E-learning CME that changed practice behavior

One of the things I want to focus on in this blog are the kind of learning interventions that have been successful in changing practice behavior.    Today I'm looking at a study published in JAMA in 2005. 

In this study, what worked was 1) getting the information from an expert, 2) the opportunity to practice skills while working through cases, 3) the opportunity to spread the instruction out over a period of time, and 4) job aids that the physicians could use in their practices. 

This was a well-designed study comparing a previously successful live CME event for physicians, with the same material presented in an e-learning format, and a control group that did not receive instruction.  This was a good study, they measured learning immediately and at 12 weeks and more importantly, they measured actual physician behavior using chart reviews. 

The live CME consisted of a lecture, followed by interactive case discussion with faculty, the participants received a number of job aids to help them when they got back to work. 

The internet based instruction was designed to give people a similar experience - a recorded lecture, followed by cases that the physicians could work through.  Both sets of learners had access to faculty if they wanted to ask questions.  the internet CME group also had a live session, where they worked through cases with an expert. The major difference was that the internet-based instruction was done at the learners' convenience, and often over several different sessions. 

Learning increased for both the live and the internet-based instruction group, both immediately after the instruction and at 12 weeks. 

Practice behavior only changed significantly for the group that received instruction over the internet. 

This is kind of a surprising result, why should the internet-based instruction be successful, while the live-training was not. 

One reason might be that the internet-based group had the chance to complete the instruction in a single sitting.  This fits with the instructional principle pf spaced practice - that is - spreading the practice over a period of time, which gives people a better chance to learn the material.