher fastball velocity decreased and frequency of curveball and change-up pitch selection increased. Players undergoing operative management were less likely to return to play. CONCLUSIONS Major league baseball player performance declines following back injury regardless of the form of treatment. Players undergoing surgery miss more playing time and are less likely to return to play than those undergoing conservative therapy. However, when indicated, surgery may be beneficial in maintaining pitching performance as opposed to conservative management.

Pediatric Type 1 Diabetes: Reducing Admission Rates for Diabetes Ketoacidosis

Background:Diabetes ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM). Reducing DKA admissions in children with T1DM requires a coordinated, comprehensive management plan. We aimed to decrease DKA admissions, 30-day readmissions, and length of stay (LOS) for DKA admissions.Methods:A multipronged intervention was designed in 2011 to reach all patients: (1) increase insulin pump use and basal-bolus regimen versus sliding scales, (2) transform educational program, (3) increased access to medical providers, and (4) support for patients and families. A before-after study was conducted comparing performance outcomes in years 2007-2010 (preintervention) to 2012-2014 (postintervention) using administrative data and Wilcoxon rank sum and Fischer exact tests.Results:DKA admissions decreased by 44% postintervention (16.7 vs 9.3 per 100 followed patient-years; P = .006), unique patient 30-day readmissions decreased from 20% to 5% postintervention (P = .001), and median LOS significantly decreased postintervention (P < .0001). Although not an original goal of the study, median hemoglobin A1C of a subset of the population transitioned from sliding scale decreased, 10.3% to 8.9% (P < .02).Conclusions:When clinical and widespread program interventions were used, significant reductions in DKA hospitalizations, 30-day readmissions, and LOS occurred for pediatric T1DM. Continuous performance improvement efforts are needed for improving DKA outcomes.

The effect of the adoption of an alternative corporate governance system on firms’ performances

Purpose – Alternative corporate governance systems (CGSs) have attracted a significant bulk of research recently. While the connection between the adoption of an alternative system (one tier board or two tier board system) and firms’ performances has not been fully analysed yet, the purpose of this paper is to analyse whether companies which have turned into an alternative board system have eventually improved their performance over time. Design/methodology/approach – Using a sample of more than 15,000 Italian unlisted joint stock companies, the authors compare performance outcomes in 2009 of firms adopting alternative systems with performances of firms that maintained the system in force before the 2003 Corporate Law Reform (defined as “traditional”). Because of the choice of an alternative system (one tier or two tier board) instead of a traditional one is not random, the authors reduce selection bias implementing matching methods and comparing firms that are close in terms of propensity score measured in 2003 (the year before the new CGSs have been introduced by a corporate law reform). Findings – The authors do not find evidence of a significant improvement of performances in 2009 concerning those firms that have adopted a one tier or two tier board systems with respect to those which maintained a traditional one. Originality/value – The novelty of the study concerns the application of propensity score matching for the evaluation of the impact of the change of the CGS that is possible in presence of two conditions that are all verified in our setting: first, to have a country where corporate law allows for choosing among different systems; in this case Italy is a good laboratory, because it allows for the choice among three different systems; and second, to have the opportunity to evaluate the effect of the change in light of a relatively recent “pre-treatment” condition; this is made possible by the fact that before the 2003 Reform of corporate law all the companies had a traditional system.

Lung cancer interval times from point of referral to the acute health sector to the start of first treatment.

