Community-based Medicine

From Classrooms to Neighborhoods -- A Reality Students Must Be Prepared For

Alejandro Avelino Bonilla

In recent decades, medical education has been changing around the world in an effort to improve quality, equity, and relevance among other characteristics. A good example for this is the accreditation process of many medical institutions around the world. Besides this, institutions are also aiming to reach what has been defined as social accountability, and it is the main topic of the must-read, “Global Consensus for Social Accountability of Medical Schools.” ¹ Both topics have been widely explored by The Network: TUFH and its members during the last years and are reflected on The Fortaleza Declaration (2014)² and the Tunis Declaration (2017)³ seeking global learning objectives for health professionals and to enhance health and social justice in the social accountability context respectively.  

Accreditation and social accountability are topics that deserve their own review and discussion, but both are related to an issue I want to highlight, the disparity between what is taught and learned during the undergraduate period and what is really useful and needed to work with, and in, communities. From the accreditation perspective, standards are given in order to develop programs and activities in the communities (depending on the national standard that is widely used), meaning that students will, for sure, be in touch with the communities and their surroundings in non-clinical or outreach activities. On the other hand, social accountability has a much bigger picture of the community and includes relevance, quality, cost-effectiveness, and equity to the activities developed in the community.^4,5 

We, as health educators, talk about the relevance of community-based practices and that students must be in touch with the community (even though some students and even teachers may be slightly against it), but community-based practices are not the same as socially accountable actions, neither being a social accountability program. Therefore, students are being taken to communities to perform activities, within accreditation standards, but they might not be socially accountable and it endangers the development of health care students and the reason is quite simple, during and around four to seven years, health care education institutions train students to face and treat health issues in a clinical context (of course this does not apply to all medical institutions but for most it does), and then, they are taken to a more social context where they do not have the tools and environment they are used to, so they must face a completely new reality. This situation can be so deeply entrenched that even the country's health system is not designed to respond to the needs of the community outside the hospital, so what do we expect from students when it comes to commitment and delivery within the community? Why do we proudly say that our students perform activities in the community when we are not really having the desired effect on them nor on the community? Or at least in most communities because even faced with these difficulties, some students actually “fall in love” with the community’s health and that’s what brings us to this discussion. 

Recently in Latin America there was a debate about the voluntary interruption of pregnancy as a right, Argentina⁶ and Colombia⁷ just to cite some examples, and many institutions refused to train their students about this type of care. In the specific case of Colombia when the students where asked, many reported that they received little or almost no training about the topic. If this happens with a subject that is specific, what might be happening when we try to teach and inform students around health in the communities, and even more complex, social accountability issues?

Now, from the community context, are they involved in the planning, execution, and follow up of these community-based practices or social accountable activities? Do we even ask them what they need and what is a priority for them? Or do we just assume that we know what is best because we are the health professionals? A highly involved and active community is not a common thing but is not impossible to find or to nurture. Yet it does require time and work and once it is archived, it can basically guarantee the sustainability part of the impact of the intervention. This brings us to the “the elephant in the room,” are we involving the community? Are we working for the community, in the community, or with the community? Most of the community-based activities tend to be focused on building capacities for the students, but not all of them aim for building capacities for the community as well. These activities ended up being used as a means to reach the objectives with the students, instead of being the end itself and forming students along the way.

So, if we combine these factors, students are being formed on a clinical level and then taken to perform community-based practices that do not meet the needs of the community, ultimately we will have newly graduated doctors that do not possess the theoretical and practical knowledge to answer a community’s health needs, and additionally, communities that do not feel like they can identify with these newly graduated doctors. Isn’t this a problem we are facing worldwide? Of course, it has other contributing causes, but this is one we can face now.

The solution can be found in the problem itself once we face it. Building programs and curriculums around the needs of the community -- with the community -- will allow students to face these needs in a much more real scenario, while during classes students will receive education in primary health care. This is a solution that does not require additional funding, it requires a restructuring and prioritization, something that is extensively addressed during the actions of primary health care and community-based primary health care.

