Continuing Medical Education Sessions Research Articles

Barriers and Facilitators in Continuous Medical Education Related to Allogeneic Stem Cell Transplantation: A Qualitative Study of Physicians

Introduction: This study explored qualitatively, in a sample of German hematologists working in clinical allogeneic hematopoietic stem cell transplantation (alloHSCT), perceptions of barriers and facilitators to participate in continuous medical education (CME), to provide detailed information on how to improve participation in CME activities related to alloHSCT, which may also be applicable to other areas of medicine. Methods: Based on a recruitment campaign of the German Association for Hematopoietic Stem Cell Transplantation (DAG-HSZT), 21 semi-structured telephone interviews were conducted, transcribed, and analyzed using framework analysis. Results: Three clusters of barriers were identified that explain why alloHSCT physicians may or may not participate in CME: individual constraints (e.g., better networking, young physicians being overwhelmed by the complexity of alloHSCT), structural constraints (e.g., time and financial issues, tailoring CME courses according to the targeted audience), and content-related constraints (e.g., requirement of CME sessions, provision of an overview of CME courses, more flexible offers). We discuss the ten most frequently raised issues, including the use of incentives and the need for support at the start of residency, staff shortages, and requirements for learning sessions. Conclusion: There is a need for a paradigm shift in CME related to alloHSCT toward a more individualized and needs-based approach. Close monitoring of residents’ needs and learning progress, as well as feedback systems, could help identify appropriate CME courses that should be integrated into a tiered learning system. CME should be more targeted to specific audiences (i.e., residents, fellows, and attendees) to provide training that is tailored to individual CME needs. On-demand courses can help balance work and family obligations. Finally, peer-reviewed, up-to-date information platforms should be expanded.

The Perceived Effectiveness of Online vs Physical Continuous Medical Education Sessions among Malaysian Doctors: A Cross-Sectional Study.

Ever since the pandemic, many educational platforms have gone online including Continuing Medical Education (CME). The objective of this study was to identify perceived focus and perceptions of both modes amongst Malaysian doctors. This was a cross-sectional study conducted from May to June 2020 via an online questionnaire. The researchers sent out the questionnaire to doctors via social media to study the perceived focus amongst attendees. We included all those who claimed to have participated in both types of CME previously. The final analysis included 357 respondents. The mean age of respondents was 46.54 (SD:17.52) years and the mean duration of practice was 21.46 (13.61) years. From the total, 46.5% of them were General Practitioners (GPs) and 49.9% were from the private sector. From the total, 60.4% of them participated in the online CME from their homes and 51.7% of them accessed it via their handphones. In a 60-minute CME activity, the perceived ability to focus (focus which participant perceive to have had/attained) in a physical CME was 32.94 (SD: 13.17) minutes and 32.65 (12.61) minutes for online CME (p=0.76). The perceived attention span and participation were better in a physical CME (both p<0.001) and attention was mainly diverted to do other things during the meeting for online CME (p<0.001). Although online CME was convenient during the pandemic, many participants felt they had a shorter attention span, less participation and had some attention diversion during online CME. Improving participation and attention span for online CME is very much needed.

Effectiveness of half-day interactive continuing medical education workshop in improving oncologists’ knowledge in prescribing opioids

Background: Patients with cancer commonly experience persistent pain, and opioids have remained the mainstay of pain treatment because of their rapid effectiveness in treating moderate to severe pain. As medicine progresses, we need to establish continuous medical education sessions to educate, update, and establish competency in opioid prescribing in cancer patients. Aim: The objective of this study was to explore whether continuing medical education interventions improve oncologists’ knowledge about pain management when prescribing opioids. Methods: We conducted a cross-sectional prospective pre- post-test study. Continuing medical education workshops lasting three identical half-days was offered in 2019. Training sessions were held at the Princess Noorah Oncology Education Center. A total of 40 participants were recruited from a single discipline (oncology) rather than from multiple disciplines for the workshops. The continuing medical education program included six lectures and case presentations. An assessment of 16 multiple-choice questions (case scenario format) with four options was administered to the participants before the training workshop. Results: The mean scores of the participants’ knowledge increased from 9.48 (pre-test) to 11.93 (post-test). This improvement was statistically significant (p < 0.001). A novel finding of this study is that continuing medical education lasting a half-day is as effective as a one-day workshop and even superior to traditional continuing medical education lasting two days. Conclusions: A half-day continuing medical education program significantly improved physicians’ knowledge of prescribing opioids in cancer patients. This study suggests that a well-designed continuing medical education program is essential for its success.

