title: Design and Implementation of a Novel Web-Based E-Learning Tool for Education of Health Professionals on the Antibiotic Vancomycin.
abstract: Traditional approaches to health professional education are being challenged by increased clinical demands and decreased available time. Web-based e-learning tools offer a convenient and effective method of delivering education, particularly across multiple health care facilities. The effectiveness of this model for health professional education needs to be explored in context.
  
  
  
  The study aimed to (1) determine health professionals' experience and knowledge of clinical use of vancomycin, an antibiotic used for treatment of serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and (2) describe the design and implementation of a Web-based e-learning tool created to improve knowledge in this area.
  
  
  
  We conducted a study on the design and implementation of a video-enhanced, Web-based e-learning tool between April 2014 and January 2016. A Web-based survey was developed to determine prior experience and knowledge of vancomycin use among nurses, doctors, and pharmacists. The Vancomycin Interactive (VI) involved a series of video clips interspersed with question and answer scenarios, where a correct response allowed for progression. Dramatic tension and humor were used as tools to engage users. Health professionals' knowledge of clinical vancomycin use was obtained from website data; qualitative participant feedback was also collected.
  
  
  
  From the 577 knowledge survey responses, pharmacists (n=70) answered the greatest number of questions correctly (median score 4/5), followed by doctors (n=271; 3/5) and nurses (n=236; 2/5; P<.001). Survey questions on target trough concentration (75.0%, 433/577) and rate of administration (64.9%, 375/577) were answered most correctly, followed by timing of first level (49%, 283/577), maintenance dose (41.9%, 242/577), and loading dose (38.0%, 219/577). Self-reported "very" and "reasonably" experienced health professionals were also more likely to achieve correct responses. The VI was completed by 163 participants during the study period. The rate of correctly answered VI questions on first attempt was 65% for nurses (n=63), 68% for doctors (n=86), and 82% for pharmacists (n=14; P<.001), reflecting a similar pattern to the knowledge survey. Knowledge gaps were identified for loading dose (39.2% correct on first attempt; 64/163), timing of first trough level (50.3%, 82/163), and subsequent trough levels (47.9%, 78/163). Of the 163 participants, we received qualitative user feedback from 51 participants following completion of the VI. Feedback was predominantly positive with themes of "entertaining," "engaging," and "fun" identified; however, there were some technical issues identified relating to accessibility from different operating systems and browsers.
  
  
  
  A novel Web-based e-learning tool was successfully developed combining game design principles and humor to improve user engagement. Knowledge gaps were identified that allowed for targeting of future education strategies. The VI provides an innovative model for delivering Web-based education to busy health professionals in different locations.
authors.affiliation: Wollongong Hospital, Department of Pharmacy, Illawarra Shoalhaven Local Health District, Wollongong, Australia.|School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia.|Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia.
authors.forename: Stuart Evan
authors.identifier: 0000-0001-9640-2474
authors.initials: SE
authors.lastname: Bond
authors.affiliation: Wollongong Hospital, Department of Pharmacy, Illawarra Shoalhaven Local Health District, Wollongong, Australia.
authors.forename: Shelley P
authors.identifier: 0000-0003-4259-3484
authors.initials: SP
authors.lastname: Crowther
authors.affiliation: St George Hospital, Department of Pharmacy, South Eastern Sydney Local Health District, Kogarah, Australia.|St George Clinical School, Faculty of Medicine, University of New South Wales, Kogarah, Australia.
authors.forename: Suman
authors.identifier: 0000-0001-5454-4300
authors.initials: S
authors.lastname: Adhikari
authors.affiliation: Prince of Wales Hospital, Department of Pharmacy, South Eastern Sydney Local Health District, Randwick, Australia.
authors.forename: Adriana J
authors.identifier: 0000-0002-4905-1269
authors.initials: AJ
authors.lastname: Chubaty
authors.affiliation: School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia.
authors.forename: Ping
authors.identifier: 0000-0002-7910-9396
authors.initials: P
authors.lastname: Yu
authors.affiliation: Research Central, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, Australia.
authors.forename: Jay P
authors.identifier: 0000-0003-3651-898X
authors.initials: JP
authors.lastname: Borchard
authors.affiliation: Wollongong Hospital, Department of Infectious Diseases, Illawarra Shoalhaven Local Health District, Wollongong, Australia.
authors.forename: Craig Steven
authors.identifier: 0000-0002-4754-0501
authors.initials: CS
authors.lastname: Boutlis
authors.affiliation: School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia.|Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia.|Wollongong Hospital, Division of Medicine, Illawarra Shoalhaven Local Health District, Wollongong, Australia.
authors.forename: Wilfred Winston
authors.identifier: 0000-0001-9554-5203
authors.initials: WW
authors.lastname: Yeo
authors.affiliation: School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia.|Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia.|Wollongong Hospital, Department of Infectious Diseases, Illawarra Shoalhaven Local Health District, Wollongong, Australia.
authors.forename: Spiros
authors.identifier: 0000-0003-4268-1599
authors.initials: S
authors.lastname: Miyakis
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D003194:Computer-Assisted Instruction / Q000379:methods*; D004501:Education, Medical / Q000379:methods*; D006282:Health Personnel / Q000193:education*; D006801:Humans; D020407:Internet; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D011795:Surveys and Questionnaires; D014640:Vancomycin / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: anti-bacterial agents; continuing education; medical education; nursing education; pharmacy education; survey methods; vancomycin