There are many programs and institutions that are changing the health related education paradigm and that we all can meet in the next The Network: TUFH Social Accountability: From Evidence to Action Conference in Darwin, Australia, which demands that institutions, teachers, students, and policymakers among others participate in this must attend event.

This is just a short reflection on a subject that requires a wide and rich debate with different perspectives to support primary health care as a reality that will last over time and that will deliver the impact we are looking for -- education and health promotion, disease prevention, early detection and treatment, and the improvement of the quality of life of the entire population. It may sound idealistic, but Ayn Rand stated it best, “Anyone who fights for the future, lives in it today.”


Works Cited

• Abdalla, Mohamed Elhassan, y Charles Boelen. “Social Accountability of Medical Schools: The New Frontier For Development”, 2012, 7–31.
• Awases, Magdalena, Rebecca Bailey, Charles Boelen, y Mario Dal Poz. “Global consensus on social accountability of medical schools”. Sante publique (Vandoeuvre-les-Nancy, France) 23, núm. 3 (2010): 247–50. www.ncbi.nlm.nih.gov/pubmed/21896218.
• Boelen, Charles, Jeffery E Heck, y World Health Organization. Division of Development of Human Resources for Health. “Defining and measuring the social accountability of medical schools”, 1995. apps.who.int//iris/handle/10665/59441.
• Cañón, Laura Natalia Cruz. “Facultades de medicina, reprobadas en Interrupción Voluntaria del Embarazo”. El Espectador. 2019. www.elespectador.com/noticias/salud/.
• Garcia, Glenn. “Abortion in Argentina”. The Lancet 393, núm. 10173 (2019): 744. doi.org/10.1016/s0140-6736(18)32767-3.
• Goñi, Uki. “‘Thousands’ of young girls denied abortion after rape in Argentina”. THe Guardian, 2019. www.theguardian.com/global-development/.
• Members of The Network; TUFH. “The Fortaleza Declaration”. Fortaleza, Brasil, 2014. thenetworktufh.org/declarations/.
• ———. “Tunis Declaration”. Hammamet, Tunisia, 2017. thenetworktufh.org/declarations/.

 
 
 
Footnotes

 

• ¹ Magdalena Awases et al., “Global consensus on social accountability of medical schools”, Sante publique (Vandoeuvre-les-Nancy, France) 23, núm. 3 (2010): 247–50, www.ncbi.nlm.nih.gov/pubmed/21896218.
• ² Members of The Network; TUFH, “The Fortaleza Declaration” (Fortaleza, Brasil, 2014), thenetworktufh.org/declarations/.
• ³ Members of The Network; TUFH, “Tunis Declaration” (Hammamet, Tunisia, 2017), thenetworktufh.org/declarations/.
• ⁴ Charles Boelen, Jeffery E Heck, y World Health Organization. Division of Development of Human Resources for Health, “Defining and measuring the social accountability of medical schools”, 1995, apps.who.int//iris/handle/10665/59441.
• ⁵ Mohamed Elhassan Abdalla y Charles Boelen, “Social Accountability of Medical Schools: The New Frontier For Development”, 2012, 7–31.
• ⁶ Glenn Garcia, “Abortion in Argentina”, The Lancet 393, núm. 10173 (2019): 744, https://doi.org/10.1016/s0140-6736(18)32767-3; Uki Goñi, “‘Thousands’ of young girls denied abortion after rape in Argentina”, THe Guardian, 2019, www.theguardian.com/global-development/2019/mar/05/.
• ⁷ Laura Natalia Cruz Cañón, “Facultades de medicina, reprobadas en Interrupción Voluntaria del Embarazo”, El Espectador, 2019, www.elespectador.com/noticias/salud/.

