General practitioners’ knowledge of whiplash guidelines improved with online education
T. Rebbeck A F , L. Macedo B , P. Paul C , L. Trevena D and I. D. Cameron EA Discipline of Physiotherapy, Faculty of Health Science, The University of Sydney, Lidcombe, NSW 2141, Australia.
B Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada.
C Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia.
D Sydney School of Public Health, University of Sydney, Sydney, NSW 2006, Australia.
E Rehabilitation Studies Unit, Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia.
F Corresponding author. Email: trudy.rebbeck@sydney.edu.au
Australian Health Review 37(5) 688-694 https://doi.org/10.1071/AH13057
Submitted: 13 March 2013 Accepted: 2 August 2013 Published: 28 October 2013
Abstract
Objective The primary objective of this study was to evaluate the effect of an online education program used to implement the Australian (New South Wales) whiplash guidelines with general practitioners (GP). The secondary aim was to identify factors associated with learning.
Methods An online educational and evaluation activity was developed to reflect the key messages for GP from the Australian whiplash guidelines. The educational activity was hosted on the Royal Australian College of General Practitioners’ website (www.gplearning.com.au) for a period of 3 years. Participants were recruited through advertisement and media releases. Participants completed a baseline evaluation of their knowledge, participated in the interactive educational activity and completed a post-knowledge questionnaire. The primary outcome was change in professional knowledge, predictors of learning were computed using linear regression.
Results Two hundred and fifteen GP participated. Knowledge significantly improved between baseline and post-knowledge questionnaire scores (P < 0.00001). A total of 57.2% of participants improved their knowledge by more than 20%, indicating a large effect. Low baseline knowledge predicted learning, accounting for 71% of the variance.
Conclusions Online education of GP significantly improved their knowledge in relation to guidelines for whiplash. Those with low baseline knowledge improved their knowledge the most, suggesting that implementation strategies should be targeted at this group.
What is known about the topic? Clinical guidelines are usually developed to improve knowledge and ultimately change clinical practice to reflect best practice management of that condition. However, developing and publishing guidelines alone rarely changes knowledge or clinical practice. With GP, effective implementation strategies to improve knowledge have included face to face education such as interactive educational meetings and educational outreach. However, these strategies are expensive and time consuming. Whiplash is a significant health problem in Australia, and although GP are commonly consulted for this condition, an individual GP may only see one whiplash case per year, meaning that face to face implementation strategies may not be pragmatic for this condition.
What does this paper add? This paper shows that online education was effective in improving GP knowledge of clinical guidelines for whiplash. The effect was as large as the reported effects for face to face education in other studies. Importantly this paper shows that the less GP knew about whiplash, the more they learnt, indicating that the strategy was effective for those who most required the education. Finally, the online strategy reached GP in rural and remote places in Australia. This paper therefore shows that online education can be an effective method to improve GP knowledge about managing whiplash. It is hoped that it may provide the impetus to use this strategy for implementing clinical guidelines for other conditions.
What are the implications for practitioners? Practitioners can be confident that using an online educational program will improve their knowledge of managing conditions they previously knew little about. It is hoped that this will translate into a change in clinical practice. For example, GP using this strategy improved knowledge in knowing when to X-ray, when to refer and what interventions to provide for people with whiplash. For any health practitioners managing whiplash access to this information is still available using the New South Wales Motor Accident Authority website (www.maa.nsw.gov.au)
Additional keywords: clinical guidelines, implementation, online learning.
References
[1] Motor Accidents Authority of New South Wales. MAA whiplash guidelines − GP summary. 2nd edn. Sydney: Motor Accidents Authority of NSW; 2007. Available at http://www.maa.nsw.gov.au/default.aspx?MenuID=141 [verified 8 August 2012][2] Motor Accidents Authority of New South Wales. Summary guidelines for the management of acute whiplash-associated disorders for health professionals. 2nd edn. Sydney: Motor Accidents Authority of NSW; 2007. Available at http://www.maa.nsw.gov.au/default.aspx?MenuID=141 [verified 8 August 2012]
[3] Grimshaw JM, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L, et al Changing provider behavior: an overview of systematic reviews of interventions. Med Care 2001; 39 II2–II45.
| Changing provider behavior: an overview of systematic reviews of interventions.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MrjsFSjsQ%3D%3D&md5=f7b63db1fe5339fe9804a3c09cd89635CAS | 11583120PubMed |
[4] Grol R. Successes and failures in implementation of evidence-based guidelines for clinical practice. Med Care 2001; 39 II46–II54.
