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* From the Department of Anesthesia, Continuing Education, UHN Mount Sinai Hospital; and
The Centre for Research in Education, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Address correspondence to: Dr. Sharon Davies, Department of Anesthesia and Pain Management, Mount Sinai Hospital, Room 1514, 600 University Avenue, Toronto M5G 1X5, Canada. Phone: 416-586-5270; Fax: 416-586-8664; E-mail: sharon.davies{at}uhn.on.ca
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Abstract |
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Methods: Following University of Toronto Ethics approval, a survey questionnaire was sent to 875 anesthesiologists practicing in Ontario. Included with the questionnaire was an offer of a free module to be delivered by e-mail, regular mail or fax that could, upon completion, generate MainCert credits.
Results: Of the 875 questionnaires mailed, 413 (47%) were returned. A total of 404 responses, 113 from female (30%) and 291 from male (70%) anesthesiologists, were entered in the database. Three hundred and thirty three respondents requested the module and of these 51% preferred delivery by regular mail, 40% by e-mail and 3% by fax. Chi squared tests showed no significant differences between gender, among age groups, location of practice nor affiliation with university/teaching hospitals. When asked to rate their level of comfort with the Internet on a ten-point scale (1 = low, 10 = high), 59% of respondents indicated a level of 8 or higher. Of those who preferred regular mail, 40% indicated that they were also comfortable with electronic communication.
Conclusion: It was concluded that both e-mail and regular mail options should be offered to facilitate continuing medical education.
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Introduction |
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With the expansion of electronic communication, many education providers have suggested that web-based learning might offer a convenient and inexpensive way to obtain materials for continuing education credits. However, to date a search of the pertinent literature revealed that, despite the expressed interest in distant education through computer programs, these programs are not actually used by physicians.1 Therefore, before extensive work on web-based module development is carried out, it is necessary to determine if anesthesiologists are actually interested in this form of learning. In addition, we wished to explore the demographics of those interested in electronic delivery to find out whether particular characteristics influence the choice.
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Methods |
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The first part of the questionnaire elicited information regarding the demographics of the respondents. The second part asked if they were interested in receiving a sample learning module and, if so, whether they preferred delivery by e-mail, regular mail or fax. This module, entitled Laryngeal Mask Airway (LMA),A was designed so that it could be adapted for use in any of the three modalities. It consisted of photographs and a written compilation of current LMA literature followed by multiple-choice questions; it was therefore possible to complete the module either on-line or in hard copy. Requests for the module obviously required that respondents include their name and address but this identifying page was separated from the remainder of the questionnaire, thereby maintaining the anonymity of the data.
Descriptive statistics were generated from the data. Pearson Chi square analyses were calculated between demographic items and delivery preference.
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Results |
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The median age-range was 41 to 50 yr, the number of years in practice was 11 to 25 yr and the average number of continuing medical education (CME) courses taken in one year was three. One hundred and seventy-seven respondents (55%) were in non-teaching hospitals, with 138 (44%) in university or teaching hospitals.
Respondents were asked to rate their level of comfort using computers on a ten-point scale with level 1 indicating discomfort and level 10 indicating a high level of comfort. Fifty-nine percent indicated a level of 8 or higher.
Three hundred and thirty-three respondents requested the LMA module and of these the preferred delivery was regular mail 172 (52%), e-mail 134 (40%), fax ten (3%), and preference not selected 17 (5%). Given the basic gender ratio of practicing anesthesiologists in Ontario, Chi squared analysis showed no significant differences in choice of delivery among gender, age nor hospital affiliation (Figures 1
–3).
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2 = 80.0 P < 0.001, though it was noted that Chi square cell ‘level 10/request for computer delivery’ was a source of significant relationship. That is, those who indicated 10 as their level of comfort with computers were most likely to request the modules on-line. At the same time, the data showed that some of those who indicated a relatively high level of comfort (
8 on a ten-point scale) still preferred to receive the module by regular mail (Figure 4).
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Discussion |
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To explore the basic needs of physicians as learners, Slotnick3–5 undertook a comprehensive overview of adult learning theories. Extrapolating from these theories he suggested that physicians as adults would: 1) be practical in their approach to learning (interested in solving problems of specific importance to them); 2) be active participants in their own learning; and 3) have multiple demands on their lives. His survey indicated that physicians were most interested in continuing education activities that provided CME credit, topics that were important to them and events that did not conflict with social or family obligations. However, the authors point out that, although the adult learning perspective can aid CME design, the theoretical approach does not address the cost benefits (financial, time and efforts) from a physician’s point of view. Multiple demands on physicians’ lives suggest that CME courses should address these cost benefit notions. The learning event should also be geared to their interest and be easily accessible. This concept is supported by a study of family physicians6 which found that the cost factors in terms of time and energy appear to be more important in selecting sources of information than quality issues. In essence, physicians appear to value resources that are accessible, relevant and already known to them.5
In designing CME modules it was anticipated that computer based education would meet some of the above needs; that is, learners would find the Internet convenient and easily accessible, while at the same time providing CME credits. Our findings suggest that this is the case for many anesthesiologists. However, there are still others who prefer the traditional delivery methods.
