Two of the test questions were designed to determine participants’ knowledge of the criteria for severe malaria, as patients who meet these criteria and those who are unable to tolerate oral therapy should be given IV therapy. Scores on these questions and feedback from participants indicated confusion about one of these questions, which presented 3 patient scenarios and asked the following question: “You are screening orders and come across some interesting notes in the documents section of the patient care information system. For which of the following scenarios would you recommend ORAL antimalarial therapy?” The number of pharmacists who answered correctly was low for both the pre-test (8/59) and the post-test (8/60). In retrospect, the information provided in the answer choices for this question was unclear and ambiguous. A larger focus or pilot group, more stringent validation of the test questions, and the use of statistical tests for internal consistency might have improved the quality and design of the this and other test questions. Nevertheless, the impact of this question on patient care is probably minimal, since inpatient dispensary pharmacists would not likely make the final decision about route of therapy.
Pre-post testing is an effective way to measure change in knowledge among medical students and residents, and was applied here to hospital pharmacists. However, there were several limitations to this study. First, although the module led to an increase in pharmacist knowledge, this would not necessarily translate into an increase in competency. For example, online case-based learning was only partially effective in a sample of 58 Ontario family practice physicians. Stewart and others found that although this type of learning was associated with an increase in knowledge and quality of practice for certain disease topics (defined as documentation in patients’ charts that physicians had followed clinical practice guidelines), physician behaviour, as assessed by patients, remained unchanged. Although knowledge and competency are related, measuring an increase in competency may involve case-based experiential learning or pharmacy/ pharmacist audits. Second, the pre-post tests used here could not be used to measure knowledge retention, since participants’ knowledge was evaluated only twice, immediately before and immediately after they had completed the educational material. However, knowledge retention is an important consideration, since malaria is encountered only infrequently in the Calgary Health Region. As with other uncommonly encountered clinical situations, online educational materials are convenient and easily accessible. However, without regular review, the long-term effects of such Web-based educational initiatives may be limited. Further Web-based evaluation of knowledge retention or dissemination of updated malaria guidelines is not currently planned but would be feasible, given the adaptability and increasing acceptance of Web-based materials. Periodic re-testing would be advantageous for the benefit of new staff members or when treatment guidelines have changed. Third, the number of pharmacists who completed the module was small, and the sample was confined to voluntary inpatient pharmacists within the Calgary Health Region, a group that may not reflect other inpatient pharmacist populations. tadacip
Feedback to participants in continuing professional education was a key contributor to learning in several previous evaluations. Prompt feedback stimulates independent learning and increases ratings of perceived beneficial learning experiences. Many inpatient pharmacists asked for their scores or the answers to the test questions. An answer key was posted at the end of the data collection period and pharmacists were given an e-mail address through which they could contact the authors; however, at the time of writing, no participants had contacted the authors to discuss specific results.
The educational module described in this report continues to be available to pharmacists in the Calgary Health Region and will be updated as needed, for example when the Committee to Advise on Tropical Medicine and Travel issues new guidelines (release pending in 2008). A major communication effort to all Canadian health care professionals will be required if important antimalarial drugs such as the artemisinin derivatives are made available in Canada, a development that is expected to occur within the next several years. Pharmacists will be notified. cialis soft tabs online