title: Interactive Online Module Failed to Improve Sustained Knowledge of the Maryland Medical Orders for Life-Sustaining Treatment Form.
abstract: Legal documents similar to the Maryland Medical Orders for Life-Sustaining Treatment (MOLST) form requiring physician endorsement are increasingly used by critically ill patients.
  
  
  
  To evaluate whether an interactive, online training module on completion and interpretation of the MOLST form leads to a sustained increase in knowledge among house staff.
  
  
  
  Pre/post survey of 329 house staff at Johns Hopkins Hospital who admit and discharge patients between June 2014 and July 2015. House staff were encouraged to complete a voluntary, interactive, online educational module on completing and interpreting MOLST forms. Participants received $25 for accessing the module and $10 for completing each survey.
  
  
  
  The primary outcome was the change in the number of questions answered correctly on the post- versus presurvey comparing house staff who viewed the module for at least 20 minutes with house staff who never viewed or never completed the module. Overall, 329 (69%) house staff completed the knowledge assessment survey both before and after the module was available, and 201 (61%) of these house staff completed the voluntary module. The median score on the presurvey conducted in July and August of 2014 was 14 out of 21 (interquartile range [IQR] 12, 16). The median (IQR) score on the postsurvey conducted in May and June of 2015 was 15 out of 21 (13, 17). The median (IQR) change in score among those who spent at least 20 minutes completing the module was 1 question (-1, 3), and among those who never viewed or never completed the module it was also 1 (IQR -1, 2). The postsurvey was completed a median (IQR) of 59 (52, 62) days after viewing the module. After adjusting for years of postgraduate clinical training, self-reported baseline experience completing MOLST forms, and self-reported responsibility for discharging patients, viewing the module for at least 20 minutes was associated with a nonsignificant increase in score of 0.41 questions (95% confidence interval, -0.25, 1.06; P = 0.23).
  
  
  
  An interactive, online educational module had no effect on trainee knowledge of completing and interpreting MOLST forms approximately 2 months after completion. Information conveyed via online modules alone may have minimal sustained impact on house staff knowledge.
authors.affiliation: 1 Outcomes after Critical Illness and Surgery Group.|2 Division of Pulmonary and Critical Care Medicine, School of Medicine.|3 Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Alison E
authors.identifier: 0000-0002-1564-6547
authors.initials: AE
authors.lastname: Turnbull
authors.affiliation: 4 Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts; and.
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Hayes
authors.affiliation: 1 Outcomes after Critical Illness and Surgery Group.|2 Division of Pulmonary and Critical Care Medicine, School of Medicine.
authors.forename: Mohamed D
authors.initials: MD
authors.lastname: Hashem
authors.affiliation: 1 Outcomes after Critical Illness and Surgery Group.|2 Division of Pulmonary and Critical Care Medicine, School of Medicine.|5 Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D016223:Advance Directives; D016638:Critical Illness / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D020407:Internet; D007396:Internship and Residency; D016014:Linear Models; D008396:Maryland; D015999:Multivariate Analysis; D011361:Professional Competence / Q000592:standards*; D000066908:Simulation Training / Q000706:statistics & numerical data*
keywords: adult learning; advance directives; interactive tutorial; professional competence; resident education