title: Development and assessment of an e-learning course on breast imaging for radiographers: a stratified randomized controlled trial.
abstract: BACKGROUND
  Mammography is considered the best imaging technique for breast cancer screening, and the radiographer plays an important role in its performance. Therefore, continuing education is critical to improving the performance of these professionals and thus providing better health care services.
  
  
  OBJECTIVE
  Our goal was to develop an e-learning course on breast imaging for radiographers, assessing its efficacy, effectiveness, and user satisfaction.
  
  
  METHODS
  A stratified randomized controlled trial was performed with radiographers and radiology students who already had mammography training, using pre- and post-knowledge tests, and satisfaction questionnaires. The primary outcome was the improvement in test results (percentage of correct answers), using intention-to-treat and per-protocol analysis.
  
  
  RESULTS
  A total of 54 participants were assigned to the intervention (20 students plus 34 radiographers) with 53 controls (19+34). The intervention was completed by 40 participants (11+29), with 4 (2+2) discontinued interventions, and 10 (7+3) lost to follow-up. Differences in the primary outcome were found between intervention and control: 21 versus 4 percentage points (pp), P<.001. Stratified analysis showed effect in radiographers (23 pp vs 4 pp; P=.004) but was unclear in students (18 pp vs 5 pp; P=.098). Nonetheless, differences in students' posttest results were found (88% vs 63%; P=.003), which were absent in pretest (63% vs 63%; P=.106). The per-protocol analysis showed a higher effect (26 pp vs 2 pp; P<.001), both in students (25 pp vs 3 pp; P=.004) and radiographers (27 pp vs 2 pp; P<.001). Overall, 85% were satisfied with the course, and 88% considered it successful.
  
  
  CONCLUSIONS
  This e-learning course is effective, especially for radiographers, which highlights the need for continuing education.
authors.affiliation: Faculty of Medicine of the University of Porto, Porto, Portugal. icm@estsp.ipp.pt.
authors.forename: Inês C
authors.identifier: http://orcid.org/0000-0001-6868-1613
authors.initials: IC
authors.lastname: Moreira
authors.forename: Sandra Rua
authors.identifier: http://orcid.org/0000-0001-9608-2343
authors.initials: SR
authors.lastname: Ventura
authors.forename: Isabel
authors.identifier: http://orcid.org/0000-0002-5007-3000
authors.initials: I
authors.lastname: Ramos
authors.forename: Pedro Pereira
authors.identifier: http://orcid.org/0000-0001-7867-6682
authors.initials: PP
authors.lastname: Rodrigues
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging; D020375:Education, Distance; D004502:Education, Medical, Continuing; D004521:Educational Measurement; D005260:Female; D006801:Humans; D008297:Male; D008327:Mammography; D011174:Portugal; D011634:Public Health; D011871:Radiology / Q000193:education*; D013334:Students; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: breast neoplasms; continuing education; distance learning; evaluation studies; mammography