* Alejandro Avelino Bonilla is a physician and epidemiology postgraduate student from Juan N. Corpas University in Bogotá, Colombia. He is a National Research Leader in the Colombian Medical Student Association ACOME and member of the advisory board of The Network: TUFH. For more than three years he was a student representative for his University, as well as founder and co-president of the Colombian Association of Students Representatives of Higher Education ACREES. Alejandro also previously served as a Latin Americas´ representative and president of SNO.

Gamification

Startup “gamifica” o aprendizado de alunos de medicina

O biólogo Vinicius Gusmão e o engenheiro de automação Sandro Nhaia decidiram, em 2016, que era o momento de unir suas áreas de competência em um empreendimento: a MedRoom. A startup surgiu com o objetivo de utilizar a modelagem 3D para auxiliar professores de medicina a ensinarem por meio da realidade virtual (RV). Com a premissa de potencializar o aprendizado dos alunos, desenvolvendo um ambiente imersivo dentro dos óculos de RV, a startup dialoga com as duas pontas do setor da saúde para fazer o seu negócio crescer: as universidades, onde apresenta sua solução para o corpo docente e procura gerar novas funcionalidades para sua tecnologia; e os hospitais, com o objetivo de validar cientificamente cada aspecto médico das aulas que cria dentro da sua ferramenta. Para saber mais, não perca o novo episódio do Terra Inovação! 

Habilidades de Comunicação

 

Comunicação de Notícias Difíceis 

em Cuidados Paliativos

O Projeto de Educação Médica Continuada e a Câmara Técnica de Cuidados Paliativos do CRM-PR promovem, no dia 28 de novembro, evento com o tema "Comunicação de Notícias Difíceis em Cuidados Paliativos". Podem participar médicos, estudantes de Medicina e demais interessados.

Para se inscrever, clique aqui e informe o tipo de participação (presencial ou online). A transmissão online é disponibilizada no site do CRM-PR no dia do evento e a sala virtual abre 1h antes do início da aula. O participante deverá acessar a página inicial do site e clicar no botão (quadro laranja) da "Transmissão Online", quando será direcionado para a sala virtual. Confira os pré-requisitos técnicos para garantir uma boa conexão.

Programação:

20h00 | Abertura

20h10 | Palestra: Comunicação de Notícias Difíceis em Cuidados Paliativos
Palestrante: Dra. Ursula Bueno do Prado Guirro (CRM-PR 25.634)

21h00 | Perguntas e Respostas 

22h00 | Encerramento 

Conheça a palestrante

Dra. Ursula Bueno do Prado Guirro (CRM-PR 25.634)
Conselheira do CRM-PR. Formada pela Universidade Federal de Juiz de Fora (UFJF-MG), em 2003, é especialista em Anestesiologia (RQE 513). É mestre e doutora em Medicina pela Universidade Federal do Paraná (UFPR). Atua como professora de Bioética e Cuidados Paliativos do curso de Medicina da UFPR e trabalha também com Humanização e Cuidados na Terminalidade da Vida.

* * *

 

Certificados

Todos os certificados de Educação Médica Continuada são disponibilizados no site do CRM-PR em até 30 dias após a realização do evento.

 

* * *

Serviço:

Comunicação de Notícias Difíceis em Cuidados Paliativos
Data: 28 de novembro de 2018
Hora: das 20h às 22h
Local: Auditório Raquele Rotta Burkiewicz, Sede do CRM-PR (Rua Victório Viezzer, 84 – Vista Alegre – Curitiba, PR)
Informações: eventos@crmpr.org.br | (41) 3240-4045

 FORMULÁRIO DE INSCRIÇÃO 

 

Congresso Médico de Maringá 2018

Congresso Médico de Maringá 2018

O Centro Acadêmico de Medicina de Maringá - UEM, com o apoio do Curso de Medicina, Departamento de Medicina e Hospital Universitário Regional de Maringá, promoverá nos dias 11 a 13 de outubro de 2018 o Congresso Médico de Maringá 2018. 

O Congresso fará parte das comemorações pelos 30 anos da criação do Curso de Medicina da UEM e pretende congregar as comunidades médica e acadêmica da cidade e região em torno da sua programação científica.