Objective The aim of the present study was to compare lung cancer diagnostic and treatment intervals with agreed target measures across three large public health services in Victoria and assess any differences in interval times by treatment type and health service. Methods A retrospective medical record audit of 78 patients admitted with a new diagnosis of lung cancer was conducted. Interval times from referral to diagnosis, diagnosis to first treatment and referral to first treatment were recorded in three treatment types: surgery, chemotherapy and radiotherapy. Results There was a significant difference in the mean number of days from referral to diagnosis by treatment type. Patients who underwent surgery waited significantly longer (mean (± s.d.) 41.6±38.4 days) to obtain a diagnosis than those who received radiotherapy (15.1±18.6 days). Only 47% of surgical patients obtained a diagnosis within the recommended 28 days. Moreover, only 45% and 44% of patients, respectively, met the diagnosis-to-treatment target of 14 days and referral-to-treatment target of 42 days. Conclusion The present study highlights the effect of treatment type on lung cancer referral interval times. It demonstrates the benefits of using evidenced-based interval target times to benchmark and compare performance outcomes in lung cancer. What is known about the topic? Lung cancer is the leading cause of cancer mortality in Australia and has the lowest 5-year survival rate of all cancer types. Delays in the diagnosis of lung cancer can change the prognosis from potentially curable to incurable, particularly in faster-growing tumours. What does this paper add? This study reveals treatment type was a greater factor in explaining variations in diagnosis and treatment than health service. Surgical patients were consistently lower in meeting the recommended interval targets across referral to diagnosis, diagnosis to treatment and referral to treatment. What are the implications for practitioners? This study demonstrates the value of using evidenced-based interval target times to benchmark and compare performance outcomes in lung cancer. Such measures may further improve prognostic outcomes in lung cancer by reducing unwanted delays.

Language Intervention via Text-Based Tele-AAC: A Case Study Comparing On-site and Telepractice Services

There is a shortage of qualified speech and language pathologists (SLPs) to not only meet the needs of students with a variety of communicative disabilities, but also the needs of those students with severe impairments who use augmentative and alternative communication (AAC). Special education administrators need to consider additional methods of service delivery, such as telepractice. However, there is limited evidence regarding the efficacy of services delivered to students using AAC via telepractice as opposed to face-to-face services. This study examines the effectiveness of services provided using both methodologies, and aims to provide some validation of telepractice as an alternative treatment method. Using a single-subject design to compare performance outcomes, a 7 year-old male participant, who used a Vantage Plus™ device with an 84-sequenced overlay, was studied over an eight-week period, with four weeks of on-site therapy immediately followed by four weeks of telepractice therapy. Student progress was measured by comparing outcomes in both conditions to baseline data with respect to short-term goals focused on grammatical morphemes. The results indicate that the performance outcomes were comparable in both conditions. The authors discuss the implications of using telepractice to deliver direct intervention and future applications of telepractice as a service delivery model for individuals using AAC.

Clinical evaluation of the Nucleus® 6 cochlear implant system: Performance improvements with SmartSound iQ

Objective: This paper provides a detailed description of the Nucleus 6 system, and clinically evaluates user performance compared to the previous Nucleus 5 system in cochlear implant recipients. Additionally, it clinically evaluates a range of Nucleus 6 and Nucleus 5 programs to determine the performance benefits provided by new input processing technologies available in SmartSound iQ. Design: Speech understanding tests were used to clinically validate the default Nucleus 6 program, by comparing performance outcomes against up to five custom Nucleus 5 or Nucleus 6 programs in a range of listening environments. Clinical comparisons between programs were conducted across the following listening environments; quiet, speech weighted noise (co-located and spatially separated noise), and 4-talker babble (co-located and spatially separated noise). Study sample: Twenty-one adult cochlear implant recipients participated. Results: Significant speech understanding benefits were found with the default Nucleus 6 program compared to the participants’ preferred program using their Nucleus 5 processor and compared to a range of custom Nucleus 6 programs. All participants successfully accepted and upgraded to the new default Nucleus 6 SmartSound iQ program. Conclusion: This study demonstrates the acceptance and clinical benefits of the Nucleus 6 cochlear implant system and SmartSound iQ.

