Web-based education in systems-based practice - A randomized trial

Background: All accredited US residency programs are expected to offer curricula and evaluate their residents in 6 general competencies. Medical schools are now adopting similar competency frameworks. We investigated whether a Web-based program could effectively teach and assess elements of systems-based practice. Methods: We enrolled 276 medical students and 417 residents in the fields of surgery, medicine, obstetrics-gynecology, and emergency medicine in a 9-week randomized, controlled, crossover educational trial. Participants were asked to sequentially complete validated Web-based modules on patient safety and the US health care system. The primary outcome measure was performance on a 26-item validated online test administered before, between, and after the participants completed the modules. Results: Six hundred forty (92.4%) of the 693 enrollees participated in the study; 512 (80.0%) of the participants completed all 3 tests. Participants' test scores improved significantly after completion of the first module (P <. 001). Overall learning from the 9-week Web-based program, as measured by the increase in scores (post-test scores minus pretest scores), was 16 percentage points (95% confidence interval, 14-17 percentage points; P <. 001) in public safety topics and 22 percentage points (95% confidence interval, 20-23 percentage points; P <. 001) in US health care system topics. Conclusion: A Web-based educational program on systems-based practice competencies generated significant and durable learning across a broad range of medical students and residents.