title: Internet Training Resulted in Improved Trainee Performance in a Simulated Opioid-Poisoned Patient as Measured by Checklist.
abstract: Opioid overdose is a leading cause of death in the USA. Internet-based teaching can improve medical knowledge among trainees, but there are limited data to show the effect of Internet-based teaching on clinical competence in medical training, including management of opioid poisoning.
  
  
  
  We used an ecological design to assess the effect of an Internet-based teaching module on the management of a simulated opioid-poisoned patient. We enrolled two consecutive classes of post-graduate year-1 residents from a single emergency medicine program. The first group (RA) was instructed to read a toxicology textbook chapter and the second group (IT) took a brief Internet training module. All participants subsequently managed a simulated opioid-poisoned patient. The participants' performance was evaluated with two types of checklist (simple and time-weighted), along with global assessment scores.
  
  
  
  Internet-trained participants performed better on both checklist scales. The difference between mean simple checklist scores by the IT and RA groups was 0.23 (95 % CI, 0.016-0.44). The difference between mean time-weighted checklist scores was 0.27 (95 % CI, 0.048-0.49). When measured by global assessment, there was no statistically significant difference between RA and IT participants.
  
  
  
  These data suggest that the Internet module taught basic principles of management of the opioid-poisoned patient. In this scenario, global assessment and checklist assessment may not measure the same proficiencies. These encouraging results are not sufficient to show that this Internet tool improves clinical performance. We should assess the impact of the Internet module on performance in a true clinical environment.
authors.affiliation: School of Medicine, University of Maryland, Baltimore, MD, USA.
authors.forename: Hong
authors.initials: H
authors.lastname: Kim
authors.affiliation: John Hopkins University, Baltimore, MD, USA.
authors.forename: Harry
authors.initials: H
authors.lastname: Heverling
authors.affiliation: John Hopkins University, Baltimore, MD, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Cordeiro
authors.affiliation: John Hopkins University, Baltimore, MD, USA.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Vasquez
authors.affiliation: John Hopkins University, Baltimore, MD, USA. astolba2@jhmi.edu.
authors.forename: Andrew
authors.initials: A
authors.lastname: Stolbach
mesh_terms: D015142:Baltimore; D001786:Blood Glucose / Q000032:analysis; D002983:Clinical Competence; D003131:Combined Modality Therapy; D003194:Computer-Assisted Instruction; D003663:Decision Trees; D062787:Drug Overdose / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D004635:Emergency Medicine / Q000193:education; D006801:Humans; D020407:Internet; D007396:Internship and Residency; D008487:Medical History Taking; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D016544:Patient Simulation; D010808:Physical Examination; D000067716:Point-of-Care Testing; D012025:Reflex, Pupillary / Q000187:drug effects; D012131:Respiratory Insufficiency / Q000209:etiology / Q000517:prevention & control; D056152:Respiratory Rate / Q000187:drug effects; D000066477:Work Performance; D000078329:Workforce
chemical_list: D001786:Blood Glucose; D009292:Narcotic Antagonists; D009270:Naloxone
keywords: Medical education; Opioids; Simulation; Toxicology