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A web-based simulation of a longitudinal clinic used in a 4-week ambulatory rotation: a cohort study.

Wong RW, Lochnan HA - BMC Med Educ (2009)

Bottom Line: Compared to residents who did the rotation alone, residents who used COCOS during the rotation had significantly higher improvements in test scores (% increase in pre-post test scores +21.6 [standard deviation, SD, 8.0] vs. +5.9 [SD 6.8]; p < .001).There were no significant differences in changes in confidence.The adaptable, web-based format allows the creation of cases for most chronic medical conditions.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine, Division of Endocrinology, University Health Network, Toronto General Hospital, Toronto, Canada. Rene.Wong@uhn.on.ca

ABSTRACT

Background: Residency training takes place primarily on inpatient wards. In the absence of a resident continuity clinic, internal medicine residents rely on block rotations to learn about continuity of care. Alternate methods to introduce continuity of care are needed.

Methods: A web-based tool, Continuity of Care Online Simulations (COCOS), was designed for use in a one-month, postgraduate clinical rotation in endocrinology. It is an interactive tool that simulates the continuing care of any patient with a chronic endocrine disease. Twenty-three residents in internal medicine participated in a study to investigate the effects of using COCOS during a clinical rotation in endocrinology on pre-post knowledge test scores and self-assessment of confidence.

Results: Compared to residents who did the rotation alone, residents who used COCOS during the rotation had significantly higher improvements in test scores (% increase in pre-post test scores +21.6 [standard deviation, SD, 8.0] vs. +5.9 [SD 6.8]; p < .001). Test score improvements were most pronounced for less commonly seen conditions. There were no significant differences in changes in confidence. Residents rated COCOS very highly, recommending its use as a standard part of the rotation and throughout residency.

Conclusion: A stand-alone web-based tool can be incorporated into an existing clinical rotation to help residents learn about continuity of care. It has the most potential to teach residents about topics that are less commonly seen during a clinical rotation. The adaptable, web-based format allows the creation of cases for most chronic medical conditions.

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Related in: MedlinePlus

Flow diagram showing the structure of the cohort study.
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Figure 1: Flow diagram showing the structure of the cohort study.

Mentions: At the University of Ottawa Medical school (Ottawa, Canada), medical residents assigned to the endocrinology rotation were invited to participate. Attending physicians were aware of the objectives for the rotation, but were not made aware of the specific objectives for COCOS. We designed this study as a single institution, double cohort trial to investigate whether the use of COCOS during a clinical rotation can significantly improve learning and confidence of medical residents in the longitudinal management of patients with endocrine disorders. The hospital's ethics board approved this study. Written consent was obtained from all study participants. Figure 1 shows an algorithm of the control and intervention group analysis. The control group consisted of residents completing the endocrinology rotation. They were provided specific reading material and printed guidelines on endocrine topics. The intervention group completed the same rotation, but was expected to complete COCOS before the end of the rotation. Thus this group was using COCOS as an adjunct to the existing rotation. No designated time was allocated to use COCOS, which was accessible using unique usernames and passwords. The control group was recruited and assessed over a 9-month period before the intervention group to ensure users of COCOS did not discuss or share the website content with members of the control group.


A web-based simulation of a longitudinal clinic used in a 4-week ambulatory rotation: a cohort study.

Wong RW, Lochnan HA - BMC Med Educ (2009)

Flow diagram showing the structure of the cohort study.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2654557&req=5

Figure 1: Flow diagram showing the structure of the cohort study.
Mentions: At the University of Ottawa Medical school (Ottawa, Canada), medical residents assigned to the endocrinology rotation were invited to participate. Attending physicians were aware of the objectives for the rotation, but were not made aware of the specific objectives for COCOS. We designed this study as a single institution, double cohort trial to investigate whether the use of COCOS during a clinical rotation can significantly improve learning and confidence of medical residents in the longitudinal management of patients with endocrine disorders. The hospital's ethics board approved this study. Written consent was obtained from all study participants. Figure 1 shows an algorithm of the control and intervention group analysis. The control group consisted of residents completing the endocrinology rotation. They were provided specific reading material and printed guidelines on endocrine topics. The intervention group completed the same rotation, but was expected to complete COCOS before the end of the rotation. Thus this group was using COCOS as an adjunct to the existing rotation. No designated time was allocated to use COCOS, which was accessible using unique usernames and passwords. The control group was recruited and assessed over a 9-month period before the intervention group to ensure users of COCOS did not discuss or share the website content with members of the control group.

Bottom Line: Compared to residents who did the rotation alone, residents who used COCOS during the rotation had significantly higher improvements in test scores (% increase in pre-post test scores +21.6 [standard deviation, SD, 8.0] vs. +5.9 [SD 6.8]; p < .001).There were no significant differences in changes in confidence.The adaptable, web-based format allows the creation of cases for most chronic medical conditions.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine, Division of Endocrinology, University Health Network, Toronto General Hospital, Toronto, Canada. Rene.Wong@uhn.on.ca

ABSTRACT

Background: Residency training takes place primarily on inpatient wards. In the absence of a resident continuity clinic, internal medicine residents rely on block rotations to learn about continuity of care. Alternate methods to introduce continuity of care are needed.

Methods: A web-based tool, Continuity of Care Online Simulations (COCOS), was designed for use in a one-month, postgraduate clinical rotation in endocrinology. It is an interactive tool that simulates the continuing care of any patient with a chronic endocrine disease. Twenty-three residents in internal medicine participated in a study to investigate the effects of using COCOS during a clinical rotation in endocrinology on pre-post knowledge test scores and self-assessment of confidence.

Results: Compared to residents who did the rotation alone, residents who used COCOS during the rotation had significantly higher improvements in test scores (% increase in pre-post test scores +21.6 [standard deviation, SD, 8.0] vs. +5.9 [SD 6.8]; p < .001). Test score improvements were most pronounced for less commonly seen conditions. There were no significant differences in changes in confidence. Residents rated COCOS very highly, recommending its use as a standard part of the rotation and throughout residency.

Conclusion: A stand-alone web-based tool can be incorporated into an existing clinical rotation to help residents learn about continuity of care. It has the most potential to teach residents about topics that are less commonly seen during a clinical rotation. The adaptable, web-based format allows the creation of cases for most chronic medical conditions.

Show MeSH
Related in: MedlinePlus