| 1:STN:280:DC%2BD3MrjsFSjtg%3D%3D&md5=7bcaa267513236e3342fef751366ae33CAS | 11583121PubMed |
[5] Grol R, Dalhuijsen J, Thomas S, Veld C, Rutten G, Mokkink H. Attributes of clinical guidelines that influence use of guidelines in general practice: an observational study. BMJ 1998; 317 858–61.
| Attributes of clinical guidelines that influence use of guidelines in general practice: an observational study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1cvitFCgsg%3D%3D&md5=36bf16fa7052a005fceebca1e12e7f42CAS | 9748183PubMed |
[6] Flodgren G, Parmelli E, Doumit G, Gattellari M, O’Brien MA, Grimshaw J, et al Local opinion leaders: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2007; CD000125
[7] Forsetlund L, Bjorndal A, Rashidian A, Jamtvedt G, O’Brien MA, Wolf F, et al Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2009; CD003030
| 19370580PubMed |
[8] Cantillon P, Jones RH. Does continuing medical education in general practice make a difference? BMJ 1999; 318 1276
| Does continuing medical education in general practice make a difference?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1M3ksl2ltw%3D%3D&md5=e1e5404d5fc127a4e72a93500995f8a7CAS | 10231265PubMed |
[9] Flottorp S, Havelsrud K, Oxman A. Process evaluation of a cluster randomized trial of tailored interventions to implement guidelines in primary care − why is it so hard to change practice? Fam Pract 2003; 20 333–9.
| Process evaluation of a cluster randomized trial of tailored interventions to implement guidelines in primary care − why is it so hard to change practice?Crossref | GoogleScholarGoogle Scholar | 12738704PubMed |
[10] Wensing M, van der Weijden T, Grol R. Implementing guidelines and innovations in general practice: which interventions are effective? Br J Gen Pract 1998; 48 991–7.
| 1:STN:280:DyaK1c3oslyksg%3D%3D&md5=c52c7ee175c2165b295f0949d8f062d9CAS | 9624774PubMed |
[11] Anderson S. A collaborative approach to management of motor vehicle related injuries (whiplash, anxiety ANF) in general practice. Final report to the Motor Accidents Authority of New South Wales. Central Coast Division of General Practice. Sydney: Motor Accidents Authority of NSW; 2005. Available at www.ccdgp.com.au/site/content.cfm?page_id=20177
[12] Brown TT, Proctor SE, Sinkowitz-Cochran RL, Smith TL, Jarvis WR. Education with a focus on the topic of antimicrobial resistance: a society for healthcare epidemiology of America. Infect Control Hosp Epidemiol 2001; 22 656–60.
| Education with a focus on the topic of antimicrobial resistance: a society for healthcare epidemiology of America.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38%2FkvVyiuw%3D%3D&md5=73754005924de7eb0e4ced037e82e78eCAS | 11776356PubMed |
[13] Cobb SC. Internet continuing education for health care professionals: an integrative review. J Contin Educ Health Prof 2004; 24 171–80.
| Internet continuing education for health care professionals: an integrative review.Crossref | GoogleScholarGoogle Scholar | 15490549PubMed |
[14] Trevena LJ, Robinson L. Online continuing education in evidence-based medicine for general practitioners: does it work? Proceedings of 2nd International Conference for EBHC teachers and developers. 2003; Sicily, Italy.
[15] McKimm J, Jollie C, Cantillon P. ABC of learning and teaching. Web based learning. BMJ 2003; 326 870–3.
| ABC of learning and teaching. Web based learning.Crossref | GoogleScholarGoogle Scholar | 12702625PubMed |
[16] Ruiz JG, Mintzer MJ, Leipzig RM. The impact of E-learning in medical education. Acad Med 2006; 81 207–12.
| The impact of E-learning in medical education.Crossref | GoogleScholarGoogle Scholar | 16501260PubMed |
[17] Waldorff FB, Almind G, Makela M, Moller S, Waldemar G. Implementation of a clinical dementia guideline: a controlled study on the effect of a multifaceted strategy. Scand J Prim Health Care 2003; 21 142–7.
| Implementation of a clinical dementia guideline: a controlled study on the effect of a multifaceted strategy.Crossref | GoogleScholarGoogle Scholar | 14531504PubMed |
[18] Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier L. Accuracy of physician self-assessment compared with observed measures of competence. A systematic review. JAMA 2006; 296 1094–102.
