Development of an e-learning prototype for assessing occupational stress-related disorders: a qualitative study.

BACKGROUND: Occupational stress-related disorders are complex to diagnose and prevent, due to their multifactorial origin. We developed an e-learning programme aimed at supporting occupational physicians when diagnosing and preventing occupational stress-related disorders. In order to explore the extent to which a developed e-learning prototype was perceived as useful and feasible by occupational physicians, we executed a qualitative study. METHODS: We conducted semi-structured, face-to-face interviews with fifteen occupational physicians, who were recruited using a combination of convenience and purposive sampling. Participants were shown a hard copy prototype of the e-learning programme, on which they were invited to comment in terms of perceived usefulness and feasibility. The interview data was transcribed verbatim and coded by two researchers using a content analysis approach. RESULTS: Occupational physicians perceived e-learning as useful when it contributed to creating a full clinical picture and supported the diagnosis. Its structure had to support occupational physicians to work systematically. The programme had to be applicable to their daily practice and had to incorporate learning tools in order to increase the competences of occupational physicians. Feasibility was perceived to increase when the e-learning programme took less time to complete, when the quantity of written text was not too high, and when the user was guided and recertification points provided. CONCLUSIONS: An e-learning programme can be an asset in continuing medical education for occupational physicians when assessing occupational stress-related disorders. Perceived usefulness depended on the clinical picture, structure, practicality and the increasing of competences. Feasibility depended on text, time, structure and reward.

Effectiveness of an individual, online e-learning program about sexually transmitted infections: a prospective cohort study.

BACKGROUND: Primary health-care professionals play an important role in the treatment and prevention of Sexually Transmitted Infections (STI). Continuing Medical Education (CME)-courses can influence the knowledge and behavior of health-care professionals concerning STI. We performed a prospective cohort study to evaluate if the individual and online e-learning program "The STI-consultation", which uses the Commitment-to-Change (CtC)-method, is able to improve the knowledge, attitude and behavior of Dutch General Practitioners (GPs), concerning the STI-consultation. This e-learning program is an individual, accredited, online CME-program, which is freely available for all GPs and GP-trainees in the Netherlands. METHODS: In total 2192 participants completed the questionnaire before completing the e-learning program and 249 participants completed the follow-up questionnaire after completing the e-learning program. The effect of the program on their knowledge, attitude and behavior concerning the STI-consultation was evaluated. RESULTS: In total 193 participants formulated 601 learning points that matched the learning objectives of the program. The knowledge and attitude of the participants improved, which persisted up to two years after completing the program. Another 179 participants formulated a total of 261 intended changes concerning the sexual history taking, additional investigation and treatment of STI, 97.2% of these changes was partially or fully implemented in daily practice. Also, 114 participants formulated a total of 180 "unintended" changes in daily practice. These changes concerned the attitude of participants towards STI and the working conditions concerning the STI-consultation. CONCLUSION: The individual, online e-learning program "The STI-consultation", which uses the CtC-method, has a small but lasting, positive effect on the knowledge, attitude, and behavior of GPs concerning the STI-consultation.

Learning results of GP trainers in a blended learning course on EBM: a cohort study.

BACKGROUND: General practitioners (GPs) experience barriers to the use of evidence-based medicine (EBM) related to a negative attitude and to insufficient knowledge and skills. We therefore designed a blended learning intervention to develop the competence of GP trainers in EBM. This study investigated the effectiveness of this intervention in increasing the trainers' EBM competencies (i.e. knowledge, skills, attitude and behaviour). METHODS: In total 129 GP trainers participated in the blended learning course on EBM consisting of four 3-h face-to-face meetings and an intensive preparatory e-course before each meeting over a 12-month period. The primary outcomes were changes in knowledge and skills (Fresno test), changes in attitude (McColl test) and intentions to change behaviour. Secondary outcomes were changes in self-rated knowledge, skills and attitude, and the relation between personal characteristics and changes in knowledge, skills and attitude. Data were collected before the start of the intervention (T0), at the end of the last day of the intervention (T1) and four months after the end of the intervention (T2). RESULTS: The mean changes in scores on the Fresno test were ∆T1-T0 = 40.8 (SD ±36.7, p < .001) and ∆T2-T0 = 20.8 (±39.9, p < .001). The mean changes in scores on the McColl test were ∆T1-T0 = 2.2 (SD ±12.8, p = .16) and ∆T2-T0 = -.87 (±10.0, p = .49). Of the GP trainers, 16.7 % fulfilled their intentions to change in behaviour, 47.6 % partly fulfilled them and 35.7 % did not fulfil them at all. Female trainers scored significantly higher on the Fresno test after the intervention compared to male trainers. There was a weak positive correlation between self-rated knowledge and the scores on the Fresno test. A moderate correlation was found between the overall score on the McColl test and self-rated attitude. CONCLUSION: An intensive blended learning course on EBM for GP trainers induces an increase in knowledge and skills that, although decreased, remains after four months. Attitude and behaviour towards EBM show no differences before and after the intervention, although GPs' intention to use EBM more often in their practice is present.

Barriers to the use of evidence-based medicine: knowledge and skills, attitude, and external factors.

Although efforts are made to integrate evidence-based medicine (EBM) into clinical practice, physicians experience significant barriers to its implementation. The aim of this study is to quantify the barriers that general practice (GP) trainees experience when using EBM in practice. In September 2008, a questionnaire was administered to 140 GP trainees from three Dutch GP Speciality Training Institutes. The questionnaire focused on barriers that GP trainees meet when using EBM in practice. Factor analysis identified components in which barriers exist, and the validity and reliability of the questionnaire were established. After removing four items that did not fit the questionnaire structure, factor analysis identified three relevant components. All three components had similar mean scores, indicating a similar negative influence of these components on the practice of EBM: knowledge/skills (α = 0.72, mean score 2.9 ± 0.8), attitude (α = 0.70, mean score 2.9 ± 0.6), and external factors (α = 0.66, mean score 3.0 ± 0.5). The barrier that trainees experienced most was lack of time to practise EBM. Barriers to the use of EBM were present in three components: knowledge/skills, attitude, and external factors.

Barriers to GPs' use of evidence-based medicine: a systematic review.

BACKGROUND: GPs report various barriers to the use and practice of evidence-based medicine (EBM). A review of research on these barriers may help solve problems regarding the uptake of evidence in clinical outpatient practice. AIM: To determine the barriers encountered by GPs in the practice of EBM and to come up with solutions to the barriers identified. DESIGN: A systematic review of the literature. METHOD: The following databases were searched: MEDLINE (PubMed), Embase, CINAHL, ERIC, and the Cochrane Library, until February 2011. Primary studies (all methods, all languages) that explore the barriers that GPs encounter in the practice of EBM were included. RESULTS: A total of 14 700 articles were identified, of which 22 fulfilled all inclusion criteria. Of the latter, nine concerned qualitative, 12 concerned quantitative, and one concerned both qualitative and quantitative research methods. The barriers described in the articles cover the categories: evidence (including the accompanying EBM steps), the GP's preferences (experience, expertise, education), and the patient's preferences. The particular GP setting also has important barriers to the use of EBM. Barriers found in this review, among others, include lack of time, EBM skills, and available evidence; patient-related factors; and the attitude of the GP. CONCLUSION: Various barriers are encountered when using EBM in GP practice. Interventions that help GPs to overcome these barriers are needed, both within EBM education and in clinical practice.