Skills in Assessing the Professional Literature (SAPL): A 7-year Analysis of Student EBD Performance

PurposeThe primary goal of this project was to describe the level of knowledge acquisition using detailed test performance outcomes of the EBD SAPL curriculum over its first 7-years of implementation at the NYU College of Dentistry. A secondary goal was to compare performance outcomes impact of the full 60 h base SAPL curriculum as taught to 4-year DDS students vs an abbreviated 30 h base SAPL curriculum as taught to 3-year Advanced Placement DDS students. MethodsThe findings for the period 2004–2010 are reported for 1647 dental students (63.6% 4-year DDS students, 36.3% 3-year Advanced Placement DDS students). The database consisted of the score earned by each student on each individual question of the SAPL course's 4 h final examination in which each student read an original research article and answered all questions on the Literature Analysis Form. ResultsThe major findings were overall high performance by both groups of students (SAPL exam scores of 85.8 vs 83.7, respectively) as well as very similar outcomes between these two student groups on: 1) recognizing research design elements and on interpreting those design elements for clinical application, 2) detailed performance of knowledge within the specific five traditional sections of research articles, and 3) detailed performance across 18 identified research design topics. ConclusionIn conclusion, both course formats appear to be highly effective for their respective student groups, but should not be interpreted as evidence favoring the shorter format given the different characteristics of the two student groups.

Use of Cognitive Task Analysis to Guide the Development of Performance-Based Assessments for IntraOperative Decision Making

There is a paucity of performance-based assessments that focus on intraoperative decision making. The purpose of this article is to review the performance outcomes and usefulness of two performance-based assessments that were developed using cognitive task analysis (CTA) frameworks. Assessment-A used CTA to create a "think aloud" oral examination that was administered while junior residents (PGY 1-2's, N = 69) performed a porcine-based laparoscopic cholecystectomy. Assessment-B used CTA to create a simulation-based, formative assessment of senior residents' (PGY 4-5's, N = 29) decision making during a laparoscopic ventral hernia repair. In addition to survey-based assessments of usefulness, a multiconstruct evaluation was performed using eight variables. When comparing performance outcomes, both approaches revealed major deficiencies in residents' intraoperative decision-making skills. Multiconstruct evaluation of the two CTA approaches revealed assessment method advantages for five of the eight evaluation areas: (1) Cognitive Complexity, (2) Content Quality, (3) Content Coverage, (4) Meaningfulness, and (5) Transfer and Generalizability. The two CTA performance assessments were useful in identifying significant training needs. While there are pros and cons to each approach, the results serve as a useful blueprint for program directors seeking to develop performance-based assessments for intraoperative decision making.

Six Sigma adoption: Operating performance impacts and contextual drivers of success

We assess the operational impacts of Six Sigma program adoptions through an event study methodology, comparing financial data for 200 Six Sigma adopting firms against data for matched firms, which serve as control groups for the analyses. We employ various matching procedures using different combinations of pre-adoption return on assets (ROA), industry, and size as matching criteria. By comparing performance outcomes across a hierarchy of operating metrics, we establish a pattern of Six Sigma adoption effects that provides strong evidence of a positive impact on ROA. Interestingly, these ROA improvements arise mostly from significant reductions in indirect costs; significant improvements in direct costs and asset productivity are not evident. We also find small improvements in sales growth due to Six Sigma adoption. Cross-sectional analyses of the performance results reveal that distinctions in Six Sigma impacts across manufacturing and service firms are negligible. Interestingly, we find that the performance impact of Six Sigma adoption is negatively correlated to the firm's quality system maturity (indicated by prior ISO 9000 certification). Further analyses of manufacturing and service firms reveals that Six Sigma benefits are significantly correlated with intensity in manufacturing, and with financial performance before adoption in services. We discuss the implications of these findings for practice and for future research.

