Knowledge retention after an online tutorial: a randomized educational experiment among resident physicians.

BACKGROUND: The time course of physicians' knowledge retention after learning activities has not been well characterized. Understanding the time course of retention is critical to optimizing the reinforcement of knowledge. DESIGN: Educational follow-up experiment with knowledge retention measured at 1 of 6 randomly assigned time intervals (0-55 days) after an online tutorial covering 2 American Diabetes Association guidelines. PARTICIPANTS: Internal and family medicine residents. MEASUREMENTS: Multiple-choice knowledge tests, subject characteristics including critical appraisal skills, and learner satisfaction. RESULTS: Of 197 residents invited, 91 (46%) completed the tutorial and were randomized; of these, 87 (96%) provided complete follow-up data. Ninety-two percent of the subjects rated the tutorial as "very good" or "excellent." Mean knowledge scores increased from 50% before the tutorial to 76% among those tested immediately afterward. Score gains were only half as great at 3-8 days and no significant retention was measurable at 55 days. The shape of the retention curve corresponded with a 1/4-power transformation of the delay interval. In multivariate analyses, critical appraisal skills and participant age were associated with greater initial learning, but no participant characteristic significantly modified the rate of decline in retention. CONCLUSIONS: Education that appears successful from immediate posttests and learner evaluations can result in knowledge that is mostly lost to recall over the ensuing days and weeks. To achieve longer-term retention, physicians should review or otherwise reinforce new learning after as little as 1 week.

Development, feasibility and performance of a health risk appraisal questionnaire for older persons.

BACKGROUND: Health risk appraisal is a promising method for health promotion and prevention in older persons. The Health Risk Appraisal for the Elderly (HRA-E) developed in the U.S. has unique features but has not been tested outside the United States. METHODS: Based on the original HRA-E, we developed a scientifically updated and regionally adapted multilingual Health Risk Appraisal for Older Persons (HRA-O) instrument consisting of a self-administered questionnaire and software-generated feed-back reports. We evaluated the practicability and performance of the questionnaire in non-disabled community-dwelling older persons in London (U.K.) (N = 1090), Hamburg (Germany) (N = 804), and Solothurn (Switzerland) (N = 748) in a sub-sample of an international randomised controlled study. RESULTS: Over eighty percent of invited older persons returned the self-administered HRA-O questionnaire. Fair or poor self-perceived health status and older age were correlated with higher rates of non-return of the questionnaire. Older participants and those with lower educational levels reported more difficulty in completing the HRA-O questionnaire as compared to younger and higher educated persons. However, even among older participants and those with low educational level, more than 80% rated the questionnaire as easy to complete. Prevalence rates of risks for functional decline or problems were between 2% and 91% for the 19 HRA-O domains. Participants' intention to change health behaviour suggested that for some risk factors participants were in a pre-contemplation phase, having no short- or medium-term plans for change. Many participants perceived their health behaviour or preventative care uptake as optimal, despite indications of deficits according to the HRA-O based evaluation. CONCLUSION: The HRA-O questionnaire was highly accepted by a broad range of community-dwelling non-disabled persons. It identified a high number of risks and problems, and provided information on participants' intention to change health behaviour.

Learning and retention from an online tutorial among resident physicians.

We randomized 91 residents who completed an online diabetes tutorial to take a post-test after 0, 1, 3, 8, 21, or 55 days. 87 subjects provided complete follow-up data (96%). Knowledge scores were 2.5 standard deviations above baseline for those tested immediately; gains were half as great after 8 days; no retention remained at 55 days. In linear regression modeling, critical appraisal skills and time spent on the interactive tutorial correlated with greater learning.

A test of knowledge about prostate cancer screening. Online pilot evaluation among Southern California Physicians.

BACKGROUND: Although the benefits of prostate cancer screening are uncertain and guidelines recommend that physicians share the screening decision with their patients, most U.S. men over age 50 are routinely screened, often without counseling. OBJECTIVE: To develop an instrument for assessing physicians' knowledge related to the U.S. Preventive Services Task Force recommendations on prostate cancer screening. PARTICIPANTS: Seventy internists, family physicians, and general practitioners in the Los Angeles area who deliver primary care to adult men. MEASUREMENTS: We assessed knowledge related to prostate cancer screening (natural history, test characteristics, treatment effects, and guideline recommendations), beliefs about the net benefits of screening, and prostate cancer screening practices for men in different age groups, using an online survey. We constructed a knowledge scale having 15 multiple-choice items. RESULTS: Participants' mean knowledge score was 7.4 (range 3 to 12) of 15 (Cronbach's alpha=0.71). Higher knowledge scores were associated with less belief in a mortality benefit from prostate-specific antigen (PSA) testing (r=-.49, P<.001). Participants could be categorized as low, age-selective, and high users of routine PSA screening. High users had lower knowledge scores than age-selective or low users, and they believed much more in mortality benefits from PSA screening. CONCLUSIONS: Based on its internal consistency and its correlations with measures of physicians' net beliefs and self-reported practices, the knowledge scale developed in this study holds promise for measuring the effects of professional education on prostate cancer screening. The scale deserves further evaluation in broader populations.

The stadium diagram, a web-based tool for visualizing the expected outcomes of alternative clinical management strategies.

OBJECTIVE: To explore the use of graphical animation for helping clinicians to understand the evidence about expected risks and benefits associated with multi-step clinical management strategies. METHODS: We used Flash and XML to create a tool capable of displaying the sequence of health state changes that may result from a specific management strategy, as applied to a simulated population. We evaluated this tool in 6 focus groups involving a total of 44 community internists and family physicians. We successively revised the tool based on grounded theory analysis of the focus group transcripts. RESULTS: The process of responding to design issues raised in focus groups resulted in a final tool that presents a group of person icons arranged in rows to give the illusion of people in a stadium or theater. Each action in the management strategy causes persons to change color and move among rows to reflect changes in health state. The tool can play audio narration to explain each step and links are provided to the supporting evidence. Most physicians found these visualizations to be attractive and clear. Some were interested in using the tool with patients. Others rejected the specific decision model used to demonstrate the tool and a few rejected the notion of applying quantitative risks to individual patients. CONCLUSIONS: A visual approach to demonstrating the possible benefits and harms of a given management strategy holds interest for many clinicians. However, visualizations may fail to influence clinicians who do not believe the available evidence.