Text messaging to improve resident knowledge: a randomized controlled trial.

BACKGROUND AND OBJECTIVES: Advances in technology present opportunities to develop and test innovative teaching methods. We sought to evaluate whether text messaging could improve medical resident knowledge in musculoskeletal medicine. METHODS: Eleven U.S. family medicine residency programs with a total of 269 residents participated in this randomized, controlled trial. Residents were invited to complete a pretest to assess musculoskeletal medicine knowledge. The residents randomized to the intervention group were then offered to receive text messages termed electronically Generated Educational Messages (eGEMs) three times per week during a 12-week period. The primary outcome was change in pretest and posttest scores among residents in an intervention group (those who received text messages) as compared to a control group (those who did not receive the text messages). Focus groups were conducted to assess resident acceptability and usefulness of text messaging as a teaching tool. RESULTS: Sixty-three residents completed the pretests and posttests. The intervention group's score improved from 55% of questions answered correctly to 64%; the control group improved from 56% to 61%. While these pretest/posttest changes each were statistically significant, the difference in improvement between the two groups was not. Focus groups revealed that participants liked the intervention, but suggestions for improvement included ability to tailor the eGEMs. CONCLUSIONS: The use of eGEMs as initially developed did not increase resident knowledge based on exam scores. Further study is needed to determine if a more tailored intervention is effective.

Paradichlorobenzene (toxin)-induced leucoencephalopathy.

A 40-year-old woman with a history of polysubstance abuse, hypertension, depression and anxiety with panic attacks admitted to the emergency room at the request of her primary physician owing to progressive decline in her mental status associated with anorexia and generalised pruritic skin rashes. Initial outpatient workup and that during two previous hospital admissions including thyroid function and syphilis tests, urine toxicology screen and brain imaging studies were unremarkable. Repeat MRI of the brain during her third hospital admission showed diffuse periventricular and white matter disease. This prompted further questioning of family members which revealed chronic ingestion of mothballs and toilet cakes containing paradichlorobenzene in the patient leading to toxin-induced leucoencephalopathy consistent with her neurological symptoms of altered mental status, ataxic gait, cogwheel rigidity in the arms and characteristic skin rashes. Subsequently, a feeding tube was placed to address her worsening nutritional status and she was discharged home in a stable state.