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Using Internet CME to Improve PCP Skin Cancer Knowledge and Skills

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Title: Using Internet CME to Improve PCP Skin Cancer Knowledge and Skills


1
  • Using Internet CME to Improve PCP Skin Cancer
    Knowledge and Skills
  • John M. Harris Jr., MD, FACP
  • February 6, 2003

2
The Opportunity
  • Based on a small number of well-conducted
    trials, didactic sessions
    do not appear to be effective in changing
    physician performance.
  • Haynes RB, Davis DA, McKibbon A, Tugwell P. A
    critical appraisal of the efficacy of continuing
    medical education. JAMA. 198425161-64.
  • Davis DA, Thomson MA, Oxman AD, Haynes RB.
    Evidence for effectiveness of CME A review of 50
    randomized controlled trials. JAMA.
    19922681111-1117.
  • Davis DA, Thomson MA, Oxman AD, Haynes RB.
    Changing physician performance. A systematic
    review of the effect of continuing medical
    education strategies. JAMA. 1995274700-705.
  • Davis DA, Thomson O'Brien MA, Freemantle N, Wolf
    FM, Mazmanian P, Taylor-Vaisey A. Do conferences,
    workshops, rounds, and other traditional
    continuing education activities change physician
    behavior or health care outcomes? JAMA.
    1999282867-874.

3
Goal ? Improved Performance
  • In the first place, it is assumed that education
    is a process which seeks to change the behavior
    pattern of human beings.

Tyler RW. General statement on evaluation.
Journal of Educational Research. 194235492-501
4
Background
  • Three online CME programs in cancer prevention
    funded by NIH, 1998-2001
  • Skin 12 hours
  • Breast 3 hours
  • Prostate 2 hours
  • Most experience with skin cancer
  • Most users 1,631 since 1998
  • Three studies of effectiveness

5
Previous Results
  • Successfully teaches a melanoma management
    algorithm to faculty and house officers (Harris
    JM, Salasche SJ, Harris RB. Journal of Evaluation
    in Clinical Practice. 19995199-211).
  • Improves MD knowledge, confidence, skills in
    managing pigmented lesions via Internet (Harris
    JM, Salasche SJ, Harris RB. Journal of General
    Internal Medicine. 20011650-56).
  • 6 hour online CME program
  • 354 MDs, pretest/posttest
  • Improvement in confidence (P
  • 52?85 on 10-item knowledge test (P
  • 81 ?90 on 15-item clinical skills test (P

6
Previous Results - continued
  • Can be successfully exported to other settings
    via Internet (Harris JM, Salasche SJ, Harris RB.
    British Medical Journal. 20013231106).
  • 18 hour online CME program sponsored by RCGP
  • Offered to UK physicians only
  • 150 MDs, same pretest/posttest as previous work
  • Improvement in confidence (P
  • 60?86 on 10-item knowledge test (P
  • 87 ?90 on 15-item clinical skills test (P

7
Objective
  • To determine
  • If the online skin cancer CME program,
    previously shown to be effective in improving
    physician knowledge and skills in a research
    setting, would be utilized by physicians in a
    community-based IPA
  • Whether the online CME program could improve IPA
    physicians skin cancer knowledge and skills

8
Outcome Measure
  • Percent of physicians using program
  • Cost/user cost/CME hour granted
  • 3 satisfaction questions
  • 39 question pre/posttest
  • 1 training
  • 1 practice
  • 7 attitude
  • 9 knowledge
  • 21 skills 9 benign 12 malignant lesions
  • No training/practice questions on posttest
  • No images repeated from the program
  • After posttest questions user given comparison of
    results and discussion of answers

9
7 Teaching Modules
  • 60,000 words, 150 images
  • Early recognition of melanoma
  • Skin cancer risk factors
  • Skin cancer prevention
  • Common benign lesions
  • Actinic keratoses
  • Squamous cell carcinoma
  • Basal cell carcinoma

10
Educational Approach
  • Simplify issues where possible
  • Allow practice of clinical skills
  • Provide customized feedback
  • Offer JIT tutorials
  • Let user control the pace
  • Continuous availability - use asynchronous
    technology
  • Make navigation easy, allow pause/return
  • Permit author feedback
  • Example at http//melanoma.lecturehall.com

11
Simplify Issues
  • Clinical algorithm for managing a pigmented skin
    lesion

12
Practice Skills
13
More Practice
14
Customized Feedback
15
JIT Information
16
User-Controlled Pace, Easy Navigation
Once pretest is complete, user selects which
module to view
User can return to start or navigate within each
module
17
Oasis IPA/Desert Medical Group
  • 250 physicians in Palm Springs
  • Medical Director interested in improving skin
    cancer care and in improving relations with PCPs
  • Offered online program via custom Web site to 50
    PCPs May-Sept 2002
  • 12 hours CME 50

18
Results
  • 14/50 completed entire program (28.0)
  • Users extremely pleased (1-5 scale)
  • How well were the learning objectives of this
    program met? 4.7
  • How relevant was the information in this program
    to your clinical practice? 4.9 How would you
    rate this program overall? 4.8
  • Medical Director extremely pleased
  • Total cost to IPA 5,500

19
Results (continued)
  • 9 knowledge questions Pre 57.1, Post 79.4,
    p
  • 21 clinical questions Pre 72.6 Post 76.9,
    p0.05
  • I am confident in my ability to distinguish
    classic basal cell carcinomas from benign nodular
    lesions. (1-5 scale) Pre3.57, Post4.00
  • Confidence otherwise unchanged
  • Clinical skills better for 12 malignant lesions
    Pre 88, Post 97
  • Worse for 9 benign lesions Pre 65, Post 47

20
User Characteristics
  • Oasis Users (14)
  • 43 Female
  • 71 FP 29 IM
  • Age 45
  • Oasis Non-Users (36)
  • 10 Female
  • 44 FP 49 IM
  • Age 52

21
Why Not Used?
  • Surveyed 28/36 non-users (78)
  • Familiar with program 61
  • Never previously used Internet for CME 61
  • Most common reasons No Internet access, too busy

22
Conclusions
  • Online CME program was reasonably utilized (28)
  • Program was well appreciated by users
  • Program provided increase in knowledge skills
  • Typical user more likely to be young, female,
    FP
  • Probably best used as part of larger QI effort
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