Impact of Educational Activity Formats, Online or In-Person, on the Intention of Medical Specialists to Adopt a Clinical Behaviour: A Comparative Study

Figures & data

Figure 1. Flow chart of study participants.

Table 1. Socio-demographic profile of participants.

	All participants	In-person format	Online learning format
Variables	N = 400	N = 82	N = 318
Age (years), mean ± SD	50 ± 12	52 ± 10	49 ± 12
Sex, n (%)
Male	240 (60)	41 (50)	199 (63)
Female	160 (40)	41 (50)	119 (37)
Profession, n (%)
Specialist	396 (99)	82 (100)	314 (99)
Other	4 (1)	0 (0)	4 (1)
Clinical domain, n (%)
Surgery	257 (64)	39 (47)	218 (68)
Clinic	91 (23)	31 (38)	60 (19)
Laboratory	46 (12)	12 (15)	34 (11)
Other	6 (1)	0 (0)	6 (2)

Table 2. Dispersion parameters for physicians’ behavioural intention.

	n	Mean ± SD	Median	Interquartile range	Min	Max
In-Person Format
T0-Before	81	6.0 ± 1.2	6.5	5.0–7.0	1	7
T1-After	82	6.4 ± 0.8	7.0	6.0–7.0	3	7
Online Format
T0-Before	315	5.5 ± 1.5	6.0	5.0–7.0	1	7
T1-After	316	6.0 ± 1.1	6.0	5.8–7.0	1	7

Table 3. Impact of course on medical specialists’ intention.

		Intention
	N	Means difference (SE^*)	CI 95%	P-value
Unadjusted model for all participants
After vs. Before	397	0.47 (0.09)	[0.30; 0.64]	<0.0001
Adjusted** model for all participants
After vs. Before	397	0.47 (0.09)	[0.30; 0.65]	<0.0001
Adjusted** model for in-person format
After vs. Before	81	0.45 (0.15)	[0.16; 0.74]	0.0029
Adjusted model** for online format
After vs. Before	316	0.44 (0.07)	[0.30; 0.58]	<0.0001

*standard error; **adjustment variables: topics, age, sex, and medical field.

Figure 2. Box plots of psychosocial factors of intention.

Notes: IS refers to Social Influence; BCap refers to Beliefs about Capabilities; NM refers to Moral Norms; BCon refers to Beliefs about consequences

Table 4. Changes in psychosocial factors before and after courses.

	T0-Before			T1-After			Difference
	n	Mean	SD	n	Mean	SD	Mean	CI 95%
In-person format
Social influence	82	4.6	1.5	82	5.0	1.3	0.41	[0.31;0.50]
Beliefs about capabilities	80	5.2	1.3	82	5.9	1.0	0.73	[0.63; 0.83]
Moral standards	82	6.2	0.9	81	6.6	0.8	0.40	[0.33; 0.47]
Beliefs about consequences	82	6.1	1.1	82	6.4	0.9	0.28	[0.20; 0.36]
Online Format
Social influence	318	4.7	1.4	318	5.1	1.3	0.36	[0.33; 0.39]
Beliefs about capabilities	315	5.1	1.5	318	5.7	1.2	0.64	[0.60; 0.67]
Moral standards	313	5.8	1.5	315	6.2	1.2	0.46	[0.41; 0.51]
Beliefs about consequences	318	5.6	1.4	318	5.9	1.2	0.36	[0.32; 0.39]

SD: Standard Deviation, CI: Confidence Interval.

Table 5. Frequencies of self-reported behaviour according to CPD course format (N = 56).

	Behaviour change reported		Total
	No	Yes
Format, n (%)
In-Person	11 (31)	25 (69)	36 (64)
Online	5 (25)	15 (75)	20 (36)
Total	16 (29)	40 (71)	56 (100)

Figure 3. Box plots of intention after course according to self-reported adoption or not of target behaviour at six-month follow-up.

Figure 4. Observed gain or loss of intention compared to self-reported behaviour six months after CPD course.

Table 6. Association between intention and self-reported behaviour (N = 56).

	n	Mean ± SD	P-value of test of Wilcoxon
Intention T1-after course
Targeted behaviour adopted	40	6.59 ± 0.7	0.42
Targeted behaviour not adopted	16	6.59 ± 0.8

Table 7. Self-reported behaviour and association with behavioural intention’s evolution before-after courses (N = 56).