Esperamos vocês!

https://www.facebook.com/events/713825902283048/

Comics and Medical Education

Medical and physician assistant students’ views on integrating comics into medical education

Amani Elghafri^[1], Renee R. Stewart^[2], Ramya A. Sampath^[3], Jennifer C. Kesselheim^[4], Michael J. Green^[5]

Institution: 1. Internal Medicine Residency Program, Medical Education, Beaumont Hospital, Dearborn, MI, 2. Department of Humanities, Penn State College of Medicine, Hershey, PA, 3. Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, 4. Master of Medical Sciences in Medical Education Program, Harvard Medical School, Boston, MA, 5. Departments of Humanities and Medicine, Penn State College of Medicine, Hershey, PA,

Corresponding Author: Dr Amani Elghafri dr.elghafri@gmail.com

Categories: Professionalism/Ethics, Medical Education (General), Teaching and Learning 

 

DOI: https://doi.org/10.15694/mep.2017.000196

Abstract

Purpose: This study explored comics as a tool for teaching medical and physician assistant (PA) students about end-of-life decisions and advance care planning.

Methods: Using a mixed method convergent design, a survey (consisting of a five-point Likert scale and open-ended questions) was administered to second-year medical and first-year PA students enrolled in an Ethics and Professionalism class at a US medical school. The survey assessed students’ perspectives on the addition of a comic “Betty P.” to assigned readings and about the use of comics in the classroom. Quantitative results were compared by demographics, and open-ended responses were analyzed qualitatively for emergent themes. Quantitative and qualitative findings were compared for correspondence.

Results: Of the 145 students who completed the survey (83%), 141 students (81%) had read the comic. The vast majority (89%) felt that “Betty P.” helped them understand end of life care for patients, and 84% felt that the comic did not distract them from the seriousness of the subject. Qualitative analysis revealed 2 major themes: 1) comics were educational, and 2) comics engaged learners emotionally. We observed convergence between quantitative and qualitative results.

Conclusion: Integrating comics as a supplemental teaching tool is an innovative way to engage medical students.  

Keywords: Comics and Medicine, Medical Education, Educational Comics, Medical Ethics, End of Life Care 

 

 

https://www.mededpublish.org/manuscripts/1297/v1?platform=hootsuite

Internship

A Letter to new interns

Annals of Internal Medicine 167(1), 4 Jul 2017.

Lectures in Medical School

Saying Goodbye to Lectures in Medical School — Paradigm Shift or Passing Fad?

Richard M. Schwartzstein, M.D., and David H. Roberts, M.D.

