Web‐Based Training in Geriatrics for Medical Residents: A Randomized Controlled Trial Using Standardized Patients to Assess Outcomes

Abstract

Although Web-based instruction offers an advantageous approach to medical education, few studies have addressed the use of Web-based education to teach clinical content at the postgraduate level. Even fewer studies have addressed clinical outcomes after the Web-based instruction, yet postgraduate training requirements now focus on outcomes of training. A randomized trial was conducted to compare knowledge of postgraduate year (PGY) 1 residents after Web-based with that after paper-based instruction and to compare residents' clinical application of their instruction using unannounced standardized patients (SPs) and unannounced activated standardized patients (ASPs). PGY 1 residents were assigned to a month-long ambulatory rotation during which they were randomized as a block to Web- or paper-based instruction covering the same four geriatric syndromes (dementia, depression, falls, and urinary incontinence). Outcome measures were mean change scores for before and after testing and scores from SP and ASP clinical encounter forms (checklist, chart abstraction, and electronic order entry). Residents who completed the Web-based instruction showed significantly greater improvement on the knowledge tests than those who received paper-based instruction. There were no significant differences in the scores from the SP and ASP clinical encounters except that the chart abstraction score was better for Web-based group than the paper-based group for dementia. Web-based instruction is an educational tool that medical residents readily accept and can be used to improve knowledge of core geriatrics content as measured using immediate posttesting. More-intensive educational interventions are needed to improve clinical performance by trainees in the care of older patients.

Geriatrics Curricula for Internal and Family Medicine Residents: Assessing Study Quality and Learning Outcomes

“…25,28,31,34,[36][37][38] Thirteen studies reported changes in knowledge and/or skills (Kirkpatrick Level 2b). [25][26][27][28][29][30][31][32][33][35][36][37][38] Of these, 10 reported statistically significant changes in knowledge and/or skills. 25,[29][30][31][32][33][35][36][37][38] Five studies reported behavioral changes in learners (Kirkpatrick Level 3), [25][26][27][28]30 and 3 of these changes were statistically significant.…”

“…Fourteen studies met the inclusion criteria. [25][26][27][28][29][30][31][32][33][34][35][36][37][38] The 14 studies are summarized in 27,29,[31][32][33][34]36 ; didactics 25,28,29 ; web-based 30 or electronic medical record modules 26 ; cues to action 38 ; decision support 27,37 or simulation combined with video and case discssion 38 ; grand rounds 29 ; interdisciplinary team meetings or rounding 29,32 ; geriatrics patient rounds 25,29,32 ; nursing home rounds 31 ; morning case report 28,29 ; independent study projects 29 ; formative feedback 35,38 ; and direct observation. 25 Learning outcomes were matched to Kirkpatrick levels 1 to 4.…”

The development and evaluation of a distance learning system in ophthalmology

“…This did not occur in our study, since all of the participants did the post-test together. The fact that the residents' participation was compulsory could also be considered as another bias (22) , and this may also have been applied to our study. The problem is that if we had let the residents voluntarily join the course, our sample size would have been even smaller and another bias would have been created, since only those in favor of online courses would have joined the study.…”

“…Perhaps this did not occur in our study because of the small number of participants. However, a possible bias cited by the authors is that the tests were performed at different moments: the access group took the test soon after the course, while the other group did it at the end of the month for the ambulatory stage (22) . This did not occur in our study, since all of the participants did the post-test together.…”

“…The authors attribute this result to the small number of participants in the study, and this may also have affected our results. In some studies in which an online clinical simulation course was performed, a comparison of the written tests between a site access group and a non-access group showed that the first group achieved better grades than the second one (20,22) , which means that the access group improved their knowledge. Perhaps this did not occur in our study because of the small number of participants.…”