Effectiveness of a game-based educational strategy e-EDUCAGUIA for implementing antimicrobial clinical practice guidelines in family medicine residents in Spain: a randomized clinical trial by cluster

BMC Medical Education

Research Article

Jesús Martín-Fernández¹  Blanca Andreu-Ivorra²  Gloria Ariza-Cardiel³  Elena Polentinos-Castro⁴  Isabel del Cura-González⁴  Juan A. López-Rodríguez⁵  Jaime Barrio-Cortes⁶  Ricardo Rodríguez-Barrientos⁷  Teresa Sanz-Cuesta⁷  Cristina Lozano-Hernández⁸  José F. Ávila-Tomas⁹  Elisa Gallego-Ruiz-de-Elvira^1,10 

[1] Department of Medical Specialties and Public Health, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain;Research Network Health Services in Chronic Diseases (REDISSEC) & Research Network RICORS-RICAPP. ISCIII, Madrid, Spain;Instituto de Investigación Sanitaria Gregorio Marañon, IiSGM, Madrid, Spain;Multiprofessional Family and Community Care Teaching Unit Madrid, Madrid, Spain;Preventive Medicine Unit, Alcorcon Foundation University Hospital, Alcorcón, Madrid Health Service, Madrid, Spain;Research Network Health Services in Chronic Diseases (REDISSEC) & Research Network RICORS-RICAPP. ISCIII, Madrid, Spain;Instituto de Investigación Sanitaria Gregorio Marañon, IiSGM, Madrid, Spain;Multiprofessional Family and Community Care Teaching Unit Madrid, Madrid, Spain;Research Unit, Primary Care Assistance Management, Madrid Health Service Madrid, C/ San Martín de Porres, 6 _ 5ª Planta, 28035, Madrid, Spain;Department of Medical Specialties and Public Health, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain;Research Network Health Services in Chronic Diseases (REDISSEC) & Research Network RICORS-RICAPP. ISCIII, Madrid, Spain;Instituto de Investigación Sanitaria Gregorio Marañon, IiSGM, Madrid, Spain;Research Unit, Primary Care Assistance Management, Madrid Health Service Madrid, C/ San Martín de Porres, 6 _ 5ª Planta, 28035, Madrid, Spain;Department of Medical Specialties and Public Health, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain;Research Network Health Services in Chronic Diseases (REDISSEC) & Research Network RICORS-RICAPP. ISCIII, Madrid, Spain;Instituto de Investigación Sanitaria Gregorio Marañon, IiSGM, Madrid, Spain;General Ricardos Health Center, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain;Research Unit, Primary Care Assistance Management, Madrid Health Service Madrid, C/ San Martín de Porres, 6 _ 5ª Planta, 28035, Madrid, Spain;Primary Health Care Research and Innovation Foundation. FIIBAP, Madrid, Spain;Universidad Camilo José Cela, Madrid, Spain;Research Unit, Primary Care Assistance Management, Madrid Health Service Madrid, C/ San Martín de Porres, 6 _ 5ª Planta, 28035, Madrid, Spain;Research Network Health Services in Chronic Diseases (REDISSEC) & Research Network RICORS-RICAPP. ISCIII, Madrid, Spain;Instituto de Investigación Sanitaria Gregorio Marañon, IiSGM, Madrid, Spain;Research Unit, Primary Care Assistance Management, Madrid Health Service Madrid, C/ San Martín de Porres, 6 _ 5ª Planta, 28035, Madrid, Spain;Research Network Health Services in Chronic Diseases (REDISSEC) & Research Network RICORS-RICAPP. ISCIII, Madrid, Spain;Instituto de Investigación Sanitaria Gregorio Marañon, IiSGM, Madrid, Spain;Primary Health Care Research and Innovation Foundation. FIIBAP, Madrid, Spain;Santa Isabel Health Center, Primary Care Assistance Management, Madrid Health Service Leganes, Madrid, Spain;Servicio de Medicina Preventiva, Hospital Infantil Universitario Niño Jesús, Madrid Health Service, Madrid, Spain;

关键词: Health Personnel/education;    Professional Competence;    Experimental Games;    Problem Solving;    Practice Guidelines;    Game-based learning;   

DOI  :  10.1186/s12909-022-03843-4

 received in 2022-01-20, accepted in 2022-10-29,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundClinical practice guidelines (CPGs) have teaching potential for health professionals in training clinical reasoning and decision-making, although their use is limited. The objective was to evaluate the effectiveness of a game-based educational strategy e-EDUCAGUIA using simulated clinical scenarios to implement an antimicrobial therapy GPC compared to the usual dissemination strategies to improve the knowledge and skills on decision-making of family medicine residents. Additionally, adherence to e-EDUCAGUIA strategy was assessed.MethodsA multicentre pragmatic cluster-randomized clinical trial was conducted involving seven Teaching Units (TUs) of family medicine in Spain. TUs were randomly allocated to implement an antimicrobial therapy guideline with e-EDUCAGUIA strategy ( intervention) or passive dissemination of the guideline (control). The primary outcome was the differences in means between groups in the score test evaluated knowledge and skills on decision-making at 1 month post intervention. Analysis was made by intention-to-treat and per-protocol analysis. Secondary outcomes were the differences in mean change intrasubject (from the baseline to the 1-month) in the test score, and educational game adherence and usability. Factors associated were analysed using general linear models. Standard errors were constructed using robust methods.ResultsTwo hundred two family medicine residents participated (104 intervention group vs 98 control group). 100 medicine residents performed the post-test at 1 month (45 intervention group vs 55 control group), The between-group difference for the mean test score at 1 month was 11 ( 8.67 to 13.32) and between change intrasubject was 11,9 ( 95% CI 5,9 to 17,9). The effect sizes were 0.88 and 0.75 respectively. In multivariate analysis, for each additional evidence-based medicine training hour there was an increase of 0.28 points (95% CI 0.15–0.42) in primary outcome and in the change intrasubject each year of increase in age was associated with an improvement of 0.37 points and being a woman was associated with a 6.10-point reduction. 48 of the 104 subjects in the intervention group (46.2%, 95% CI: 36.5–55.8%) used the games during the month of the study. Only a greater number of evidence-based medicine training hours was associated with greater adherence to the educational game ( OR 1.11; CI 95% 1.02–1.21).ConclusionsThe game-based educational strategy e-EDUCAGUIA shows positive effects on the knowledge and skills on decision making about antimicrobial therapy for clinical decision-making in family medicin residents in the short term, but the dropout was high and results should be interpreted with caution. Adherence to educational games in the absence of specific incentives is moderate.Trial registrationClinicalTrials.gov Identifier: NCT02210442. Registered 6 August 2014.

【 授权许可】

CC BY   
© The Author(s) 2022

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