Follow-up after six months	n	Difference of intention T1 -T0 mean ± SD	P-value of paired Wilcoxon test
Targeted behaviour adopted	40	0.78 ± 1.4	0.002
Targeted behaviour not adopted	16	0.34 ± 1.0	0.223

Table

Construct scale		Item^a	Response choice	Pre‐coded item value^b	Final item score^c	Score by construct^d
Intention	I1	I intend to [behavior]	Strongly disagree/agree	1 to 7	1 to 7	(I1+I7)/2
	I7	I plan to [behavior]	Strongly disagree/agree	1 to 7	1 to 7
Social influence	I2	To the best of my knowledge, the percentage of my colleagues who [behavior] is…	0‐20% 21‐40% 41‐60% 61‐80% 81‐100%	1 2 3 4 5	1.4 2.8 4.2 5.6 7	(I2+I6+I9)/3
	I6	Now think about a co‐worker whom you respect as a professional. In your opinion, does he/she [behavior]?	Never/Always	1 to 7	1 to 7
	I9	Most people who are important to me in my profession [behavior]	Strongly disagree/agree	1 to 7	1 to 7
Beliefs about capabilities	I3	I am confident that I could [behavior] if I wanted to.	Strongly disagree/agree	1 to 7	1 to 7	(I3+I5+I11)/3
	I5	For me, [behavior] would be…	Extremely difficult/easy	1 to 7	1 to 7
	I11	I have the ability to [behavior]	Strongly disagree/agree	1 to 7	1 to 7
Moral norm	I4	[Behavior] is the ethical thing to do.	Strongly disagree/agree	1 to 7	1 to 7	(I4+I10)/2
	I10	It is acceptable to [behavior]	Strongly disagree/agree	1 to 7	1 to 7
Beliefs about consequences	I8	Overall, I think that for me [behavior] would be…	Useless/Useful	1 to 7	1 to 7	(I8+I12)/2
	I12	Overall, I think that for me [behavior] would be…	Harmful/Beneficial	1 to 7	1 to 7

^aNumber item (e.g. I1= Item 1); ^b Pre‐coded item value is an assigned value on a Likert scale (e.g. Strongly disagree = 1, Strongly agree = 7; never = 1, always = 7, etc.); ^c Final item score is the score by item for each participant (possible scale range = 1 to 7).

^bScore by construct = mean score by construct (possible scale range = 1 to 7). Note: for constructs with two items, no imputed values are possible. For constructs with three items, the raw score of the scale is missing if two or more items are missing. In the case of one missing, the missing item is imputed by the mean of the two others items.

Table

CPD Course	Main behavior	In-person format					Online format
		Duration	Number of lecturer	Group work and experience sharing	Quiz	Discussions and questions	Duration	Number of lecturer	Group work and experience sharing	Quiz	Discussions and questions
1 Essentials of Patient Safety Education and Assessment (Patient Safety)	Teach my learners the principles of patient safety and continuous improvement in the hospital setting	4h	3	Yes	No	interactive	4h45	3	No	Yes	NA
2 A care incident is more than just a mishap! (Care incident)	Complete an incident/accident report according to the guidelines in effect in my institution when a care incident occurs	4h	4	Yes	No	interactive	3h30	4	No	Yes	NA
3 The ERC initiative: an innovative interdisciplinary approach to optimizing care (Optimizing care)	Use at least one of the 6 recommendations of Optimized Recovery Canada when managing perioperative patients	4h	2	No	No	interactive	1h30	2	No	Yes	NA
4 Can the opioid crisis be contained through optimal perioperative pain management? (Perioperative pain-Opioid)	Prescribe opioids in a safe manner when managing perioperative pain in my patients	4h	2	No	Yes	interactive	3h30	2	No	Yes	NA
5 Sports injuries: assessment and treatment of common musculoskeletal conditions (Sports injuries)	Use a clinician-radiologist approach to investigate common musculoskeletal injuries in active patients	8h	13	No	Yes	at the end of the course	9h	13	No	Yes	NA
6 Eating disorders in adolescents (Eating disorders)	Systematically assess the medical and psychological health status of my patients with eating disorders	8h	6	Yes	Yes	interactive	6h30	4	No	Yes	NA
7 ADHD is also a matter of the heart (Attention deficit)	To use psychostimulants in a safe manner for ADHD patients with heart problems	4h	4	No	No	Noe	3h45	4	No	Yes	NA
8 Cardio-oncology, to get to the bottom of it! (Cardio-oncology)	Use a cardiologist-hemato-oncologist approach to manage cardiovascular risks induced by hemato-oncology in my patients	4h	4	No	No	Noe	3h15	3	No	Yes	NA
9 Local anesthesia: when blocking rhymes with toxicity (Local anesthesia)	Follow the 2018 ASRA recommendations for the management of systemic toxicity resulting from local anesthesia (LAST kit)	4h	6	No	No	interactive	3h	6	No	Yes	NA