Occupational Medicine Advance Access published online on May 20, 2008
Occupational Medicine, doi:10.1093/occmed/kqn053
© 2008 The Author(s).
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Effectiveness of e-learning in continuing medical education for occupational physicians
Nathalie I. R. Hugenholtz,
Einar M. de Croon,
Paul B. Smits,
Frank J. H. van Dijk and
Karen Nieuwenhuijsen
Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, The Netherlands
Correspondence to: Nathalie I. R. Hugenholtz, Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands. Tel: +31 20 566 5325; fax +31 20 697 7161; e-mail: n.i.hugenholtz{at}amc.uva.nl
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Abstract
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Background Within a clinical context e-learning is comparable
to traditional approaches of continuing medical education (CME).
However, the occupational health context differs and until now
the effect of postgraduate e-learning among occupational physicians
(OPs) has not been evaluated.
Aim To evaluate the effect of e-learning on knowledge on mental health issues as compared to lecture-based learning in a CME programme for OPs.
Methods Within the context of a postgraduate meeting for 74 OPs, a randomized controlled trial was conducted. Test assessments of knowledge were made before and immediately after an educational session with either e-learning or lecture-based learning.
Results In both groups, a significant gain in knowledge on mental health care was found (P < 0.05). However, there was no significant difference between the two educational approaches.
Conclusion The effect of e-learning on OPs' mental health care knowledge is comparable to a lecture-based approach. Therefore, e-learning can be beneficial for the CME of OPs.
Keywords Continuing medical education; e-learning; mental health; occupational medicine; randomized controlled trial
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Introduction
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In contrast to what is commonly believed, elderly physicians
and physicians with many years of experience generally possess
less factual medical knowledge [
1]. Continuing medical education
(CME), therefore, is widely acknowledged as an indispensable
part of the working life of physicians. With the introduction
of the Internet, e-learning, i.e. the use of Internet technologies
that enhance knowledge and performance, can be integrated into
CME programmes. Compared to conventional learning, e-learning
has the advantage that participants can choose the place and
time of education themselves. Within a clinical context, the
effect of Internet-based CME programmes is comparable to traditional
approaches of CME [
2,
3]. Although there are some initiatives
among undergraduate occupational physicians (OPs) in using e-learning,
until now the effect of postgraduate e-learning among OPs has
not been evaluated [
4].
The occupational health context differs from the clinical context or primary health care because OPs must, next to medical issues, consider the working situations of their patients, management priorities and legislation. Another barrier for e-learning in CME in occupational health care could be that OPs are not frequently using the Internet for obtaining information [5]. The aim of this study, therefore, was to evaluate the effect of e-learning on knowledge gain as compared to regular lecture-based learning in a CME programme on mental health care for OPs.
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Methods
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The study was a randomized controlled trial and was conducted
in December 2006 during a meeting on mental health care within
a series of four postgraduate meetings for OPs. OPs were randomly
assigned to four different groups in order of arrival at the
meeting, by means of a four-block randomization system. The
OPs were unaware that two teaching approaches were compared
during the meeting. Two groups received lecture-based teaching
while the other two groups received individual e-learning in
a classroom, both with the same content. The duration of both
lessons was 30 min. Immediately before and immediately after
the lesson, the OPs completed a knowledge test.
Since employees with mental health problems constitute a large part of the working population that visits the OP, we developed the website http://mentalhealthandwork.com (psychischenwerk.nl), covering three main topics: diagnosis, prognosis and treatment. The website includes an e-learning module which was designed as a self-directed teaching tool for occupational health care professionals. The module provides participants with information, invites to search for information on the website and asks to solve cases or answer multiple-choice questions using this information.
Each knowledge test consisted of 30 true/false questions and three open-ended ones. Two experts in mental health care and one expert in occupational health care education developed a pool of 66 questions. Two versions of the test, version X and Y, each containing different questions from the pool were generated. The use of the knowledge tests was counterbalanced: one e-learning group completed test X before finishing the e-learning module and test Y after finishing. The other e-learning group completed test Y before the e-learning module and test X after finishing it. The same procedure was used in the two lecture-based learning groups. For each correct answer, the score was ‘1’ and for each incorrect answer the score was ‘0’. Sum scores were converted to a percentage of the possible total score.
