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The Educational Impact of Weekly E-Mailed Fast Facts and Concepts

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In this study, the authors assessed the educational impact of weekly Fast Facts and Concepts (FFAC) e-mails on residents’ knowledge of palliative care topics, self-reported preparedness in palliative care skills, and satisfaction with palliative care education.

The more papers I read, like learning a foreign language, the thinner the blur between mystery and comprehension in terms of judging a paper and its contents. My goal is to be able to conduct such research and write such papers. I understandably feel that a first degree in medicine and a second masters degree in education is required at this level. At best I might be able to take on psychology or neuroscience. My preference and hope would be to become part of a team of experts.

Purpose: Educational interventions such as electives, didactics, and Web-based teaching have been shown to improve residents’ knowledge, attitudes, and skills. However, integrating curricular innovations into residency training is difficult due to limited time, faculty, and cost.

What – A clear problem:

Integrating palliative care into residency training can be limited by the number of trained faculty, financial constraints, and the difficulty of adding educational content with limited resident duty hours. (Claxton et al. p. 475 2011)

Who – Participants

Beginning internal medicine interns

Why – Time- and cost-efficient strategies for creating knowledge transfer are increasingly important. Academic detailing, an educational practice based on behavioral theory, uses concise materials to highlight and repeat essential messages. Soumerai  (1990)

How – We designed this study to assess the educational impact of weekly e-mailed FFAC on
internal medicine interns in three domains: knowledge of palliative care topics, satisfaction with palliative care education, and self-reported preparedness in palliative care skills.

Methods

This randomized, controlled study of an educational intervention included components of informed consent, pretest, intervention, and posttest.

Fast Facts and Concepts

FFAC are 1-page, practical, peer-reviewed, evidence-based summaries of key palliative care topics first developed by Eric Warm, M.D., at the University of Cincinnati Internal Medicine Residency Program in 2000.6

Intervention

One e-mail containing two FFAC was delivered weekly for 32 weeks to interns in the intervention group.

Pre-test

All participants completed a pretest that assessed knowledge of palliative care topics, self-rated preparedness to perform palliative care skills, and satisfaction with palliative care education.

Method: Internal medicine interns at the University of Pittsburgh and Medical College of Wisconsin were randomized to control and intervention groups in July 2009. Pretests and post-tests assessed medical knowledge through 24 multiple choice questions, preparedness on 14 skills via a 4-point Likert scale and satisfaction based on ranking of education quality.

The intervention group received 32 weekly e-mails.

Control Group
No e-mails were sent to the control group.

Post-test
Respondents completed a post-test 1 to 8 weeks after the
intervention

Educational equipoise
All study participants were informed of the content and the online availability of FFAC during recruitment. At the conclusion of the study, both control and intervention groups were given a booklet that contained all the e-mailed FFAC.

Statistical analysis

Descriptive statistics and t tests were used to compare the demographic data between the control and intervention groups. Medical knowledge, preparedness, and satisfaction were compared pretest and post-test within groups by Wilcoxon tests and between groups via Mann-Whitney U tests. The data did not meet assumptions for multivariate analysis due to the small sample size. Only univariate analysis was performed.

Although traditional academic detailing techniques include educational outreach visits and distribution of printed graphic materials, e-learning techniques such as e-mail delivery of educational content, listservs and Web-based tutorials can also be considered rooted in this behavioral theory given their focus on repeated, concise content.

Pain assessment and management, breaking bad news, communicating about care goals, and providing appropriate medical care for a dying patient are necessary skills for surgery, family medicine, pediatric, obstetrics and gynaecology, physical medicine and rehabilitation, emergency medicine, neurology, radiation oncology, anesthesiologist, and psychiatry residents.

Studies that focus on e-mail education interventions have shown that weekly e-mails change the behavior of e-mail recipients, improve learner retention of educational content and that retention improvements increase with the duration over which e-mails were received. (Kerfoot et al. 2007 ) (Matzie et al. 2009)

Results: The study group included 82 interns with a pretest response rate of 100% and post-test response rate of 70%. The intervention group showed greater improvement in knowledge than the control (18% increase compared to 8% in the control group, p = 0.005).

Preparedness in symptom management skills (converting between opioids, differentiating types of pain, treating nausea) improved in the intervention group more than the control group ( p = 0.04, 0.01, and 0.02, respectively).

There were no differences in preparedness in communication skills or satisfaction between the control and intervention groups.

Conclusions: E-mailed FFAC are an educational intervention that increases intern medical knowledge and self-reported preparedness in symptom management skills but not preparedness in communication skills or satisfaction with palliative care education.

REFERENCE

Claxton, R, Marks, S, Buranosky, R, Rosielle, D, & Arnold, R 2011, ‘The Educational Impact of Weekly E-Mailed Fast Facts and Concepts’, Journal Of Palliative Medicine, 14, 4, pp. 475-481, Academic Search Complete, EBSCOhost, viewed 25 February 2013.

Matzie KA, Price Kerfoot B, Hafler JP, Breen EM: (2009) Spaced education improved the feedback that surgical residents given to medical students: A randomized trial. Am J Surg 2009;197:252–257.

Price Kerfoot B, DeWolf WC, Masser BA, Church PA, Federman DD: (2007) Spaced educational improves the retention of clinical knowledge by medical students: A randomized controlled trial. Med Educ 2007;41:23–31.

Soumerai SB, Avorn J: (1990) Principles of educational outreach (‘academic detailing’) to improve clinical decision making. JAMA 1990;263:549–556.

 

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