KNOWLEDGE, ATTITUDE, AND PRACTICE TOWARDS ASYMPTOMATIC HYPERURICEMIA AND GOUT AMONG FAMILY MEDICINE RESIDENTS IN KING SAUD MEDICAL CITY IN RIYADH, SAUDI ARABIA, 2023: A CROSS-SECTIONAL STUDY

Introduction: Asymptomatic Hyperuricemia is defined as blood serum urate concentration above 6mg/dl (357 μmol/L) for women and above 7mg/dl (416 μmol/L) for men. It is important to highlight that in Saudi Arabia, family medicine residents encounter multiple cases of AH and gout. Thus, it would be of significance to assess their knowledge, attitude, and practice regarding AH and gout. Methodology: A cross-sectional hospital-based descriptive study. The study was conducted in King Saud Medical City Riyadh -in June 2023, among all family medicine residents training in King Saud Medical City Riyadh. Consecutive sampling was implemented. Full coverage of all family medicine residents training in King Saud Medical City Riyadh (n= 119). Results: This study included a total of 117. 87(74.7%) have an experience of 1-3 years. About one quarter of participants (26.5%) attended continuing medical education (CME) on asymptomatic hyperuricemia (AH) or gout. 83(70.9%) have moderate knowledge, and 75(64.1%) have moderate practice, and 22(18.8%) have good practice. Participants level of knowledge was found to be significantly associated with reading about asymptomatic hyperuricemia (AH) or gout in the last year and being aware with the guidelines on the management of both AH and gout (P< .05). On the other hand, level of practice was found to be associated significantly with reading about asymptomatic hyperuricemia (AH) or gout in the last year only (P= .04). Conclusions: More than half of patients showed moderate level of knowledge and favorable attitude towards AH and gout. Majority of residents showed moderate level of practice towards management of AH and gout. Significant association was found between level of knowledge and attending continuous medical education sessions (P < .05). Significant association was also found between level of practice and patients level of knowledge (P < .05).

@MondayNightIBD and the Expanding Gastroenterology Twitterverse: A Study on Continuing Medical Education on #GITwitter.

@MondayNightIBD provides weekly continuing medical education (CME) activities focused on inflammatory bowel diseases to clinicians on Twitter. Given its novelty, we assessed whether @MondayNightIBD improves learner knowledge and leads to practice change. We also examined whether inflammatory bowel disease topics addressed in @MondayNightIBD are aligned with entrustable professional activities (EPA) set forth by national gastroenterology societies. @MondayNightIBD CME sessions from February 2020 (date the handle was accredited to provide CME) to May 2021 were analyzed. Preactivity and postactivity knowledge was assessed for average score improvement using the Student t test and Cohen d effect size. Postactivity surveys examined for learners' perceptions of whether activities met educational goals and affected willingness to change clinical practice using descriptive percentages. In addition, activities from April 2019 (date of @MondayNightIBD inception) to May 2021 were assessed for whether they address EPA set forth by national gastroenterology societies. Learners' knowledge improved after @MondayNightIBD activities with average preactivity correct answers of 58% to a postactivity average of 79% ( P < 0.001). Greater than 95% of learners found that activities met learning objectives and enhanced knowledge. A total of 92% of learners were committed to practice change because of their @MondayNightIBD participation. Finally, 78% of EPA set forth by a national gastroenterology society have been covered by @MondayNightIBD since its inception. @MondayNightIBD is a Twitter-based CME activities platform for gastroenterologists and other clinicians that is embraced by learners, improves knowledge, and encourages practice change. Topics covered during @MondayNightIBD are aligned with EPA set forth by national gastroenterology societies. @MondayNightIBD is a successful model of social media medical education and a novel approach to effectively provide evidence-based CME.

