Teaching preventive medicine
A Community-Based Trial of an Online Intimate Partner Violence CME Program

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Background

There is a broad need to improve physician continuing medical education (CME) in the management of intimate partner violence (IPV). However, there are only a few examples of successful IPV CME programs, and none of these are suitable for widespread distribution.

Design

Randomized controlled trial beginning in September 2003 and ending in November 2004. Data were analyzed in 2005.

Setting/Participants

Fifty-two primary care physicians in small (fewer than eight physicians), community-based medical offices in Arizona and Missouri.

Intervention

Twenty-three physicians completed a minimum of 4 hours of an asynchronous, multi-media, interactive, case-based, online CME program that provided them flexibility in constructing their educational experience (“constructivism”). Control physicians received no CME.

Main Outcome Measures

Scores on a standardized self-reported survey, composed of ten scales of IPV knowledge, attitudes, beliefs, and self-reported behaviors (KABB) administered before randomization and repeated at 6 and 12 months following the CME program.

Results

Use of the online CME program was associated with a significant improvement in eight of ten KABB outcomes, including physician self-efficacy and reported IPV management practices, over the study period. These measures did not improve in the control group.

Conclusions

The Internet-based CME program was clearly effective in improving long-term individual educational outcomes, including self-reported IPV practices. This type of CME may be an effective and less costly alternative to live IPV training sessions and workshops.

Section snippets

Background

Intimate partner (domestic) violence (IPV), is a common problem seen in medical practice1, 2, 3 that physicians have historically handled poorly, and for which there have been long-standing calls for better education.4, 5, 6, 7 Responding to these calls, medical organizations have developed workshop-based education programs designed to improve practicing physicians’ knowledge, attitudes, beliefs, and behaviors (KABB) in dealing with IPV. Combined with other systems-based interventions, such

Study Design

This study evaluated the effectiveness of an online IPV program in a community practice setting. The study used a pre–post test design, comparing changes in baseline measures of physician KABB on IPV at 6 and 12 months, between physicians who completed the online IPV program and physicians not assigned to take the program. The primary study hypothesis was that there would be significantly greater improvement at 6 and 12 months in KABB scores in physicians completing the online CME versus

Participant Characteristics and Flow Through the Study

Baseline PREMIS (KABB) data were collected in September and October 2003. Randomization occurred in October 2003. Initial post-test data were collected from March through May 2004. The second set of post-test data was collected between September and November 2004. Data were analyzed in 2005. As depicted in Figure 1, 85 physicians initially agreed to participate in the study; however, only 81 physicians completed the first PREMIS surveys. Forty-four of these physicians were randomly assigned to

Discussion

This study shows that an asynchronous, interactive, online CME program developed by a cadre of national experts (see acknowledgments below), in accordance with current online education best practices, can be successful in changing a number of physicians’ IPV knowledge, attitudes, beliefs, and self-reported behaviors and practices, and that these changes can persist over ≥12 months. Importantly, these positive outcomes occurred in the absence of other systems changes that are typically

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