title: Long-term impact of four different strategies for delivering an on-line curriculum about herbs and other dietary supplements.
abstract: BACKGROUND
  Previous research has shown that internet education can lead to short-term improvements in clinicians' knowledge, confidence and communication practices. We wished to better understand the duration of these improvements and whether different curriculum delivery strategies differed in affecting these improvements.
  
  
  METHODS
  As previously described, we conducted a randomized control trial comparing four different strategies for delivering an e-curriculum about herbs and other dietary supplements (HDS) to clinicians. The four strategies were delivering the curriculum by: a) email over 10 weeks; b) email within one week; c) web-site over 10 weeks; d) web-site within one week. Participants were surveyed at baseline, immediately after the course and 6-10 months after completing the course (long-term). Long-term outcomes focused on clinicians' knowledge, confidence and communication practices.
  
  
  RESULTS
  Of the 780 clinicians who completed the course, 385 (49%) completed the long-term survey. Completers and non-completers of the long-term survey had similar demographics and professional characteristics at baseline. There were statistically significant improvements from baseline to long-term follow-up in knowledge, confidence and communication practices; these improvements did not differ by curriculum delivery strategy. Knowledge scores improved from 67.7 +/- 10.3 at baseline to 78.8 +/- 12.3 at long-term follow-up (P < 0.001). Confidence scores improved from 53.7 +/- 17.8 at baseline to 66.9 +/- 12.0 at long term follow-up (P < 0.001); communication scores improved from 2.6 +/- 1.9 at baseline to 3.6 +/- 2.1 (P < 0.001) at long-term follow-up.
  
  
  CONCLUSIONS
  This e- curriculum led to significant and sustained improvements in clinicians' expertise about HDS regardless of the delivery strategy. Future studies should compare the impact of required vs. elective courses and self-reported vs. objective measures of behavior change.
authors.affiliation: Physican Assistant Program, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. tbeal@wfubmc.edu
authors.forename: Tiffany
authors.initials: T
authors.lastname: Beal
authors.forename: Kathi J
authors.initials: KJ
authors.lastname: Kemper
authors.forename: Paula
authors.initials: P
authors.lastname: Gardiner
authors.forename: Charles
authors.initials: C
authors.lastname: Woods
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003142:Communication; D003194:Computer-Assisted Instruction / Q000592:standards*; D003479:Curriculum; D019587:Dietary Supplements; D020375:Education, Distance / Q000592:standards*; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D029001:Herbal Medicine / Q000193:education*; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D015397:Program Evaluation; D011446:Prospective Studies; D013997:Time Factors