Knowledge, Attitude and Practices regarding Brucellosis among Medical Practitioners of Karachi

BACKGROUND:&#x0D; Brucellosis presents with generalized symptomatology and in a country like Pakistan it is commonly misdiagnosed by the medical practitioners as any endemic disease. We aim to assess the knowledge, attitude and practices regarding Brucellosis among the medical practitioners of Karachi and differences in knowledge scores across gender and working sectors. The study was conducted from January 2017 to April 2017 in Karachi.&#x0D; METHODS:&#x0D; Our study was a cross-sectional KAP survey, conducted with the help of a structured questionnaire among 217 medical practitioners by convenient sampling. They were divided into two groups with respect to workplace: Group 1 and Group 2. The results were analyzed using SPSS version 21. Chi-square test was used to establish associations.&#x0D; RESULTS: &#x0D; The study showed that although 89.9% of the medical practitioners have heard about brucellosis, yet only 27.6% were able to identify Brucellosis as the second most emerging zoonotic disease. Across gender, more female than male medical practitioners achieved good knowledge score. In group 1, private sector whereas in group 2, teaching hospital medical practitioners had higher percentage of good score. In the attitude section, 47.5% of the practitioners strongly agreed that Continuing Medical Education (CME) seminars help in creating awareness about diseases. In practice, poor response was recorded for inquiry of questions about Brucellosis in medical history despite of good knowledge about their importance&#x0D; CONCLUSION:&#x0D; The study recognized a gap in knowledge and practices of the medical practitioners hence, there is a need to conduct CME Sessions about the neglected disease.&#x0D; KEYWORDS: Brucellosis, Neuro-brucellosis, Zoonosis, Neglected Disease, Awareness, Health Belief Model, KAP Study, CME

Strategies to improve communication about neurocognitive impacts in pediatric oncology: Quality improvement findings.

Neurocognitive deficits are common among children who receive central nervous system (CNS)-directed therapy for childhood cancer. Parents report that they lack information from and communication with oncology providers about neurocognitive impacts of therapy. Furthermore, oncology providers report they lack training and institutional support to appropriately address the neurocognitive needs of these patients/families. A parent/provider stakeholder informed, quality improvement (QI) project was conducted to educate providers about neurocognitive impacts, increase parent/provider communication, and improve adherence to supportive care guidelines for neuropsychological assessment for children receiving CNS-directed therapy. A 1-h Continuing Medical Education (CME) course was developed to educate providers about neurocognitive impacts and their relation to schooling. A provider-focused electronic medical record (EMR) strategy was used to deliver parent stakeholder-informed return-to-school "roadmaps," with prompts to scaffold parent/provider communication and enhance documentation of findings. Hospital-based CME sessions were attended by 76% (41 out of 54) of providers from our institution. Among the 34 who completed both pretest and posttest, the mean knowledge score improved from 56% at pretest to 74% at posttest. Compliance with the EMR strategy was 80% and there was a 42% increase in neuropsychological assessment referrals. We conclude that this QI project is an example of a successful parent/provider stakeholder collaboration that achieved demonstrable positive change in the areas of provider knowledge, patient/provider communication, and alignment of neuropsychological assessment referrals with existing guidelines. Our results confirm that improving knowledge, communication, and compliance with neuropsychological standards of care is possible with this evidence-based approach.

Continuing medical education about postexposure prophylaxis of rabies in tribal area medical college hospital of Gujarat, India: One step towards rabies elimination.