| Accuracy of physician self-assessment compared with observed measures of competence. A systematic review.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD28XptlKjtr0%3D&md5=87c9acdaea3afaf689b309209c57645dCAS | 16954489PubMed |
[19] Rebbeck T, Macedo L, Maher C. Compliance with clinical guidelines for whiplash improved with a targeted implementation strategy. A prospective cohort study. BMC Heatlh Services Research 2013; 13 213
| Compliance with clinical guidelines for whiplash improved with a targeted implementation strategy. A prospective cohort study.Crossref | GoogleScholarGoogle Scholar |
[20] Eccles M, Steen N, Grimshaw J, Thomas L, McNamee P, Soutter J, et al Effect of audit and feedback, and reminder messages on primary-care radiology referrals: a randomised trial. Lancet 2001; 357 1406–9.
| Effect of audit and feedback, and reminder messages on primary-care radiology referrals: a randomised trial.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M3mtlGnug%3D%3D&md5=e1a71a7ab416cfc5468b6573a23dbaa7CAS | 11356439PubMed |
[21] Oakeshott P, Kerry SM, Williams JE. Randomized controlled trial of the effect of the Royal College of Radiologists’ guidelines on general practitioners’ referrals for radiographic examination. Br J Gen Pract 1994; 44 197–200.
| 1:STN:280:DyaK2c3mtlKnsw%3D%3D&md5=52d17faaf9b86ba2769b77a1c1a02585CAS | 8204331PubMed |
[22] Dey P, Simpson CWR, Collins SI, Hodgson G, Dowwrick CF, Simison AJM, et al Implementation of RCGP guidelines for acute low back pain: a cluster randomised controlled trial. Br J Gen Pract 2004; 54 33–7.
| 14965404PubMed |
[23] Cheater FM, Baker R, Reddish S, Spiers N, Wailoo A, Gillies C, et al Cluster randomized controlled trial of the effectiveness of audit and feedback and educational outreach on improving nursing practice and patient outcomes. Med Care 2006; 44 542–51.
| Cluster randomized controlled trial of the effectiveness of audit and feedback and educational outreach on improving nursing practice and patient outcomes.Crossref | GoogleScholarGoogle Scholar | 16708003PubMed |
[24] Fordis M, King JE, Ballantyne CM, Jones P, Schneider KH, Spann SJ, et al Comparison of the instructional efficacy of internet-based CME with live interactive CME workshops: a randomized controlled tria. JAMA 2005; 294 1043–51.
| Comparison of the instructional efficacy of internet-based CME with live interactive CME workshops: a randomized controlled tria.Crossref | GoogleScholarGoogle Scholar | 16145024PubMed |
[25] Tracey J, Aroll B, Richmond D, Barhan P. The validity of general practitioners’ self assessment of knowledge: cross sectional study. BMJ 1997; 315 1426–8.
| 1:STN:280:DyaK1c%2FnvFartQ%3D%3D&md5=efcbb9f69fdac9c27481e2505f3e2f51CAS | 9418092PubMed |
[26] Minter R, Gruppen L, Napolitano K, Gauger P. Gender differences in the self assessment of surgical residents. Am J Surg 2005; 189 647–50.
| Gender differences in the self assessment of surgical residents.Crossref | GoogleScholarGoogle Scholar | 15910713PubMed |
[27] Blanch D, Hall J, Roter D, Frankel R. Medical student gender and issues of confidence. Patient Educ Couns 2008; 72 374–81.
| Medical student gender and issues of confidence.Crossref | GoogleScholarGoogle Scholar | 18656322PubMed |
[28] Harrell FEJ, Lee KL, Mark DB. Tutorial in biostatistics multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy and measuring and reducing errors. Stat Med 1996; 15 361–87.
| Tutorial in biostatistics multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy and measuring and reducing errors.Crossref | GoogleScholarGoogle Scholar |
[29] Engers AJ, Wensing M, van Tulder MW, Timmermans A, Oostendorp RA, Koes BW, et al Implementation of the Dutch low back pain guideline for general practitioners: a cluster randomized controlled trial. Spine 2005; 30 559–600.
| Implementation of the Dutch low back pain guideline for general practitioners: a cluster randomized controlled trial.Crossref | GoogleScholarGoogle Scholar | 15770171PubMed |
[30] Rebbeck T, Maher CG, Refshauge KM. Evaluating two implementation strategies for whiplash guidelines in physiotherapy: a cluster randomised trial. Australian Journal of Physiotherapy 2006; 52 165–74.
| 16942451PubMed |
[31] Burton AK, Waddell G, Tillotson KM, Summerton N. Information and advice to patients with back pain can have a positive effect. A randomized controlled trial of a novel educational booklet in primary care. Spine 1999; 24 2484–91.
| Information and advice to patients with back pain can have a positive effect. A randomized controlled trial of a novel educational booklet in primary care.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c%2FptFOmtA%3D%3D&md5=98d61f2022d003d967fa544cd81d5815CAS | 10626311PubMed |
