title: Teaching Shared Decision Making to Family Medicine Residents: A Descriptive Study of a Web-Based Tutorial.
abstract: BACKGROUND
  DECISION+2, a Web-based tutorial, was designed to train family physicians in shared decision making (SDM) regarding the use of antibiotics for acute respiratory infections (ARIs). It is currently mandatory for second-year family medicine residents at Université Laval, Quebec, Canada. However, little is known about how such tutorials are used, their effect on knowledge scores, or how best to assess resident participation.
  
  
  OBJECTIVE
  The objective of our study was to describe the usage of this Web-based training platform by family medicine residents over time, evaluate its effect on their knowledge scores, and identify what kinds of data are needed for a more comprehensive analysis of usage and knowledge acquisition.
  
  
  METHODS
  We identified, collected, and analyzed all available data about participation in and current usage of the tutorial and its before-and-after 10-item knowledge test. Residents were separated into 3 log-in periods (2012-2013, 2013-2014, and 2014-2015) depending on the day of their first connection. We compared residents' participation rates between entry periods (Cochran-Armitage test), assessed the mean rank of the difference in total scores and category scores between pre- and posttest (Wilcoxon signed-rank test), and compared frequencies of each. Subsequent to analyses, we identified types of data that would have provided a more complete picture of the usage of the program and its effect on knowledge scores.
  
  
  RESULTS
  The tutorial addresses 3 knowledge categories: diagnosing ARIs, treating ARIs, and SDM regarding the use of antibiotics for treating ARIs. From July 2012 to July 2015, all 387 second-year family medicine residents were eligible to take the Web-based tutorial. Out of the 387 eligible residents, 247 (63.8%) logged in at least once. Their participation rates varied between entry periods, most significantly between the 2012-2013 and 2013-2014 cohorts (P=.006). For the 109 out of 387 (28.2%) residents who completed the tutorial and both tests, total and category scores significantly improved between pre- and posttest (all P values <.001). However, the frequencies of those answering correctly on 2 of the 3 SDM questions did not increase significantly (P>.99, P=.25). Distribution of pre- or posttest total and category scores did not increase between entry periods (all P values >.1). Available data were inadequate for evaluating the associations between the tutorial and its impact on the residents' scores and therefore could tell us little about its effect on increasing their knowledge.
  
  
  CONCLUSIONS
  Residents' use of this Web-based tutorial appeared to increase between entry periods following the changes to the SDM program, and the tutorial seemed less effective for increasing SDM knowledge scores than for diagnosis or treatment scores. However, our results also highlight the need to improve data availability before participation in Web-based SDM tutorials can be properly evaluated or knowledge scores improved.
authors.affiliation: Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada.|Department of Mathematics and Statistics, Université Laval, Quebec, QC, Canada.
authors.forename: Maxime
authors.identifier: http://orcid.org/0000-0003-3262-9842
authors.initials: M
authors.lastname: Dion
authors.affiliation: Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada.|Department of Community Health, Université Laval, Quebec, QC, Canada.
authors.forename: Ndeye Thiab
authors.identifier: http://orcid.org/0000-0003-4522-2144
authors.initials: NT
authors.lastname: Diouf
authors.affiliation: Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada.
authors.forename: Hubert
authors.identifier: http://orcid.org/0000-0001-5817-5602
authors.initials: H
authors.lastname: Robitaille
authors.affiliation: Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada.
authors.forename: Stéphane
authors.identifier: http://orcid.org/0000-0002-4528-1315
authors.initials: S
authors.lastname: Turcotte
authors.affiliation: Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada.|Department of Social and Preventive Medicine, Université Laval, Quebec, QC, Canada.
authors.forename: Rhéda
authors.identifier: http://orcid.org/0000-0003-2271-8059
authors.initials: R
authors.lastname: Adekpedjou
authors.affiliation: Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada.|Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada.
authors.forename: Michel
authors.identifier: http://orcid.org/0000-0002-8972-5491
authors.initials: M
authors.lastname: Labrecque
authors.affiliation: Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada.|Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada.
authors.forename: Michel
authors.identifier: http://orcid.org/0000-0003-3362-6977
authors.initials: M
authors.lastname: Cauchon
authors.affiliation: Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada.|Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada.
authors.forename: France
authors.identifier: http://orcid.org/0000-0002-2296-6696
authors.initials: F
authors.lastname: Légaré
keywords: computer-assisted instruction; decision making; education, medical, graduate; educational measurement; patient participation; program evaluation