ABSTRACTBackground:Continuing Medical Education (CME) is an essential feature of the clinical practice and helps to improve the health care provider’s ability to provide quality patient care. The World Health Organization has given a global strategic plan to end human deaths from dog-mediated rabies by 2030 known as “Zero by thirty.”Methodology:A CME session was organized for staff nurses working in a tertiary medical care hospital of Valsad district about anti rabies vaccination. Ninety-one participants were administered the questionnaire about antirabies vaccine (ARV) and related practical aspects before and after the CME session.Results:Mean pre- and post-CME Score of the participants was 5.38 and 8.68 out of 10, respectively which was statistically significant. The majority of the participants could score from 5 to 6 (33, 36.2%) before CME which rose to 9 to 10 after CME (58, 63.7%). A total of 52 participants (57%) showed improvement in total score by more than 5 points after attending CME, whereas 13 (14%) showed no improvement. The maximum improvement (52.1%) was found in the fact that currently available vaccine vials are the same for intradermal (ID) and intramuscular (IM) regimes, followed by the need for immunoglobulins in category III animal bites (44.3%).Conclusion:CME showed significant improvement in knowledge regarding rabies and antirabies vaccination. The knowledge regarding the similar schedule for both adults and children needs improvement. Subsequent CME programs should focus on these aspects for the effective management of animal bite patients.

SERVICE AVAILABILITY, AND READINESS OF PRIMARY CARE HEALTH FACILITIES TO OFFER HYPERTENSION DIAGNOSIS SERVICES IN WAKISO DISTRICT – UGANDA

Objective: To determine the availability of hypertension diagnostic services, the readiness of health center IIs, health-facility associated factors, facilitators and the barriers in provision of hypertension diagnosis services. Design and method: A cross sectional study design was used, 79 health facilities were sampled randomly. Health facility checklists were administered to the health facility in-charges, individual semi-structured questionnaires to health workers and key informant interview guides to a purposive sample of health workers and personnel at Wakiso district. Chi-square and the Fisher's exact test were used to assess associations between categorical variables. Service availability was measured by assessing the provision of blood pressure (BP) measurements, weight measurements and the scheduling of regular check-ups. Readiness was measured by assessing the availability and functional status of the BP apparatus and other hypertension diagnostic equipment and supplies, and yet also the presence of a trained health care provider. Results: The majority (86%) of the primary care health facilities offered all the hypertension diagnosis services and 13% of the health centre IIs were ready to offer comprehensive hypertension diagnosis services. There were significant associations between the level of the health facility; BP measurements (P = 0.005), managing newly diagnosed cases of hypertension (P = 0.001), and scheduling of regular check-ups (P = 0.003). The health workers were facilitated by the availability of equipment, primary health care funds and implementing partners, whereas the barriers faced were the lack of equipment, availability of non-functional equipment, delays in receiving trainings’ and inadequate staffing. Conclusions: The study showed that the majority of the health facilities offered hypertension diagnosis services including the Health Centre IIs which are lowest in the tier. There were gaps in the readiness to offer hypertension diagnosis services, thus equipment should be routinely calibrated, replaced and routine continuous medical education sessions should be provided to the health workers.

Continuing medical education during a pandemic: an academic institution’s experience

The COVID-19 pandemic has affected healthcare systems worldwide. The disruption to hospital routines has affected continuing medical education (CME) for specialty trainees (STs). We share our academic institution's experience in...

An innovative continuing medical education approach of general practitioners on vaccination: ForMéVac

Abstract Background General practitioners (GPs) play a central role in vaccinating the population in France. In a context of mistrust regarding vaccination, and because patients increasingly question their GP about vaccines, we designed the continuing medical education (CME) module in order to 1) reinforce GPs knowledge about vaccination 2) help GPs answer questions most frequently asked by their patients and 3) evaluate the impact of this module on their vaccine prescriptions. Methods The CME module lasted 3 hours and focused on MMR, meningitis C and seasonal influenza vaccines; GPs were given confidential feedback information on percentages of their patients vaccinated. We included GPs practicing in Southeastern France and with less than 60% of their child patients (aged between 10 and 34 months) with 2 reimbursements of MMR vaccines (data obtained from the Health Insurance Fund). Eligible GPs were then randomly assigned to three groups: those offered either a face-to-face or e-learning CME module and a control group without CME. We used vaccine reimbursement rates for MMR 2-doses, Meningitis C, seasonal influenza as proxies for vaccine prescription rates, and a difference in differences approach to compare reimbursement rates in the year before the CME session and in the 24 months post-intervention. Results Compared to the control group, vaccine reimbursement rates for 2-dose MMR and meningitis C increased by 6% and 4% respectively (p &amp;lt; 0.05) among patients of GPs who participated in the face-to-face CME session (52 GPs, with 1 842 children). For seasonal influenza vaccine, we found a 12% increase in the face-to-face group (p &amp;lt; 0.01). We found no statistically significant increase in the e-learning group (19 GPs, with 674 children) whatever the vaccine. Conclusions We found a modest impact of face-to-face CME session with feedback on GPs practices for childhood vaccines and a stronger one for seasonal influenza. Key messages The very positive feedback from face-to-face training highlights the fact that this type of training, which bring knowledge on vaccination in general and specific vaccines to GPs, is necessary. We found weak evidence for efficiency of CME sessions associated with audit/feedback to modify GPs practices regarding MMR and meningitis C vaccines.