N Engl J Med 2017; 377:605-607August 17, 2017DOI: 10.1056/NEJMp1706474

“Become a doctor, no lectures required.”1 This headline about the University of Vermont’s proposed new approach to medical education generated considerable controversy. Although this proposed change is more drastic than the curriculum reform taking place at other medical schools, the movement away from traditional lecture-based courses has been under way in U.S. medical schools for more than three decades. Transformation began with the introduction of problem-based learning; more recently, lecture-based teaching has increasingly been replaced by team-based learning, interprofessional education, and exercises integrating clinical medicine and basic science. But are the newest proposed changes evidence-based, or are they merely the latest fad in medical education? Are all lectures to be avoided?
Most physicians today readily acknowledge that the biomedical information available exceeds what one person can learn and retain. Questions remain, however, regarding how much content students must learn, whether that learning is best done in traditional classroom settings, and what else is required for medical trainees to become successful lifelong learners and adaptable practitioners. The ubiquitous presence of personal and institutional technology permits rapid access to medical information and enables educators to focus on helping students develop a deeper understanding of human health and disease, problem-solving skills, and the ability to transfer knowledge learned in one context to another situation.2 Educators giving a traditional lecture with dozens of content-heavy PowerPoint slides may confuse what they teach with what students learn: the fact that a teacher has presented a piece of information does not mean that students have learned it. In fact, cognitive-load theory suggests that our brains are limited in the amount of information they can process at a time3; 60 slides in 45 minutes may seem like an efficient way to teach, but it is unlikely to be an effective way to learn.
Students learning new material may be deceived by the illusion of knowing and the fallacy of understanding.2 When students hear or read material that is fluent and well presented, it is common for them to believe they have now mastered the content. When confronted with a problem that requires application of that information, however, they may realize that their understanding is superficial at best.
To promote more thorough understanding and enhance problem-solving skills and self-directed learning — critical skills for a doctor who will be practicing for 30 to 50 years and, in the case of self-directed learning exercises, a new requirement for accreditation established by the Liaison Committee on Medical Education — medical schools have begun emphasizing active learning and team-based activities. Acquisition of information occurs largely outside the classroom: in accordance with principles derived from cognitive science, factual content is presented in study assignments that aren’t overwhelmingly long, and the content is interspersed with questions or problems to ensure that students can assess their level of understanding.
In the classroom, learning can be facilitated by the instructor, but it must be driven in large part by the student. Case vignettes are important for establishing the relevance of the material. Questions can be posed in a manner that requires retrieval of information, which solidifies memory but also compels students to view information from a new perspective and transfer it to the context of the given case. Instead of posing questions that begin with “what” (e.g., “What are the causes of hypotension?”), instructors can use “how” and “why” questions (e.g., “How do you think about blood pressure control?”; “Why would this patient be hypotensive under these conditions?”). Asking students to compare a new case or example with one they discussed the previous week further facilitates the transfer of knowledge.3 Questions for which there can be multiple right answers can be the most compelling because they encourage discourse and generation of contrasting hypotheses. Time must be allowed for students to work in groups to discuss thoughts, test ideas (both theirs and others), and begin to learn how to think like a doctor. These activities require more effort from students than it takes to memorize facts, but they are also more effective for learning and retaining knowledge.2
This so-called flipped classroom approach is well suited to students who are members of the millennial generation.4 These young adults are digital natives — they have grown up with technology and are intimately familiar with it. Raised to be part of teams, they thrive in collaborative environments. They are accustomed to finding information online and learn best from visually appealing content that keeps them engaged and is presented in short segments (such as videos that are less than 10 minutes long). The traditional lecture will quickly lose the attention of many of these students, and an unengaged student is not learning.
The early returns from this approach have been encouraging, particularly in college science courses and in the dozen or so medical schools that are implementing new curricula using these pedagogical methods (see photo)
Faculty and Students Interacting in Learning Studios at Harvard Medical School.). In a randomized, controlled trial comparing an early version of the flipped classroom with traditional problem-based learning tutorials, students found the alternative learning environment to be more engaging and thought-provoking.5 Students who had performed relatively poorly in prior courses had a statistically significant improvement in their exam scores — possibly because interacting with their peers and sharing their ideas prepared them better. Faculty using a flipped-classroom approach often feel liberated from the tyranny of the requirement to “cover” everything. Since acquisition of information is accomplished by the student outside class, interactions between teachers and students can focus on content that is difficult to understand and on the application of new concepts to real-world problems.
So is the lecture dead? If “lecture” refers to the traditional picture of a professor standing in front of and talking at a large group of students who are passively absorbing information, then yes, we believe medical schools should be largely abandoning that teaching format. But if it describes large-group interactive learning sessions with students who have prepared in advance, with frequent questions directed at the audience, time set aside for group discussion, and use of audience-response systems (to poll students on a question to assess for understanding, for example), then we believe an interactive lecture-style format should remain an option and can be an effective teaching tool.
As we look to the future of medical education, we believe it’s important to avoid zealotry with respect to pedagogical approaches, including the insistence that team-based learning methods must adhere to specific criteria or that no deviation from pure problem-based learning is allowed. We can often serve our students best by fusing elements of various methods, such as team-based or case-based learning and interactive large-group learning sessions, rather than feeling obliged to adhere to a particular format. But we must also use evidence-based approaches whenever possible and rigorously evaluate our innovations, acknowledging that important outcomes may include student engagement and problem-solving skills, team dynamics, and the learning environment as much as exam scores. In our daily lives as clinicians, we aim to create a culture of continuous quality improvement. We should strive to create the same culture in our educational lives.

