School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.
PLoS One. 2011 May 9;6(5):e19318. doi: 10.1371/journal.pone.0019318.
Clinicians in developing countries have had limited access to continuing education (CE) outside major cities, and CE strategies have had limited impact on sustainable change in performance. New educational tools could improve CE accessibility and effectiveness.
METHODOLOGY/PRINCIPAL FINDINGS: The objective of this study was to evaluate an interactive Internet-based CE course on Sexually Transmitted Diseases (STDs) management for clinicians in Peru. Participants included physicians and midwives in private practice drawn from a census of 10 Peruvian cities. The CE included a three-hour workshop for improving Internet skills, followed by a 22-hour online course on STD-syndrome-management, with subsequent educational support. The course used case-based clinical vignettes tailored to local STD problems. Knowledge and reported practices on STD management were assessed before, immediately after and at four months after completion of the course. Statistical analysis included parametric tests-linear regression multivariate analysis, paired t-test and repeated measures ANOVA using SPSS 14.0. Of 1,071 eligible clinicians, 510 agreed to participate, as did an additional 132 public sector clinicians. Of these 642 participants, 619 (96.4%) completed the course, and 596 (96.3%) took the four-month follow-up evaluation. Physician and midwife scores improved from 64.2% correct answers on the pre-test to 77.9% correct on the four-month follow-up test (p<0.001). Most participants (95%) found the online course useful for their work needs. Self reported STD management practices did not change.
CONCLUSIONS/SIGNIFICANCE: Among physicians and midwives in Peru, an Internet-based CE course was feasible, acceptable with high participation rates, and led to sustained improvement in knowledge at four months. Further studies are needed to test it as a model for improving the training of physicians, midwives, and other health care providers.
发展中国家的临床医生在主要城市以外获得继续教育（CE）的机会有限，CE 策略对绩效的可持续性改变影响有限。新的教育工具可以提高 CE 的可及性和有效性。
方法/主要发现：本研究的目的是评估为秘鲁临床医生提供的基于互联网的性传播疾病（STD）管理互动式 CE 课程。参与者包括来自秘鲁 10 个城市普查的私人执业医生和助产士。CE 包括提高互联网技能的三个小时讲习班，随后是 22 小时的在线 STD 综合征管理课程，并提供后续教育支持。该课程使用针对当地 STD 问题的基于案例的临床情况介绍。在完成课程之前、之后立即以及四个月后评估 STD 管理方面的知识和报告实践。统计分析包括参数检验-线性回归多变量分析、配对 t 检验和重复测量方差分析，使用 SPSS 14.0。在 1071 名符合条件的临床医生中，有 510 名同意参加，另外还有 132 名公共部门临床医生参加。在这 642 名参与者中，有 619 名（96.4%）完成了课程，有 596 名（96.3%）参加了四个月的随访评估。医生和助产士的分数从预测试的 64.2%正确答案提高到四个月随访测试的 77.9%（p<0.001）。大多数参与者（95%）认为在线课程对他们的工作需求有用。自我报告的 STD 管理实践没有改变。
结论/意义：在秘鲁的医生和助产士中，基于互联网的 CE 课程是可行的，参与率高，接受度高，并在四个月后导致知识持续提高。需要进一步研究以将其作为改善医生、助产士和其他卫生保健提供者培训的模式进行测试。