Relevance of the health insurance databases to study potentially inappropriate prescriptions

Abstract Issue/problem Potentially inappropriate prescriptions (PIP) for the elderly constitute a major issue in the quality of ambulatory care. In France, people aged 80 years or older use on average five drugs per day. This polypharmacy is justified in most cases by multimorbidity but it increases the risk of adverse events. Description of the problem In order to optimize general practitioners’ (GPs) prescribing practices for the elderly, a project involving the Southeastern Health Regional Observatory (ORS Paca), the Regional Medical Department of Health Insurance Fund (DRSM Paca-Corse) and the Regional Union of Private Practitioners (URPS-ML Paca) was conducted in 2014-2016. Its main objective was to set up a regional mapping tool giving GPs access to drug prescriptions indicators for the elderly in their practice area. Results Based on national guidelines and advice of experts in the field, we calculated 7 different indicators of potentially inappropriate prescriptions (PIPs) for people aged 65 years or older, using drug reimbursement data from the Health Insurance Fund. Those indicators were calculated among patient lists of GPs and covered prescriptions of benzodiazepines, non-steroidal anti-inflammatory (NSAI) drugs, new oral anticoagulants, proton pump inhibitors, antiplatelet therapy... PIPs’ prevalence were calculated among GPs’ lists of patients. PIPs prevalence differed between drugs type, GPs and territories: for example, the age standardized prevalence of long-term treatment with NSAI drugs varied in 2014 from 2 to 15% between municipalities and from 0 to 14% in 2017. Lessons These results allowed to identify priority areas for intervention, in which continuous medical education sessions with an individual feedback to GPs on their own indicators were implemented, to improve prescribing practices. Key messages A substantial proportion of elderly people receive PIPs. Medico-administrative databases can be used to produce indicators of prescription practices to be used to guide public health interventions.

Using rubber stamps and mobile phones to help understand and change antibiotic prescribing behaviour in private sector primary healthcare clinics in Kenya

BackgroundAntibiotic use in primary care can drive antimicrobial resistance (AMR) in the community. However, our understanding of antibiotic prescribing in low- and middle-income countries (LMICs) stems mostly from hospital-based studies...

The Management of Depressed Patients by the Tunisian General Practitioners: A Critical Trans-sectional Study.

Under-diagnosed and under-treated, depression has a pejorative prognosis. The general practitioners (GP) represent the most often consulted healthcare professionals by depressed patients. The aim was to describe how the Tunisian GPs manage the depressed patients and to note the difficulties they encounter in order to suggest corrective measures. A survey was conducted among 140 GPs in Sfax Governorate. The percentage of the GPs whose responses conformed to the scientific data in at least 67% of the items was 31.4%. Four factors were correlated to a good management of depression: age (p = 0.028), masculine gender (p = 0.016), long career (p = 0.034) and participation to continuous medical education sessions on depression (p = 0.01). Our study revealed inadequacies in the management of depression by the GPs. GPs were invited to sensitizing meetings. A training on depression was assured for the future internship supervisors by the commission of medicine of family in the Faculty of Medicine of Sfax.

Effectiveness of traditional lectures and case methods in Swedish general practitioners’ continuing medical education about COPD: a cluster randomised controlled trial

ObjectivesTo study the effects of continuing medical education (CME) about chronic obstructive pulmonary disease (COPD) for general practitioners (GPs) by comparing two commonly used CME methods with each other and...

Effect of a two-day extensive continuing medical education course on participants' knowledge of clinical and operative urology.