Differences in baseline characteristics were tested with t-tests for continuous variables and chi-square tests for categorical variables. To determine whether ‘test version’ needed to be included as a covariate in the analyses, score differences at baseline between version X and Y were tested using a t-test. The effect of both learning approaches on knowledge was evaluated by comparing the change in knowledge between the two groups. Analyses were performed using the general linear model for repeated measures. Next, subgroup analyses were conducted within both learning approaches to investigate age and experience as an OP as potential predictors for change in knowledge. Data were analysed using SPSS version 13.0.
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Results
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In total, 74 OPs attended the meeting. Randomization assigned
half of them to the e-learning and half to the lecture-based
groups. Two OPs in the lecture-based group were excluded because
they arrived too late. The baseline characteristics of the OPs
are described in
Table 1. Only the years of experience as an
OP differed significantly between both groups.
As the baseline scores of both knowledge tests X and Y (mean
52.9, SD 9.2 and mean 51.5, SD 8.1, respectively) did not differ
significantly, the variable test version was not included in
further analyses. In
Table 2, the scores of the four groups
are shown. Although the scores of the four groups differed at
baseline, they differed not significantly within each teaching
approach as well as between the two teaching approaches. Both
learning approaches significantly enhanced OPs' knowledge on
mental health care issues. The mean score for the e-learning
approach was 52.1 (SD 8.4) at baseline and 65.1 (SD 9.6) at
post-test (
P < 0.05). For the lecture-based approach, the
mean score was 52.3 (SD 9.0) at baseline and 64.3 (SD 9.0) at
post-test (
P < 0.05). The improvement in knowledge did not
differ significantly between these groups. The potential predictors'
age and experience as an OP showed no significant relation to
knowledge scores over time within the two learning approaches.
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Table 2 Total scores of the two e-learning groups and the two lecture-based learning groups at baseline and at post-test
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Discussion
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The results of this study show that for OPs, e-learning is just
as effective in enhancing knowledge as lecture-based learning.
This is especially of interest since the study was conducted
in a group of OPs with a high mean age and assumed fewer computer
skills. Earlier, a lack of computer skills has been identified
as a major barrier preventing doctors to use computer-based
learning methods, rather than a lack of preference for new technologies
[
6]. Since computer skills are part of the current vocational
training and education, e-learning may play an even more important
role in the CME of OPs in the near future. We did not include
the participants' preference for, or satisfaction with, the
tested learning approaches. Nevertheless, the meeting itself
was rated 7.1 (0–10), which was in line with the rating
of the other three meetings that year.
This study is the first to demonstrate that e-learning can be useful for CME in the occupational health care setting. It will enable OPs to choose the place and time to educate themselves. Recently, Fordis et al. [7] found that web-based CME can lead to behaviour change as well as sustained knowledge gains that are superior to traditional approaches. A next step within occupational health care may be to study the effectiveness of different forms of e-learning and also the persistence of obtained knowledge over time. Even more important is to study the impact of e-learning on professional practice.
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Funding
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Funding to pay the Open Access publication charges for this
article was provided by the OA (Open Access) Fund of the University
of Amsterdam.
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Key points
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- Within the complex setting of occupational health care, postgraduate e-learning is just as effective in enhancing knowledge as lecture-based learning.
- Since the lack of computer skills of OPs will decrease, e-learning may play an even more important role in the CME of OPs in the near future.
- Although our e-learning module enhanced the knowledge of OPs, the effectiveness of different forms of e-learning, persistence of obtained knowledge over time and the impact of e-learning on professional practice should be further explored.
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Conflicts of interest
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None declared.
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Acknowledgements
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The researchers would like to thank the Netherlands School of
Public and Occupational Health and especially Jac van der Klink,
Suzanne Lagerveld, Kitty Meulenbeld, Erik Noordik and Frans
Vlek for organizing the CME meeting.
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References
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- Kolb S, Reichert J, Hege I, et al. European dissemination of a web- and case-based learning system for occupational medicine: NetWoRM Europe. Int Arch Occup Environ Health (2007) 80:553–557.[CrossRef][Web of Science][Medline]
- Schaafsma F, Hulshof C, van Dijk F, Verbeek J. Information demands of occupational health physicians and their attitude towards evidence-based medicine. Scand J Work Environ Health (2004) 30:327–330.[Web of Science][Medline]
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Abstract
Introduction