Kerfoot BP (VA Boston Healthcare System; Harvard Medical School), Conlin PR
(VA Boston Healthcare System; Harvard Medical School; Brigham & Women's Hospital)
Prostate cancer screening with prostate-specific antigen (PSA) testing is frequently performed counter to clinical practice guidelines. We investigated whether an email-based educational intervention termed ‘Interactive Spaced Education’ [ISE] could improve practitioners’ knowledge of PSA screening guidelines.
Primary care providers (physicians, nurse practitioners, and physician assistants) in VISN 1 were recruited via email to participate in this study. Participants were stratified by hospital and block randomized into two cohorts: the ISE group received four cycles of 9 emails over a 36 week period (0-2 emails per week), while those in the control group received no intervention. Each validated email presented a clinical scenario and asked whether or not it was appropriate to perform PSA screening. Participants received immediate feedback after submission of their answers. Multiple-choice test questions were developed based on consensus PSA screening guidelines, were content-validated by three experts, and then were pilot-tested on 33 physicians. Fourteen questions were selected based on psychometric performance and were administered as an online test to both cohorts at weeks 0, 18 and 36.
Ninety-five of the 260 VISN 1 primary care providers enrolled in the trial. In the ISE group, the 4 cycles of 9 emails were completed by 84%, 88%, 94% and 92% of providers, respectively. Average Cronbach alpha reliability (internal consistency) of the test instrument was 0.71. All three tests were completed by 92% and 85% of providers in the ISE and control groups, respectively. Test 1 scores (week 0) were similar between groups (mean 72%, SD 17; p=0.9). Under an intention-to-treat analysis, the mean test scores in the ISE group were 96% (SD 8) and 95% (SD 8) for tests 2 (week 18) and 3 (week 36), respectively. Corresponding test scores in the control group were 73% (SD 20) and 76% (SD 17) [p < 0.001 for both cross-cohort comparisons]. These cross-cohort differences represent Cohen effect sizes of 1.2 and 1.1, respectively.
ISE rapidly and significantly improves practitioners’ knowledge of PSA screening guidelines.
ISE is an effective email-based education system which can improve providers’ clinical knowledge across the VA system.