Continuing Medical Education (CME) is an established method for facilitating the lifelong learning and developing knowledge, skills and attitudes to ensure delivery of a medical care which is up-to-date, evidence based, safe and patient-centered. An extensive 2 day urology course was conducted to meet the needs of learners. The purpose of the current study was to measure the effect of this CME activity on the knowledge of the participants. This quasi-experimental, single group pre-, and post-test study measured the gain in learning as a result of the two-day extensive CME course conducted by the section of Urology at Department of Surgery, the Aga Khan University, Karachi-Pakistan. Gain in knowledge, defined as the difference between the pre-test and the post-test scores, was taken as a measure of course effectiveness. The test comprised of 40 one-best type carefully constructed multiple choice questions (MCQs). Item analyses were also performed. Forty-five out of a total of 70 participants from within and outside the city completed both pre and post-tests and were included in the study. The mean age of the subjects was 33.3+6.7 years. Of these 45 participants, 68.9% (n=31) of them were trainees at different levels. Mean gain in knowledge was 12.7±6.8% (p<0.01; 95% CI: 4.17-5.79). Mean test scores improved significantly from 37.8±11.3% to 50.3±10.8%. Difference in pre and post scores due to age, gender, practice type or years since start of training was not significant. The reliability of the test using Cronbach's α was 0.634. CME sessions when designed and delivered carefully are effective means of increasing the knowledge significantly. Pre- and post-test is a reliable and valid strategy to measure gain in participants' knowledge.

Continuing Dermatology Education for Rural Physician Assistants in Ghana: An Assessment of Needs and Effectiveness

To assess the effectiveness of lectures for continuing medical education (CME) in dermatology in a global health setting and to determine provider and patient demographics of physician assistants (PAs) practicing in rural Ghana. Physician assistants from Ghana who attended dermatology lectures at the International Seminar for Physician Assistants in 2011 or 2014 were included in this study. Surveys were administered to participants to determine dermatology resource availability, commonly encountered skin diseases, and management practices. Quizzes were administered before and after CME dermatology lectures to assess short-term retention of lecture material. In all, 353 PAs participated in this study. Physician assistants reported seeing an average of 55 patients per day. The most commonly seen skin diseases were infections, with antifungals and antibiotics being the most commonly prescribed medications. Dermatology-related complaints represented 9.5% of total clinic visits. Among practicing PAs, 23.2% reported having internet access. A total of 332 PAs completed the quizzes, and a statistically significant increase in test scores was noted in postlecture quizzes. This study reinforces the importance of dermatology education for PAs practicing in rural areas of Ghana and lends insight to critical topics for dermatology curriculum development. In addition, the increase in test scores after CME sessions suggests that lectures are an effective tool for short-term retention of dermatology-related topics. Our study indicates that as the need for health workers increases globally and a paradigm shift away from the traditional physician model of care occurs, dermatology training of PAs is not only important but also achievable.

Implementation of a Flipped Classroom for Nuclear Medicine Physician CME.

Increasingly, emerging technologies are expanding instructional possibilities, with new methods being adopted to improve knowledge acquisition and retention. Within medical education, many new techniques have been employed in the undergraduate setting, with less utilization thus far in the continuing medical education (CME) sphere. This paper discusses the use of a new method for CME-the "flipped classroom," widely used in undergraduate medical education. This method engages learners by providing content before the live ("in class") session that aids in preparation and fosters in-class engagement. A flipped classroom method was employed using an online image-rich case-based module and quiz prior to a live CME session at a national nuclear medicine meeting. The preparatory material provided a springboard for in-depth discussion at the live session-a case-based activity utilizing audience response technology. Study participants completed a survey regarding their initial experience with this new instructional method. In addition, focus group interviews were conducted with session attendees who had or had not completed the presession material; transcripts were qualitatively analyzed. Quantitative survey data (completed by two-thirds of the session attendees) suggested that the flipped method was highly valuable and met attendee educational objectives. Analysis of focus group data yielded six themes broadly related to two categories-benefits of the flipped method for CME and programmatic considerations for successfully implementing the flipped method in CME. Data from this study have proven encouraging and support further investigations around the incorporation of this innovative teaching method into CME for nuclear imaging specialists.