Comparison of a Clinical Prediction Rule and a LAM Antigen-Detection Assay for the Rapid Diagnosis of TBM in a High HIV Prevalence Setting

Background/ObjectiveThe diagnosis of tuberculous meningitis (TBM) in resource poor TB endemic environments is challenging. The accuracy of current tools for the rapid diagnosis of TBM is suboptimal. We sought to develop a clinical-prediction rule for the diagnosis of TBM in a high HIV prevalence setting, and to compare performance outcomes to conventional diagnostic modalities and a novel lipoarabinomannan (LAM) antigen detection test (Clearview-TB®) using cerebrospinal fluid (CSF).MethodsPatients with suspected TBM were classified as definite-TBM (CSF culture or PCR positive), probable-TBM and non-TBM.ResultsOf the 150 patients, 84% were HIV-infected (median [IQR] CD4 count = 132 [54; 241] cells/µl). There were 39, 55 and 54 patients in the definite, probable and non-TBM groups, respectively. The LAM sensitivity and specificity (95%CI) was 31% (17;48) and 94% (85;99), respectively (cut-point ≥0.18). By contrast, smear-microscopy was 100% specific but detected none of the definite-TBM cases. LAM positivity was associated with HIV co-infection and low CD4 T cell count (CD4<200 vs. >200 cells/µl; p = 0.03). The sensitivity and specificity in those with a CD4<100 cells/µl was 50% (27;73) and 95% (74;99), respectively. A clinical-prediction rule ≥6 derived from multivariate analysis had a sensitivity and specificity (95%CI) of 47% (31;64) and 98% (90;100), respectively. When LAM was combined with the clinical-prediction-rule, the sensitivity increased significantly (p<0.001) to 63% (47;68) and specificity remained high at 93% (82;98).ConclusionsDespite its modest sensitivity the LAM ELISA is an accurate rapid rule-in test for TBM that has incremental value over smear-microscopy. The rule-in value of LAM can be further increased by combination with a clinical-prediction rule, thus enhancing the rapid diagnosis of TBM in HIV-infected persons with advanced immunosuppression.

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

Despite evidence that a variety of continuing medical education (CME) techniques can foster physician behavioral change, there have been no randomized trials comparing performance outcomes for physicians participating in Internet-based CME with physicians participating in a live CME intervention using approaches documented to be effective. To determine if Internet-based CME can produce changes comparable to those produced via live, small-group, interactive CME with respect to physician knowledge and behaviors that have an impact on patient care. Randomized controlled trial conducted from August 2001 to July 2002. Participants were 97 primary care physicians drawn from 21 practice sites in Houston, Tex, including 7 community health centers and 14 private group practices. A control group of 18 physicians from these same sites received no intervention. Physicians were randomly assigned to an Internet-based CME intervention that could be completed in multiple sessions over 2 weeks, or to a single live, small-group, interactive CME workshop. Both incorporated similar multifaceted instructional approaches demonstrated to be effective in live settings. Content was based on the National Institutes of Health National Cholesterol Education Program--Adult Treatment Panel III guidelines. Knowledge was assessed immediately before the intervention, immediately after the intervention, and 12 weeks later. The percentage of high-risk patients who had appropriate lipid panel screening and pharmacotherapeutic treatment according to guidelines was documented with chart audits conducted over a 5-month period before intervention and a 5-month period after intervention. Both interventions produced similar and significant immediate and 12-week knowledge gains, representing large increases in percentage of items correct (pretest to posttest: 31.0% [95% confidence interval {CI}, 27.0%-35.0%]; pretest to 12 weeks: 36.4% [95% CI, 32.2%-40.6%]; P<.001 for all comparisons). Chart audits revealed high baseline screening rates in all study groups (> or =93%) with no significant postintervention change. However, the Internet-based intervention was associated with a significant increase in the percentage of high-risk patients treated with pharmacotherapeutics according to guidelines (preintervention, 85.3%; postintervention, 90.3%; P = .04). Appropriately designed, evidence-based online CME can produce objectively measured changes in behavior as well as sustained gains in knowledge that are comparable or superior to those realized from effective live activities.