Abstract:

E-learning is rapidly gaining in importance in higher education. On-line continuing medical education has obtained good results in knowledge acquisition and in the learner satisfaction, although incertainty remains in the interaction among participants with asynchronous communication and in the efficacy of the learning process.
We developed an on-line training model for palliative care in cancer directed to primary care physicians with the first objective to evaluate the efficacy of the learning process and satisfaction of the participants, and the second objective to evaluate the impact of the education in the symptom control of their patients.
In a randomized and controlled educational trial, 169 participants all over the country (Spain) were divided in two groups: the intervention group followed an on-line program for palliative care self-training, while the control did not, but could follow the usual training for his working area.
The Learning Management System used was the generic Model Platform. The Dreamweaver tool was used for content design, and the platform resources were prepared based on Word documents. Evaluation forums and questionnaires were conducted, complemented by other interactive resources (images, diagrams, videos, interactive WebPages, among others).
The educational content was designed by the authors, and distributed in four modules with subjects. Each subject contained objectives, contents directed to clinical practice, with clear and concise explanations, bibliography and websites. The subjects included links to explanations for the presentation, and self-guided questions which could be reviewed several times, without a final score.
The intervention group had two tutors available to answer to any doubt through the platform and forums. On-line training, lasting 96 hours, was conducted during 75 days, with 15-20 days per module.
The first part evaluation presented here, was conducted through several tools: the knowledge questionnaire, the attitude questionnaire, and the satisfaction and Moodle questionnaires. Analysis was made with SPSS (version 18) for parametric, non-parametric tests and imputation of missing data.
Both groups (85 participants per group, of which five were excluded) were balanced in basal variables.
Evaluation of access to the on-line platform: from 82 participants in the intervention group, 59 (72%) completed all modules. The average number of visits to the platform was 266.83 visits (SD 87.26; range 118-509). Forty-two participants (59%) took part in the discussion forum. Sixty two (75.6%) Moodle survey forms were received. The most frequent score was “agree”, from 52.5% to 71% in different questions. Twenty-seven participants (43.5%) made comments regarding: on-line application difficulties, or subject presentation.
Evaluation of Knowledge, Attitude and Satisfaction: from 60 (73.17%) questionnaires the most frequent score was “good” or “very good” in satisfaction. A significant increase in knowledge (mean of differences 3.04, CI 95% (1.51 to 4.57) p=0.0001, maximum score 33) was detected as well in confidence in communication (p=0.007), while it was non-significant (p=0.151) regarding confidence in symptom management. Useful aspects as well as aspects to be improved in training were signaled. Significant differences between groups were detected in knowledge, perception of confidence in symptom management and communication.

Keywords:

Palliative care, education continuing, medical informatics.