References

1. 1
   Straumsheim C. Become a doctor, no lectures required. Inside Higher Ed. September 26, 2016 (https://www.insidehighered.com/news/2016/09/26/u-vermont-medical-school-get-rid-all-lecture-courses).
2. 2
   Brown PC, Roediger HL III, McDaniel MA. Make it stick: the science of successful learning. Cambridge, MA: Harvard University Press, 2014.
3. 3
   de Jong T. Cognitive load theory, educational research, and instructional design: some food for thought. Instr Sci 2010;38:105-134
   CrossRef | Web of Science
4. 4
   Roberts DH, Newman LR, Schwartzstein RM. Twelve tips for facilitating Millennials’ learning. Med Teach 2012;34:274-278
   CrossRef | Web of Science | Medline
5. 5
   Krupat E, Richards JB, Sullivan AM, Fleenor TJ Jr, Schwartzstein RM. Assessing the effectiveness of case-based collaborative learning via randomized controlled trial. Acad Med 2016;91:723-729
   CrossRef | Web of Science | Medline

Ensino médico no Brasil

Lideranças discutem desafios e perspectivas do ensino médico

O I Colóquio Acadêmico sobre Ensino Médico no Brasil reuniu nesta sexta-feira (14) lideranças médicas, professores, diretores e coordenadores de curso de Medicina. O objetivo do evento, promovido pelo Conselho Federal de Medicina (CFM), a Federação Brasileira de Academias de Medicina (FBAM) e a Academia de Medicina de São Paulo, foi discutir a abertura indiscriminada de novas vagas e cursos de medicina, a qualidade do corpo docente, metodologia de ensino, avaliações seriadas, entre outros assuntos.

 

A partir dos debates, as entidades médicas pretendem formular um documento que será encaminhado ao ministro da Educação, representado no evento pela secretária executiva da Comissão Nacional de Residência Médica (CNRM), Rosana Leite de Melo. 

 

Na conferência de abertura, o presidente do CFM, Carlos Vital, apresentou aos participantes o "Panorama atual do Ensino Médico no Brasil". Na oportunidade, ele relembrou os números alarmantes de instituições que continuam a ser inauguradas sem atendimento às exigências mínimas estabelecidas e destacou a importância de se equacionar e qualificar o sistema formador.

 

“Como proposta de qualificação, o CFM e a Associação Brasileira de Educação Médica (Abem) se uniram para desenvolver e implementar o Sistema de Acreditação de Escolas Médicas (Saeme). Acreditamos que este é o caminho para a promoção da segurança na assistência à saúde, do bom conceito da medicina e do prestígio daqueles que a exercem”, defendeu.

 

Vital também apresentou resultados da pesquisa encomendada pelo CFM ao Instituto Datafolha e que revela que a grande maioria da população acredita que a melhor forma de avaliar os alunos e melhorar a qualidade do ensino de Medicina é por meio de avaliações regulares ao longo do curso – 86% consideram a proposta ótima ou boa. 

 

PARTICIPAÇÃO – Além do presidente do CFM, participaram do evento o secretário geral da autarquia, Henrique Batista e Silva; o coordenador da Comissão de Ensino Médico do CFM, Lúcio Flávio Gonzaga Silva; e os conselheiros Jorge Curi (SP) e José Fernando Vinagre (MT).