Continuing Medical Education: A Cross Sectional Study on a Developing Country's Perspective.

To determine the attitude of general practitioners towards continuing medical education (CME) and reasons motivating or hindering them from attending CME procedures, we conducted a cross-sectional survey from November 2013 to April 2014 in Karachi. Three hundred general practitioners who possessed a medical license for practice in Pakistan filled a pre-designed questionnaire consisting of questions pertaining to attitudes towards CME. Data was entered and analyzed using SPSS v16.0. 70.3% (n=211) of the participants were males. Mean age was 47.75±9.47years. Only 67.33% knew about CME and only 52% had attended a CME session. Reasons for attending CME procedures reported were: need for updating knowledge, skills and competencies (67.30%), opportunity to meet colleagues (18.58%) and presenting scientific papers (8.97%). Mean Likert score was 1.67 (±0.667) for those who thought CME is worthwhile and 1.44 (±0.686) for those who consider their clinical duties as the major hurdle in attending CME procedures. Most common cause for not attending CME was lack of knowledge (32.66%) followed by time constraint (24%). Most physicians were not sufficiently informed about the potential benefits of CME and had never attended a CME session. Most common reason for attending CME procedures reported was need for updating knowledge, skills and competencies while reasons hindering physicians from attending CME were lack of knowledge and time constraint.

InsuOnline, an Electronic Game for Medical Education on Insulin Therapy: A Randomized Controlled Trial With Primary Care Physicians.

BackgroundMost patients with diabetes mellitus (DM) are followed by primary care physicians, who often lack knowledge or confidence to prescribe insulin properly. This contributes to clinical inertia and poor glycemic control. Effectiveness of traditional continuing medical education (CME) to solve that is limited, so new approaches are required. Electronic games are a good option, as they can be very effective and easily disseminated.ObjectiveThe objective of our study was to assess applicability, user acceptance, and educational effectiveness of InsuOnline, an electronic serious game for medical education on insulin therapy for DM, compared with a traditional CME activity.MethodsPrimary care physicians (PCPs) from South of Brazil were invited by phone or email to participate in an unblinded randomized controlled trial and randomly allocated to play the game InsuOnline, installed as an app in their own computers, at the time of their choice, with minimal or no external guidance, or to participate in a traditional CME session, composed by onsite lectures and cases discussion. Both interventions had the same content and duration (~4 h). Applicability was assessed by the number of subjects who completed the assigned intervention in each group. Insulin-prescribing competence (factual knowledge, problem-solving skills, and attitudes) was self-assessed through a questionnaire applied before, immediately after, and 3 months after the interventions. Acceptance of the intervention (satisfaction and perceived importance for clinical practice) was also assessed immediately after and 3 months after the interventions, respectively.ResultsSubjects’ characteristics were similar between groups (mean age 38, 51.4% [69/134] male). In the game group, 69 of 88 (78%) completed the intervention, compared with 65 of 73 (89%) in the control group, with no difference in applicability. Percentage of right answers in the competence subscale, which was 52% at the baseline in both groups, significantly improved immediately after both interventions to 92% in the game group and to 85% in control (P<.001). After 3 months, it remained significantly higher than that at the baseline in both groups (80% in game, and 76% in control; P<.001). Absolute increase in competence score was better with the game (40%) than with traditional CME (34%; P=.01). Insulin-related attitudes were improved both after the game (significant improvement in 4 of 9 items) and after control activity (3 of 9). Both interventions were very well accepted, with most subjects rating them as “fun or pleasant,” “useful,” and “practice-changing.”ConclusionsThe game InsuOnline was applicable, very well accepted, and highly effective for medical education on insulin therapy. In view of its flexibility and easy dissemination, it is a valid option for large-scale CME, potentially helping to reduce clinical inertia and to improve quality of care for DM patients.Trial RegistrationClinicaltrials.gov NCT001759953; https://clinicaltrials.gov/ct2/show/NCT01759953 (Archived by WebCite at http://www.webcitation.org/6oeHoTrBf)