title: Web-based education in systems-based practice: a randomized trial.
abstract: BACKGROUND
  All accredited US residency programs are expected to offer curricula and evaluate their residents in 6 general competencies. Medical schools are now adopting similar competency frameworks. We investigated whether a Web-based program could effectively teach and assess elements of systems-based practice.
  
  
  METHODS
  We enrolled 276 medical students and 417 residents in the fields of surgery, medicine, obstetrics-gynecology, and emergency medicine in a 9-week randomized, controlled, crossover educational trial. Participants were asked to sequentially complete validated Web-based modules on patient safety and the US health care system. The primary outcome measure was performance on a 26-item validated online test administered before, between, and after the participants completed the modules.
  
  
  RESULTS
  Six hundred forty (92.4%) of the 693 enrollees participated in the study; 512 (80.0%) of the participants completed all 3 tests. Participants' test scores improved significantly after completion of the first module (P<.001). Overall learning from the 9-week Web-based program, as measured by the increase in scores (posttest scores minus pretest scores), was 16 percentage points (95% confidence interval, 14-17 percentage points; P<.001) in public safety topics and 22 percentage points (95% confidence interval, 20-23 percentage points; P<.001) in US health care system topics.
  
  
  CONCLUSIONS
  A Web-based educational program on systems-based practice competencies generated significant and durable learning across a broad range of medical students and residents.
authors.affiliation: Urology Section, Veterans Affairs Boston Healthcare System, Harvard Medical School, and Endocrinology, Diabetes, and Hypertension Division, Brigham & Women's Hospital, Boston, Mass 02130, USA. price.kerfoot@gmail.com
authors.forename: B Price
authors.initials: BP
authors.lastname: Kerfoot
authors.forename: Paul R
authors.initials: PR
authors.lastname: Conlin
authors.forename: Thomas
authors.initials: T
authors.lastname: Travison
authors.forename: Graham T
authors.initials: GT
authors.lastname: McMahon
mesh_terms: D018592:Cross-Over Studies; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020407:Internet; D007396:Internship and Residency / Q000379:methods*; D007858:Learning; D008297:Male; D015397:Program Evaluation / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012577:Schools, Medical; D013337:Students, Medical; D014481:United States