After winning the 2014 Award for Outstanding CE Enduring Material, a three-page article was published in the April, 2014 issue of Almanac magazine. The three page article discusses the entire background of the project, the methods used in the instructional design, the layout of the course, the details of the branching format and best of all- the results of all our hard work. Click here to download the magazine in PDF format. The article is on pages 15-17.
Here are a few snippets from the article that I found interesting:
At the conclusion of this learning activity, participants should be able to:
1a. Assess female patients for major depression; for those diagnosed with depression, assess routinely for suicidal tendencies.
1b. Develop and implement, with patient consent, a longterm treatment strategy for major depression. Monitor patient response to treatment through regular follow-up visits. Consult and refer as needed.
Response Rate and Respondent Characteristics:
More than 2,167 unique visitors accessed the site, and 468 completed the activity for credit. 21% of the 468 were physicians; 69% were physician assistants and nurse practitioners; and 9% identified as other.
Intent to Change Data:
One hundred percent of the respondents committed to making at least one change in their practice. Twenty-four percent of respondents planned to implement more than ten changes.
Comparisons were made between participant in-game survey responses about their own practice patterns and their responses on the intent-to-change evaluation questions:
1a Intention to Assess Patients for Depression
Twenty-three percent of participants indicated they did no routine screening for depressions. Of these, 58% intended to conduct depression assessment of patients at-risk for depression.
1b. Intention to Treat and Refer Patients
Eight percent of participants indicated that they did not routinely follow-up with depressed patients. Of these, 27% intended to monitor their depressed patients through regular follow-up visits. Nine percent of the participants indicated that they did not typically take a long-term approach to depression management. Of these, 33% intended to take a long term approach to depression management. Thirty-two percent of participants indicated that they referred depressed patients to specialists. Of these, 60% intended to arrange for a mental health specialist to provide consultation services.
2. Actual Change at 3 Months after Learning Activity
Ninety-seven percent fully or partially implemented the change strategies they intended to make within 3 months
The results seem to indicate that this activity does affect the practice of primary care physicians since participants did improve their assessment of patients with depression and they improved their long term treatment, their consultation and their referral patterns.
Our CME program was strengthened by envisioning, developing and implementing a format highlighting personalized CME. Whether we implement Internet games like this one in the future or not, we have learned that the elements of personalizing a learning experience include having the activity be:
- Internet-based – Asynchronous access convenient to the participant
- Participant-driven – The participant works through the game by clicking, thus driving the decision-making trajectory of patient care and just-in-time learning
- Flexible – Participants can take as much time as they want and can repeat the game as many times as they want to
- Fun – Participants get drawn into the casebased decision-making, into interactions with the specialist and into the surveying of their own practice patterns.
- Action-based self-reflection – The participants make the decisions and interact with the consulting “specialist”. The participants, when surveyed, reflect on their own practice patterns in relation to what they’re learning
We were able to collect a rich database of participant comments from which we have identified two main themes for future educational activities:
- Pharmacologic treatment options with their side effect profiles
- Patient compliance issues, including patient support through education and provider shortand long-term interaction with patients.
The continued stigma of having mental health issues was also raised as a significant barrier in the care of patients with depression. We believe there is great value in using this type of learning format, i.e., an Internet, branching narrative game, as a means of actively engaging participants in case-based medical decision-making. The game provides effective involvement of participants in just-in-time learning. It provides participants the opportunity for reflection about their current practice in light of what they are learning and gives them motivation to play until they’re on target.