An Exploratory Study of Live and Web-Based Education on Bioterrorism for Healthcare Professionals: Knowledge Acquisition and Retention

Gordon F. West, George Hurrell, Donna Rane-Szostak, Robert Howard, Scott R. Lillibridge, Phillip A. Dombrowski, Anna Moll, Shel Bockman, Barbara Sirotnik, Christen Ruiz


Background: To determine the value of specific educational designs for improving healthcare professionals’ knowledge of bioterrorism, we conducted an exploratory study to compare the effectiveness of live and Web-based learning modules and specified levels of interaction with regard to the acquisition and retention of knowledge of bioterrorism agents by healthcare professionals. The primary goal was to identify the most relevant continuing medical education approach.

Methods: This large educational intervention study included 4 different experimental groups in a 2  2 design (2 levels of delivery mode and 2 levels of instructor–participant interaction). Civilian and military healthcare professionals (eg, physicians, nurses and nurse practitioners, pharmacists, public health officials) were recruited. The 2 educational-delivery modes used were “live” instruction and Web-based instruction (asynchronous/archived). Study participants were randomly assigned to 1 of the 2 levels of interactivity (interactive versus didactic), which were used to teach content about the recognition, diagnosis, and management of patient exposure to avian influenza, smallpox, toxins, and anthrax. The relative efficacy of the 2 delivery modes and interactivity was evaluated by participants completing a precourse test, a postcourse test immediately after participation in the course, and follow-up tests at 3 months and 6 months after course completion. Statistical significance was set at an α level of .01.

Results: A total of 472 healthcare professionals registered for courses. Despite the large drop-off in participation for the 3-month and 6-month follow-up tests (61% and 74%, respectively), the vast majority of learners completed the precourse test (98%) and the postcourse test (97%). The precourse and postcourse test scores indicated that participants achieved a higher level of knowledge regarding bioterrorism agents in all activities. Although there was a statistically significant decrease in knowledge after the activity, as evidenced by the decrease between the postcourse and 3-month follow-up test scores for all topics (P < .01), there was no significant further erosion in knowledge, as measured by the change between the 3-month and 6-month scores (P > .01, all topics). Additionally, the 6-month scores remained higher than the precourse test scores for all topics—evidence of some long-term retention of knowledge. There was no difference in learning between the participants in the live and Web activities for 2 of 3 topics (avian influenza and smallpox), but there was a significant difference in the activities related to the toxins topic: Participants in the live activities showed a 30% increase in mean postcourse test scores, compared with an 11% increase for those participating in the Web activities (P < .001). The anthrax course was presented in live mode only, so comparisons between delivery modes were not possible for this topic.

Conclusions: This exploratory study showed that educational interventions regarding bioterrorism led to learning by healthcare professionals, regardless of the educational-delivery mode (live or Web-based instruction) or level of instructor–participant interaction. Although participants in the study did tend to lose some of their newfound knowledge in the 3 months after completing the courses, further erosion of knowledge between the 3- and 6-month follow-up tests appeared to be limited. Generally, Web-based activities were as effective as live activities, with a few exceptions favoring the live format. Further study is needed to confirm these findings.

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