The perspectives of learners at a public medical school on the evaluation of an online learning management system for degree and non-degree courses.

BACKGROUND: There has been a rapid development and adoption of online learning in medical education. However, it is difficult to adopt the currently available online learning management systems (LMS). This study aimed to examine learners' perspectives on the evaluation of online LMS. METHODS: An online LMS was developed based on the evidence-based guidelines. Two cross-sectional studies were conducted. A short survey was conducted with 716 learners registered on the LMS to obtain their perspectives on the online participation. A satisfaction survey was conducted with 255 learners enrolled in the courses taught solely online. Data from the LMS monitoring system was used to report the uptake of online courses. Data were analyzed using descriptive statistics. RESULTS: Participants reported that the major factor influencing LMS uptake was the ability to be accessed anytime and anywhere (n = 556, 77.7%). The participants had good experience in using the LMS and were satisfied with it (n = 255, mean = 4.53, SD = 0.62). For online degree courses, the course had a high completion rate of 90% provided that a mark was assigned for course attendance. For non-degree courses, irrespective of whether they were free, paid, exam-based, or participation only, the completion rate was considered low (range 4.3-36.7%). CONCLUSION: Under a limited budget, a medical school in a low- to middle-income country could develop an effective online LMS to meet learners' needs. Our newly developed online LMS is relevant, accepted and to the satisfaction of the learners. Medical schools in the same context are encouraged to develop their own online LMS that serve and support learning in both degree and non-degree courses.

Uptake and effectiveness of online diabetes continuing education: The perspectives of Thai general practitioner trainees.

Background: Despite continuing medical education (CME) programmes on evidence-based diabetes care, evidence-based best practice and actual GP practice remain scant. Online CME offers numerous benefits to general practitioners (GPs), particularly during the coronavirus disease 2019 (COVID-19) pandemic. In Thailand, CME is a voluntary process and is yet to be established as a mandatory requirement. This study examined GP uptake of online diabetes CME and the changes in GPs' attitudes to and knowledge of Type 2 diabetes management. Methods: A cross-sectional study and a before-and-after study were employed with 279 GP trainees who voluntarily undertook a newly-developed online diabetes programme. A follow-up survey was conducted six months after the GP trainees completed their training. Results: One hundred and twelve out of 279 GP trainees (40.1%) participated in the study, of whom 37 (13.3%) enrolled in the online diabetes programme, and 20 (7.2%) completed the programme. Before enrolling in the programme, the participants' mean diabetes knowledge score was 61.5%. The participants' confidence in effective insulin treatment increased significantly after the programme (95% Confidence interval [CI], -0.51-0.00; P = 0.05), but their knowledge scores before and after the programme were not statistically different (95% CI, -3.93-0.59; P = 0.14). Conclusion: Uptake of the online diabetes CME was poor, although appropriate recruitment strategies were employed, and the online educational option was attractive and accessible during the COVID-19 pandemic. This study emphasises the gap between evidence-based practice and actual GP practice and the need for mandatory CME.

The effects of a newly established online learning management system: the perspectives of Thai medical students in a public medical school.

BACKGROUND: There are obstacles for medical schools in low- and middle-income countries (LMIC) to implement an online learning management system (LMS) during the pandemic of coronavirus disease 2019. Our medical school has developed and implemented tailored LMS for medical students and examine the acceptance and effects of this LMS on the medical students' learning outcomes and identify factors influencing their adoption of online learning. METHODS: This was a mixed-methods study using an online questionnaire and online semi-structured interviews with first-year medical students at one medical school in Thailand. The platform's monitoring system and questionnaire data were analysed using descriptive statistics and binary logistic regression. RESULTS: The response rate was 55.5% (157/283). Most of the respondents agreed on the advantages and were very satisfied with their learning experience. The logistic regression showed that content quality (adjusted odds ratio (AOR) = 2.43; 95% CI = 1.11-5.31) and perceived usefulness (AOR = 2.75; 95% CI = 1.02-7.39) were significantly associated with the acceptance of online learning among medical students. There was no association between the test scores and time spent in the course. CONCLUSION: Despite limited evidence of LMS effectiveness in medical schools in LMIC, learning on a customised LMS appeared to be accepted, useful, user-friendly, and effective among medical students. The perceived usefulness and the content quality are associated with the acceptance of online learning. Medical schools in LMIC can develop their own LMS to ensure that it meets their learners' and faculties' needs. This study is a single-institution study, further large-scale studies are needed to ensure generalisability.

Factors associated with the entry to general practice training: A multicentre study.

BACKGROUND: Despite recent studies regarding general practice (GP) career decision-making, the impact of primary care exposure during undergraduate study on career-decision-making remain unclear. PURPOSE: To examine the association between primary care exposure with the entry to GP training. METHODS: An unmatched case-control study design was employed. A total of 130 trainees in GP training and 260 trainees in other speciality training were randomly selected from speciality training registration. Questionnaires were used to identify primary care exposure and factors associated with career-decision making. Odds ratios (OR) and logistic regression were used to examine the association between the entry to GP training and those factors. RESULTS: The response rate was 66.4%. Three variables were found associated with entering GP training, including timetabled primary care sessions in all three clinical years (adjusted OR = 2.91; 95% CI = 1.23 - 6.88), enrolling in rural medical student recruitment schemes (adjusted OR = 3.07; 95% CI = 1.05 - 8.99) and valuing core values of GP (adjusted OR = 8.46; 95% CI = 3.27 - 21.88). CONCLUSION: Our findings suggest that timetabled primary care sessions in all three clinical years has a positive influence on entering GP training. This research extends our knowledge of primary care exposure regarding continuity of the exposure.

Impact of GP gatekeeping on quality of care, and health outcomes, use, and expenditure: a systematic review.

BACKGROUND: GPs often act as gatekeepers, authorising patients' access to specialty care. Gatekeeping is frequently perceived as lowering health service use and health expenditure. However, there is little evidence suggesting that gatekeeping is more beneficial than direct access in terms of patient- and health-related outcomes. AIM: To establish the impact of GP gatekeeping on quality of care, health use and expenditure, and health outcomes and patient satisfaction. DESIGN AND SETTING: A systematic review. METHOD: The databases MEDLINE, PreMEDLINE, Embase, and the Cochrane Library were searched for relevant articles using a search strategy. Two authors independently screened search results and assessed the quality of studies. RESULTS: Electronic searches identified 4899 studies (after removing duplicates), of which 25 met the inclusion criteria. Gatekeeping was associated with better quality of care and appropriate referral for further hospital visits and investigation. However, one study reported unfavourable outcomes for patients with cancer under gatekeeping, and some concerns were raised about the accuracy of diagnoses made by gatekeepers. Gatekeeping resulted in fewer hospitalisations and use of specialist care, but inevitably was associated with more primary care visits. Patients were less satisfied with gatekeeping than direct-access systems. CONCLUSION: Gatekeeping was associated with lower healthcare use and expenditure, and better quality of care, but with lower patient satisfaction. Survival rate of patients with cancer in gatekeeping schemes was significantly lower than those in direct access, although primary care gatekeeping was not otherwise associated with delayed patient referral. The long-term outcomes of gatekeeping arrangements should be carefully studied before devising new gatekeeping policies.