Electronic continuing medical education : approaches to better understand the general practitioners' intention to use eCME and assess their competences

General Practitioners (GP) update their knowledge and skills by participating in continuing medical education (CME) and electronic CME (eCME) programs. The overall aims of this thesis were to (a) understand GPs’ intention to use eCME and the factors that affect its use and (b) to explore how a self-assessment activity works in an eCME context when also compared to actual prescribing behavior. We used the theory of planned behavior (TPB) to understand GPs’ intention to use eCME. The factors’ dimensionality of the TPB was determined. The resulting model explaining the factors that lead to positive intention to use eCME had quite good fit indices. The perceived behavioral control and attitudinal constructs of the TPB were included in the model, but the subjective norms construct was not. Finally, we could explain 66% of the intention’s variance using this resulting model. The use of a TPB-based survey can increase the rigor of the research/evaluation and support CME directors and researchers in assessing, exploring, and improving GPs’ intention to use eCME.

We also designed a self-assessment with electronic cases in eCME context. The data collected were analyzed for five forms of evidence. We could not find any statistical significant association between the assessment scores and their previous actual prescription outcome indicators. More than 80% of the GPs were satisfied with the cases and the self-assessment. Furthermore, about 85% of them became more curious about antibiotic prescription after participating in the program. We recommend using the self-assessment as a tool to personalize learning at the course level or even at the CME level. Specifically, we can integrate this activity with, for example, an antibiotic stewardship CME course and, based on the performance of the learners on their prior knowledge assessment, provide personalized learning materials. The absence of a correlation between the GPs’ previous antibiotic prescription and assessment result can demonstrate the sufficiency of the GPs’ knowledge in this field.

To improve antibiotic prescription, further research for exploring and addressing the gap between knowledge and practice is needed. One implication of this research is to adapt eCME content to learners’ prior knowledge to diminish the time spent on learning activities without compromising knowledge gain. This could be a strategy to motivate busy physicians to improve their competencies.

List of scientific papers

I. Hadadgar A, Changiz T, Masiello I, Dehghani Z, Mirshahzadeh N, Zary N. Applicability of the theory of planned behavior in explaining the general practitioners eLearning use in continuing medical education. BMC Medical Education. 2016;16(1):215.
https://doi.org/10.1186/s12909-016-0738-6

II. Hadadgar A, Changiz T, Dehghani Z, Backheden M, Mirshahzadeh N, Zary N, Masiello I. A Theory-Based Study of Factors Explaining General Practitioners’ Intention to Use and Participation in Electronic Continuing Medical Education. The Journal of Continuing Education in the Health Professions. 2016;36(4):290.
https://doi.org/10.1097/CEH.0000000000000123

III. Hadadgar A, Changiz T, Kononowicz A, Safaeian L, Mirshahzadeh N, Najimi A, Ahmadi F, Mostafavizadeh K, Zary N, Masiello I. Validity of self-assessment using electronic clinical cases in continuing medical education. [Manuscript]

IV. Hadadgar A, Safaeian L, Mirshahzadeh N, Zary N, Changiz T, Masiello I. Antibiotic prescription in primary care: Investigation of association between GPs self-assessed knowledge vs. actual prescription practice. [Manuscript]