Bond Stuart Evan, Crowther Shelley P, Adhikari Suman, Chubaty Adriana J, Yu Ping, Borchard Jay P, Boutlis Craig Steven, Yeo Wilfred Winston, Miyakis Spiros
Department of Pharmacy, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, Australia.
School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia.
JMIR Med Educ. 2018 Feb 26;4(1):e5. doi: 10.2196/mededu.7719.
Internet-based learning for health professional education is increasing. It offers advantages over traditional learning approaches, as it enables learning to be completed at a time convenient to the user and improves access where facilities are geographically disparate. We developed and implemented the Vancomycin Interactive (VI) e-learning tool to improve knowledge on the clinical use of the antibiotic vancomycin, which is commonly used for treatment of infections caused by methicillin-resistant Staphylococcus aureus (MRSA).
The aims of this study were to evaluate the effect of the VI e-learning tool on (1) survey knowledge scores and (2) clinical use of vancomycin among health professionals.
We conducted a comparative pre-post intervention study across the 14 hospitals of two health districts in New South Wales, Australia. A knowledge survey was completed by nurses, doctors, and pharmacists before and after release of a Web-based e-learning tool. Survey scores were compared with those obtained following traditional education in the form of an email intervention. Survey questions related to dosing, administration, and monitoring of vancomycin. Outcome measures were survey knowledge scores among the three health professional groups, vancomycin plasma trough levels, and vancomycin approvals recorded on a computerized clinical decision support system.
Survey response rates were low at 26.87% (577/2147) preintervention and 8.24% (177/2147) postintervention. The VI was associated with an increase in knowledge scores (maximum score=5) among nurses (median 2, IQR 1-2 to median 2, IQR 1-3; P<.001), but not among other professional groups. The comparator email intervention was associated with an increase in knowledge scores among doctors (median 3, IQR 2-4 to median 4, IQR 2-4; P=.04). Participants who referred to Web-based resources while completing the e-learning tool achieved higher overall scores than those who did not (P<.001). The e-learning tool was not shown to be significantly more effective than the comparator email in the clinical use of vancomycin, as measured by plasma levels within the therapeutic range.
The e-learning tool was associated with improved knowledge scores among nurses, whereas the comparator email was associated with improved scores among doctors. This implies that different strategies may be required for optimizing the effectiveness of education among different health professional groups. Low survey response rates limited conclusions regarding the tool's effectiveness. Improvements to design and evaluation methodology may increase the likelihood of a demonstrable effect from e-learning tools in the future.
基于互联网的卫生专业教育正在增加。与传统学习方法相比，它具有优势，因为它能让学习者在方便的时间完成学习，并改善了地理上分散地区的学习机会。我们开发并实施了万古霉素交互式（VI）电子学习工具，以提高对抗生素万古霉素临床应用的认识，万古霉素常用于治疗耐甲氧西林金黄色葡萄球菌（MRSA）引起的感染。
本研究的目的是评估VI电子学习工具对（1）调查知识得分和（2）卫生专业人员中万古霉素临床应用的影响。
我们在澳大利亚新南威尔士州两个卫生区的14家医院进行了一项干预前后的比较研究。在基于网络的电子学习工具发布之前和之后，护士、医生和药剂师完成了一项知识调查。将调查得分与通过电子邮件干预这种传统教育形式获得的得分进行比较。调查问题涉及万古霉素的给药、用药和监测。结果指标是三个卫生专业组的调查知识得分、万古霉素血浆谷浓度以及计算机化临床决策支持系统记录的万古霉素批准情况。
干预前调查回复率较低，为26.87%（577/2147），干预后为8.24%（177/2147）。VI与护士知识得分的增加相关（最高得分=5）（中位数2，四分位间距1 - 2至中位数2，四分位间距1 - 3；P<0.001），但在其他专业组中未发现这种情况。比较的电子邮件干预与医生知识得分的增加相关（中位数3，四分位间距2 - 4至中位数4，四分位间距2 - 4；P = 0.04）。在完成电子学习工具时参考网络资源的参与者总体得分高于未参考的参与者（P<0.001）。通过治疗范围内的血浆水平衡量，电子学习工具在万古霉素的临床应用方面未显示出比比较的电子邮件干预显著更有效。
电子学习工具与护士知识得分的提高相关，而比较的电子邮件干预与医生得分的提高相关。这意味着可能需要不同的策略来优化不同卫生专业组的教育效果。较低的调查回复率限制了关于该工具有效性的结论。设计和评估方法的改进可能会增加未来电子学习工具产生明显效果的可能性。
