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A Randomized Trial

B. Price Kerfoot, MD, EdM; Paul R. Conlin, MD; Thomas Travison, PhD; Graham T. McMahon, MD, MMSc

Arch Intern Med. 2007;167(4):361-366.

Background  All accredited US residency programs are expected to offer curricula and evaluate their residents in 6 general competencies. Medical schools are now adopting similar competency frameworks. We investigated whether a Web-based program could effectively teach and assess elements of systems-based practice.

Methods  We enrolled 276 medical students and 417 residents in the fields of surgery, medicine, obstetrics-gynecology, and emergency medicine in a 9-week randomized, controlled, crossover educational trial. Participants were asked to sequentially complete validated Web-based modules on patient safety and the US health care system. The primary outcome measure was performance on a 26-item validated online test administered before, between, and after the participants completed the modules.

Results  Six hundred forty (92.4%) of the 693 enrollees participated in the study; 512 (80.0%) of the participants completed all 3 tests. Participants' test scores improved significantly after completion of the first module (P<.001). Overall learning from the 9-week Web-based program, as measured by the increase in scores (posttest scores minus pretest scores), was 16 percentage points (95% confidence interval, 14-17 percentage points; P<.001) in public safety topics and 22 percentage points (95% confidence interval, 20-23 percentage points; P<.001) in US health care system topics.

Conclusion  A Web-based educational program on systems-based practice competencies generated significant and durable learning across a broad range of medical students and residents.

Author Affiliations: Urology Section (Dr Kerfoot) and Endocrinology Section (Drs Conlin and McMahon), Veterans Affairs Boston Healthcare System, Harvard Medical School (Drs Kerfoot, Conlin, and McMahon), and Endocrinology, Diabetes, and Hypertension Division (Drs Conlin and McMahon), Brigham & Women's Hospital, Boston, Mass; and New England Research Institutes, Watertown, Mass (Dr Travison).