Introduction:
Evolving therapies and guideline recommendations to treat non-ST elevation myocardial infarction (NSTEMI) create clinical confusion. The educational and practice impact of a case-based design of CME were measured on clinical decision-making related to NSTEMI treatment.
Methods:
The continuing medical education (CME) activity was developed as an online case-based text activity modeled after the interactive grand rounds approach where clinicians make clinical decisions about treatment for a given patient. The activity targeted primary care physicians (PCPs) and cardiologists who manage patients experiencing a NSTEMI and focused on application of guideline recommendations. The effects of education were assessed using a linked pre-assessment/post-assessment study design that separated learners into 3 categories: improved (incorrect pre, correct post), reinforced (correct pre and post), and unaffected (incorrect post). For all questions combined, the McNemar’s chi-squared test was used to assess whether the mean post[[Unable to Display Character: ‐]]assessment score differed from the mean pre[[Unable to Display Character: ‐]]assessment score. P values are shown as a measure of significance; P values <.05 are statistically significant. Cohen’s D was used to calculate the effect size. The activity launched online on April 16, 2014 and data were collected through July 24, 2014.
Results:
533 PCPs and 531 cardiologist completed both the pre- and post-assessment survey with a large overall effect size of 1.836 (
P
<0.05) and 1.799 (
P<0
.05), respectively. PCPs Correct responses on post-assessment questions ranged between 62% and 292% higher after CME completion. While only 8 (2%) participants answered all 4 questions correctly on the pre-assessment, 296 (56%) answered them all correctly on the post-assessment. Between 33% and 63% of participants showed improvement post-educational intervention. Cardiologists Correct responses on post-assessment questions ranged between 34% and 249% higher after CME completion. While only 28 (5%) participants answered all 4 questions correctly on the pre-assessment, 430 (81%) answered them all correctly on the post-assessment. Between 26% and 65% of participants showed improvement after the educational intervention.
Conclusion:
Online case-based CME activities modeled after the interactive grand rounds approach prompted changes in clinical knowledge, showing that when effectively constructed, this methodology is an effective tool to improve clinical application of guidelines and clinical decision-making in NSTEMI. This interactive educational format should be applied to CME for future activities.
Confidence intervals and p-values in clinical decision making