Behavior
Conditions
Brief summary
Spaced education is a promising theory-driven strategy to improve clinical competence. Our aim is to improve the clinical competence of Family Physicians, an outcome associated with the quality of care delivered to Canadians.
Detailed description
Research Question: Among family medicine residents, does enhanced feedback through an app providing alerts and test questions (spaced education), compared to the same app without alerts and enhanced feedback (no spaced education), improve competence as measured by the certification examination? In building this proposal for a definitive trial, the investigators have support from coast to coast. In addition to key clinician educators, the team includes knowledge users from the organization responsible for the certification examination in Family Medicine, methodologists and experienced researchers who study how mobile apps can promote engagement with clinical information. The team has the right blend of expertise in medical education and cluster randomized trials. Approach and Methods: The investigators will follow an organizational participatory research approach, and propose a cluster randomized controlled trial. Setting: All incoming family medicine residents in Canada will be eligible to participate. Intervention site residents will receive alerts through an app to adaptively reinforce the learning of clinical content based on cases and test questions (spaced education). Residents in the control group will receive the same app providing identical clinical cases and test questions-on-demand, but with alerts inactivated (no spaced education). The primary outcome will be scores on the certification examination. This routinely collected data will be provided to the team by the College of Family Physicians of Canada. Expected Results and Conclusion: Spaced education will improve examination scores. This will inform educational practice by providing evidence to optimize the training of residents.
Interventions
BEHAVIORALSpaced educational intervention
A spaced educational intervention will be provided to participants
Sponsors
Western University, Canada
College of Family Physicians of Canada
Memorial University of Newfoundland
Université de Montréal
University of Ottawa
Queen's University, Kingston, Ontario
University of Toronto
McMaster University
University of British Columbia
University of Alberta
Université de Sherbrooke
University of Calgary
Jewish General Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
* incoming family medicine residents in Canada (July 2017)
Exclusion criteria
* not a family medicine resident * did not start residency on July 1, 2017
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Scores on the Certification Examination | 2 years | This is the score on the written component of the examination of the College of Family Physicians of Canada. This refers to the grade/score given to participants on the Short Answer Management Problems (SAMP) section of the exam ranging from 0 to 100. Higher values represent a better outcome. The score minimum observed was 53.9 and max is 84.4 for this study. |
Countries
Canada
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Intervention Intervention site residents will receive alerts through an app to adaptively reinforce the learning of clinical content based on cases and test questions (spaced education).
Spaced educational intervention: A spaced educational intervention will be provided to participants | 335 |
| Control Residents in the control group will receive the same app providing identical clinical cases and test questions-on-demand, but with alerts inactivated (no spaced education). | 299 |
| Total | 634 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Never signed in to access the app | 54 | 58 |
Baseline characteristics
| Characteristic | Intervention | Control | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 335 Participants | 299 Participants | 634 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 335 Participants | 299 Participants | 634 Participants |
| Graduate degree | 80 Participants | 66 Participants | 146 Participants |
| International Medical Graduate | 40 Participants | 57 Participants | 97 Participants |
| Region of Enrollment Canada | 335 participants | 299 participants | 634 participants |
| Sex: Female, Male Disclosed gender (included 6 undisclosed in male intervention count) Female | 229 Participants | 210 Participants | 439 Participants |
| Sex: Female, Male Disclosed gender (included 6 undisclosed in male intervention count) Male | 106 Participants | 89 Participants | 195 Participants |
| Smart phone | 234 Participants | 213 Participants | 447 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
Scores on the Certification Examination
This is the score on the written component of the examination of the College of Family Physicians of Canada. This refers to the grade/score given to participants on the Short Answer Management Problems (SAMP) section of the exam ranging from 0 to 100. Higher values represent a better outcome. The score minimum observed was 53.9 and max is 84.4 for this study.
Time frame: 2 years
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Scores on the Certification Examination | 73.9 scores on a scale | Standard Deviation 4.4 |
| Control | Scores on the Certification Examination | 73.1 scores on a scale | Standard Deviation 5.1 |