title: Efficacy of an internet-based tool for improving physician knowledge of chronic kidney disease: an observational study.
abstract: BACKGROUND
  Early recognition and management of chronic kidney disease (CKD) are associated with better outcomes. Internal medicine residency should prepare physicians to diagnose and manage CKD.
  
  
  METHODS
  To examine whether residency training and program characteristics were associated with CKD knowledge and investigate the effectiveness of an internet-based training module in improving CKD knowledge, we analyzed data from CKD training modules administered annually to U.S. internal medicine residents from July 1, 2005 to June 30, 2009. Baseline CKD knowledge was assessed using pre-tests. The modules' effectiveness was evaluated by post-tests. Comparisons were performed using X² tests and paired t-tests.
  
  
  RESULTS
  Of 4,702 residents, 38%, 33%, and 29% were program year (PGY)-1, PGY-2, and PGY-3, respectively. Baseline CKD knowledge was poor, with mean pre-test scores of 45.1-57.0% across the four years. The lowest pre-test performance was on CKD recognition. Pre-test scores were better with higher training levels (P-trend < 0.001 except 2005-2006 [P-trend = 0.35]). Affiliation with a renal fellowship program or program location within a region of high end-stage kidney disease prevalence was not associated with better baseline CKD knowledge. Completion of the CKD module led to significant improvements from pre- to post-test scores (mean improvement 27.8% [SD: 21.3%] which were consistent from 2005 to 2009.
  
  
  CONCLUSIONS
  Knowledge of diagnosis and management of CKD improves during residency training but remains poor among graduating residents. Web-based training can be effective in educating physicians on CKD-related issues. Studies are needed to determine whether knowledge gained from such an intervention translates to improved care of CKD patients.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 416, Baltimore, MD 21205, USA. mestrel1@jhmi.edu
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Estrella
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Sisson
authors.forename: Jennifer
authors.initials: J
authors.lastname: Roth
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Choi
mesh_terms: D002983:Clinical Competence; D003194:Computer-Assisted Instruction / Q000379:methods*; D006801:Humans; D007388:Internal Medicine / Q000193:education* / Q000379:methods; D020407:Internet / Q000639:trends; D007396:Internship and Residency / Q000379:methods / Q000639:trends; D010820:Physicians / Q000639:trends; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000628:therapy; D012189:Retrospective Studies