Another issue to be recognized when designing CME modules is whether the learning methodology provided is equally effective as other traditional methods. A meta-analysis of computer based instruction in health professional education was undertaken by Cohen and Dacanay.7 They concluded that, despite some gaps in the reporting of data, the overall findings indicated a promising future for computer education within the health professions.
It has often been intimated that age and/or gender may influence the use of computer technology. Previous research has shown that family and childcare responsibilities are the greatest barriers to further adult education for women.8 In an attempt to overcome these barriers, a course on information technology was developed and offered on-line to women with the premise that they would be able to complete the course at times convenient to them.9 Despite built-in flexibility, low time demands and low cost, students continued to request increased time extensions to complete the course. "The majority highlighted a lack of time to participate due to the inability to balance work, family and educational demands – the very barrier thought to be overcome by web based instruction."
It has often been speculated that age may be a barrier to the acceptance of computer based education. However, Dyck’s10 study compared computer anxiety in university and college students under the age of 30 to adults over 55 and found that, when the effects of computer experience were controlled, there were no gender or age effects. In contrast to this study, our survey included all age groups and further supports the notion that neither age nor gender can be viewed as barriers in the use of computer technologies.
In our literature search, little information was found regarding the actual use of computers by anesthesiologists for continuing education. Speculating that the Internet would be a valuable resource for isolated anesthesiologists, Oyston11 conducted an on-line survey to determine, in part, which anesthesiologists were actually using the Internet to gain information related to their practice. Contrary to the authors’ expectations, it was found that the majority of respondents were urban based and practiced in teaching or university hospital settings. In contrast, we found that location had no relationship to the expressed interest in participating in on-line continuing education.
We acknowledge that the difference between the above citations and our findings, which show insignificant effects among gender, age and location in the choice of course delivery, may be the outcome of time and the exponential increase in personal computers in the home and place of business.
Of interest to CME planners is the fact that, although many of our respondents indicated that they were comfortable with computer technology, they still requested the module to be sent by regular mail. Analyses of the data gave no indication why this may be so. It can be speculated that a hard copy may be easier to read, that it can be read in a variety of locations such as when one is travelling, or that down-loading from the computer is costly. If the cost of production is factored into future modules, regular delivery could become a more expensive modality. This, in turn, may make the computer delivery more appealing. However, none of these notions are compelling without further evidence. In addition, we acknowledge that the results of this survey are limited by the fact that it involves only Ontario anesthesiologists and therefore may not represent the needs of anesthesiologists worldwide.
In conclusion, our study suggests that in order to meet the educational needs of anesthesiologists practicing in Ontario, the delivery system needs to include both computer based and regular mail modalities.
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Acknowledgments |
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Footnotes |
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A Doyle J. Unpublished module 2001 (http:/anescme.med.utoronto.ca). 
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References |
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2 Hollenberg C. Sharing and monitoring professional expertise. In: Sanford B (Ed.). Strategies for Maintaining Competence: A Manual for Professional Associations and Faculties. Toronto, Canadian Scholars Press Inc.; 1989.
3 Slotnick HB, Raszkowski RR, Lichtenauer DF. Rethinking continuing medical education. J Contin Educ Health Prof 1995; 15: 8–22.
4 Slotnick HB. How doctors learn: the role of clinical problems across the medical school-to-practice continuum. Acad Med 1996; 71: 28–34.[Medline]
5 Slotnick HB, Harris TR, Antonenko DR. Changes in learning-resource use across physicians’ learning episodes. Bull Med Libr Assoc 2001; 89: 194–203.[Medline]
6 Connelly DP, Rich EC, Curley SP, Kelly JT. Knowledge resource preferences of family physicians. J Fam Prac 1990; 30: 353–9.[Medline]
7 Cohen PA, Dacanay LS. Computer based instruction and health professions education. A meta-analysis of outcomes. Evaluation and the Health Professions 1992; 15: 259–81.
8 Pym FR. Women and distance education: a nursing perspective. J Adv Nurs 1992; 17: 383–9.[Medline]
9 Joseph GM. Reaching and teaching women on the web: the challenge of barriers and bottom lines. Can J University CE 1999; 25: 45–62.
10 Dyck JL, Smither JA. Age differences in computer anxiety: the role of computer experience, gender and education. J Educ Comput Res 1994; 10: 239–48.
11 Oyston JP, Ascah JG. The value of the internet to anaesthetists. Can J Anaesth 1997; 44: 439–44.
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