 

A tribuna de honra da solenidade de abertura contou com a presença dos médicos José Hamilton Maciel, presidente da FBAM; José Roberto Baratella, presidente da Academia de Medicina de São Paulo; Florentino Cardoso, presidente da Associação Médica Brasileira (AMB); Sigisfredo Brenelli, diretor presidente da Abem; Krikor Boyaciyan, corregedor do Conselho Regional de Medicina do Estado de São Paulo (Cremesp); Florisval Meinão, presidente da Associação Paulista de Medicina (APM); e Gerson Sobrinho, diretor no Sindicato dos Médicos de São Paulo (Simesp).

Medical Ethics

Lectures on Inhumanity: Teaching Medical Ethics in German Medical Schools Under Nazism

 

 doi:10.7326/M16-2758

Click here to read the full article

Serious games in Medical Education

InsuOnline, an Electronic Game for Medical Education on Insulin Therapy: A Randomized Controlled Trial With Primary Care Physicians

• Leandro Arthur Diehl^1*, MD, MSc, PhD ; 
• Rodrigo Martins Souza^2*, BArch, MBA in IT ; 
• Pedro Alejandro Gordan^1*, MD, PhD, MEd ; 
• Roberto Zonato Esteves^3,4*, MD, PhD ; 
• Izabel Cristina Meister Coelho^4*, MD, PhD 

¹Internal Medicine Department, Health Sciences Center, Londrina State University (UEL), Londrina PR, Brazil
²Games Division, Oniria Software Industry, Londrina PR, Brazil
³Medicine Department, Maringá State University (UEM), Maringá PR, Brazil
⁴Pró-Ensino na Saúde, Pequeno Príncipe College, Pequeno Príncipe Complex, Curitiba PR, Brazil
*all authors contributed equally

ABSTRACT

Background: Most patients with diabetes mellitus (DM) are followed by primary care physicians, who often lack knowledge or confidence to prescribe insulin properly. This contributes to clinical inertia and poor glycemic control. Effectiveness of traditional continuing medical education (CME) to solve that is limited, so new approaches are required. Electronic games are a good option, as they can be very effective and easily disseminated.

Objective: The objective of our study was to assess applicability, user acceptance, and educational effectiveness of InsuOnline, an electronic serious game for medical education on insulin therapy for DM, compared with a traditional CME activity.

Methods: Primary care physicians (PCPs) from South of Brazil were invited by phone or email to participate in an unblinded randomized controlled trial and randomly allocated to play the game InsuOnline, installed as an app in their own computers, at the time of their choice, with minimal or no external guidance, or to participate in a traditional CME session, composed by onsite lectures and cases discussion. Both interventions had the same content and duration (~4 h). Applicability was assessed by the number of subjects who completed the assigned intervention in each group. Insulin-prescribing competence (factual knowledge, problem-solving skills, and attitudes) was self-assessed through a questionnaire applied before, immediately after, and 3 months after the interventions. Acceptance of the intervention (satisfaction and perceived importance for clinical practice) was also assessed immediately after and 3 months after the interventions, respectively.

Results: Subjects’ characteristics were similar between groups (mean age 38, 51.4% [69/134] male). In the game group, 69 of 88 (78%) completed the intervention, compared with 65 of 73 (89%) in the control group, with no difference in applicability. Percentage of right answers in the competence subscale, which was 52% at the baseline in both groups, significantly improved immediately after both interventions to 92% in the game group and to 85% in control (P<.001). After 3 months, it remained significantly higher than that at the baseline in both groups (80% in game, and 76% in control; P<.001). Absolute increase in competence score was better with the game (40%) than with traditional CME (34%; P=.01). Insulin-related attitudes were improved both after the game (significant improvement in 4 of 9 items) and after control activity (3 of 9). Both interventions were very well accepted, with most subjects rating them as “fun or pleasant,” “useful,” and “practice-changing.”

Conclusions: The game InsuOnline was applicable, very well accepted, and highly effective for medical education on insulin therapy. In view of its flexibility and easy dissemination, it is a valid option for large-scale CME, potentially helping to reduce clinical inertia and to improve quality of care for DM patients.

J Med Internet Res 2017;19(3):e72

doi:10.2196/jmir.6944

 

 * To read the full text, click here