Abstract：
BACKGROUND: Clinical 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.
METHODS: A 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.
RESULTS: Two 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).
CONCLUSIONS: The 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.
BACKGROUND: ClinicalTrials.gov Identifier: NCT02210442 . Registered 6 August 2014.
METHODS: A 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.
RESULTS: Two 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).
CONCLUSIONS: The 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.
BACKGROUND: ClinicalTrials.gov Identifier: NCT02210442 . Registered 6 August 2014.
摘要：
背景：临床实践指南（CPGs）在培训临床推理和决策方面为卫生专业人员提供了教学潜力，虽然他们的使用是有限的。目的是与通常的传播策略相比，评估基于游戏的教育策略e-EDUCAGUIA使用模拟临床情景实施抗菌治疗GPC的有效性，以提高家庭医学居民的决策知识和技能。此外,评估了对e-EDUCAGUIA策略的依从性。
方法：在西班牙进行了一项涉及七个家庭医学教学单位（TU）的多中心实用整群随机临床试验。TU被随机分配以使用e-EDUCAGUIA策略（干预）或指南的被动传播（对照）实施抗菌治疗指南。主要结果是干预后1个月，在评估知识和决策技能的评分测试中，组间均值的差异。通过意向治疗和符合方案分析进行分析。次要结果是测试评分中受试者内（从基线到1个月）的平均变化差异，和教育游戏的坚持和可用性。使用一般线性模型分析相关因素。使用稳健的方法构造标准误差。
结果：两百两个家庭医学居民参加了（104个干预组，98个对照组）。100名医学居民在1个月时进行了后期测试（45个干预组vs55个对照组），1个月时平均测试得分的组间差异为11（8.67至13.32），受试者内变化之间的差异为11,9（95％CI5,9至17,9）。效应大小分别为0.88和0.75。在多变量分析中，每增加1小时的循证医学训练时间,主要结局增加0.28分(95%CI0.15~0.42),受试者每年的年龄增长与0.37分的改善相关,女性则与6.10分的降低相关.干预组104名受试者中有48名(46.2%，95%CI：36.5-55.8%）在研究月份使用了游戏。只有更多的循证医学培训时间与对教育游戏的更高依从性相关（OR1.11；CI95％1.02-1.21）。
结论：基于游戏的教育策略e-EDUCAGUIA在短期内对家庭医疗居民的抗菌治疗决策知识和技能具有积极作用，但辍学率较高,对结果应谨慎解释.在没有特定激励措施的情况下，对教育游戏的坚持是适度的。
背景：ClinicalTrials.gov标识符：NCT02210442。2014年8月6日注册
方法：在西班牙进行了一项涉及七个家庭医学教学单位（TU）的多中心实用整群随机临床试验。TU被随机分配以使用e-EDUCAGUIA策略（干预）或指南的被动传播（对照）实施抗菌治疗指南。主要结果是干预后1个月，在评估知识和决策技能的评分测试中，组间均值的差异。通过意向治疗和符合方案分析进行分析。次要结果是测试评分中受试者内（从基线到1个月）的平均变化差异，和教育游戏的坚持和可用性。使用一般线性模型分析相关因素。使用稳健的方法构造标准误差。
结果：两百两个家庭医学居民参加了（104个干预组，98个对照组）。100名医学居民在1个月时进行了后期测试（45个干预组vs55个对照组），1个月时平均测试得分的组间差异为11（8.67至13.32），受试者内变化之间的差异为11,9（95％CI5,9至17,9）。效应大小分别为0.88和0.75。在多变量分析中，每增加1小时的循证医学训练时间,主要结局增加0.28分(95%CI0.15~0.42),受试者每年的年龄增长与0.37分的改善相关,女性则与6.10分的降低相关.干预组104名受试者中有48名(46.2%，95%CI：36.5-55.8%）在研究月份使用了游戏。只有更多的循证医学培训时间与对教育游戏的更高依从性相关（OR1.11；CI95％1.02-1.21）。
结论：基于游戏的教育策略e-EDUCAGUIA在短期内对家庭医疗居民的抗菌治疗决策知识和技能具有积极作用，但辍学率较高,对结果应谨慎解释.在没有特定激励措施的情况下，对教育游戏的坚持是适度的。
背景：ClinicalTrials.gov标识符：NCT02210442。2014年8月6日注册
