E-learning for early diagnosis of cerebral palsy: a randomised controlled trial evaluating the effectiveness of physician e-learning interventions on cerebral palsy diagnostic skills, behaviours and practice

Intervention development: The e-learning intervention was developed in two phases: 1) design of the behaviour change intervention following The Behaviour Change Wheel user guidelines, 2) design of the web-based evidence-centred education and training intervention using virtual video patients. Intervention design and development principles considered the evidence base and theoretical frameworks of behaviour change, learning processes and e-learning instructional design. Two e-learning interventions were developed for the RCT (adaptive and non-adaptive) to further the e-learning evidence base for comparing different instructional design. E-learning structure: Both intervention e-learning modules are self-paced with an estimated completion time of 30 - 60 minutes (depending on electronic knowledge resources accessed). The first 8-minute section is comprised of an opinion leader video introduction and a statement of objectives. In addition, interactive video features of knowledge questions, immediate feedback, and optional links to an e-book and fact sheet resources are available. The second section is comprised of a narrative virtual patient clinical case using an interactive video format. Interactive problem-solving and key-feature questions, with immediate feedback, are used throughout the virtual patients. Questions are multiple-choice. Immediate feedback via text onscreen is provided. A virtual patient bank of mixed practice key-feature cases is comprised of multi-media images, interactive videos and text onscreen. An accessible menu is available at all times throughout the e-learning module and virtual patient bank, comprised of downloadable resource fact sheets, an e-book and link to a web-based library of electronic knowledge resources: opinion leader videos, parent experience videos, podcasts, and lecture series. Adaptive e-learning intervention: In our adaptive instructional design of interactive videos and key-features virtual patients, we utilised designed adaptation throughout the training according to participants’ responses to reflective questions, knowledge questions, key-feature cases and problem-solving tasks. We used adaptivity of content through adapted text onscreen information and links to curriculum content. Adaptive navigation is used within the interactive video content with an enforced path determined by answers. Adaptive tools with interactive multi-media are used, for example, with hotspot interactive videos and with the scoring of video assessments (General Movements Assessment and components of Hammersmith Infant Neurological Examination) for more expert participants who respond they have pre-training in these assessments. Direct instruction and modelling videos are shown for participants not trained in these assessments, with text onscreen explanations of scores and scoring systems. Feedback to participant responses includes text onscreen knowledge information and adaptive video content displaying authentic, emotive patient reactions to their responses. Non-adaptive e-learning intervention: The non-adaptive intervention is linear in sequence, with no adaptivity of content, navigation, multi-media or tools. The only instructional design feature modified in the non-adaptive intervention is adaptivity. Both intervention groups have equal access to the e-learning module, a menu of electronic knowledge resources and a virtual patient bank of key-feature cases. Participants can repeat the e-learning module and virtual patients as many times as they choose to. Access: Access control to e-learning modules is via REDCap and secure password and key management. Availability is restricted to study participants. Participants can access via their choice of desktop or tablet, from home or work. The e-learning is based on the open-source learning platform Moodle hosted by Amazon Web Servers for the duration of the study. The intervention is entirely web-based and asynchronous. Participants will be asked to complete the e-learning module within one month. Both intervention groups have equal access to the e-learning module, a menu of electronic knowledge resources and a virtual patient bank of key-feature cases. Participants can repeat the e-learning module and virtual patients as many times as they choose to. The total number of key-feature virtual patients is 15. Moodle collects information about each user with a timestamp for each action and what resources are accessed in the e-learning package (for example, e-book and resource downloads). The duration of each e-learning session (module and virtual patient bank) and the number of links accessed in a session will be recorded. The number of reminders sent to participants to complete the eLearning module or virtual patients is recorded in REDcap. Participants in all groups will be asked to complete a survey to provide information on any early diagnosis of CP training or continuing professional development they accessed during the study period. The intervention e-learning and educational resources were custom designed for this study based on a published clinical guideline, consumer co-design, and Delphi survey of prospective learners perceived needs. A suite of early diagnosis of cerebral palsy electronic fact sheet resources, based on a published clinical guideline, have been published on Figshare: https://mcri.figshare.com/authors/Lynda_McNamara/5207980. These fact sheet resources are accessible and downloadable through the study e-learning interventions in addition to new educational resources designed specifically for this study.