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Abstract：
BACKGROUND: In order to eliminate tuberculosis (TB) in the USA, primary care providers must take on an expanded role in the diagnosis and management of latent tuberculosis infection (LTBI). Clinical practice guidelines and recommendations exist for LTBI management, but there is a need for innovative tools to improve medical students\' and residents\' knowledge of evidence-based practices for LTBI testing and treatment.
OBJECTIVE: To assess the impact of LTBI-ASSIST, a free online decision support aid, as a novel educational tool and mechanism of delivering clinical practice guidelines for medical trainees.
METHODS: A single site, randomized controlled trial of trainees delivered by electronic survey.
METHODS: Medical students and Internal Medicine residents at the Johns Hopkins University School of Medicine.
METHODS: Participants were randomized in 1:1 ratio to receive the US clinical practice guidelines and recommendations for Latent TB management (control arm) or the guidelines plus an introduction to LTBI-ASSIST (LTBI-ASSIST arm) as they completed a case-based knowledge assessment and reported confidence with domains of LTBI care.
METHODS: (1) Proportion of questions answered correctly on a case-based knowledge assessment; (2) change in reported confidence with domains of LTBI care.
RESULTS: One hundred and thirty participants completed the knowledge assessment. Those randomized to receive the LTBI-ASSIST Tool performed better on the case-based knowledge assessment with a mean score of 75.9% (95% CI: 70.6-81.1), compared to 57.4% (52.8-62.0) in the group that received the guidelines only (p <0.001). Similarly, the LTBI-ASSIST group reported a higher change in confidence (measured as post-assessment confidence minus pre-assessment confidence), compared to the control group, in six of the seven domains of LTBI care.
CONCLUSIONS: LTBI-ASSIST can be an effective supplement to existing guidelines in educating medical trainees and helping providers find evidence-based, guideline-supported answers for questions encountered in clinical practice.
BACKGROUND: NIH Clinical Trial Registry No. NCT05772065.
OBJECTIVE: To assess the impact of LTBI-ASSIST, a free online decision support aid, as a novel educational tool and mechanism of delivering clinical practice guidelines for medical trainees.
METHODS: A single site, randomized controlled trial of trainees delivered by electronic survey.
METHODS: Medical students and Internal Medicine residents at the Johns Hopkins University School of Medicine.
METHODS: Participants were randomized in 1:1 ratio to receive the US clinical practice guidelines and recommendations for Latent TB management (control arm) or the guidelines plus an introduction to LTBI-ASSIST (LTBI-ASSIST arm) as they completed a case-based knowledge assessment and reported confidence with domains of LTBI care.
METHODS: (1) Proportion of questions answered correctly on a case-based knowledge assessment; (2) change in reported confidence with domains of LTBI care.
RESULTS: One hundred and thirty participants completed the knowledge assessment. Those randomized to receive the LTBI-ASSIST Tool performed better on the case-based knowledge assessment with a mean score of 75.9% (95% CI: 70.6-81.1), compared to 57.4% (52.8-62.0) in the group that received the guidelines only (p <0.001). Similarly, the LTBI-ASSIST group reported a higher change in confidence (measured as post-assessment confidence minus pre-assessment confidence), compared to the control group, in six of the seven domains of LTBI care.
CONCLUSIONS: LTBI-ASSIST can be an effective supplement to existing guidelines in educating medical trainees and helping providers find evidence-based, guideline-supported answers for questions encountered in clinical practice.
BACKGROUND: NIH Clinical Trial Registry No. NCT05772065.
摘要：
背景：为了消除美国的结核病（TB），初级保健提供者必须在潜伏性结核感染(LTBI)的诊断和管理中发挥更大的作用.存在针对LTBI管理的临床实践指南和建议，但需要创新工具来提高医学生和居民对LTBI检测和治疗循证实践的认识。
目的：为了评估LTBI-ASSIST的影响，免费的在线决策支持援助，作为一种新颖的教育工具和机制，为医学学员提供临床实践指南。
方法：单个站点，通过电子调查对受训人员进行的随机对照试验。
方法：约翰霍普金斯大学医学院的医学生和内科住院医师。
方法：参与者以1：1的比例随机分配，以接受美国临床实践指南和潜伏性结核病管理建议（控制臂）或指南以及LTBI-ASSIST（LTBI-ASSIST臂）的介绍，因为他们完成了基于病例的知识评估并报告了对LTBI护理领域的信心。
方法：（1）在基于案例的知识评估中正确回答的问题比例；（2）LTBI护理领域报告的置信度变化。
结果：一百三十名参与者完成了知识评估。那些随机接受LTBI-ASSIST工具的人在基于案例的知识评估中表现更好，平均得分为75.9％（95％CI：70.6-81.1），与仅接受指南组的57.4%(52.8-62.0)相比(p<0.001)。同样，LTBI-ASSIST组报告了更高的置信度变化（以评估后的置信度减去评估前的置信度来衡量），与对照组相比，在LTBI护理的七个领域中的六个领域。
结论：LTBI-ASSIST可以有效地补充现有指南，以教育医学学员和帮助提供者找到基于证据的指南。指南支持的临床实践中遇到的问题的答案。
背景：NIH临床试验登记号。NCT05772065。
目的：为了评估LTBI-ASSIST的影响，免费的在线决策支持援助，作为一种新颖的教育工具和机制，为医学学员提供临床实践指南。
方法：单个站点，通过电子调查对受训人员进行的随机对照试验。
方法：约翰霍普金斯大学医学院的医学生和内科住院医师。
方法：参与者以1：1的比例随机分配，以接受美国临床实践指南和潜伏性结核病管理建议（控制臂）或指南以及LTBI-ASSIST（LTBI-ASSIST臂）的介绍，因为他们完成了基于病例的知识评估并报告了对LTBI护理领域的信心。
方法：（1）在基于案例的知识评估中正确回答的问题比例；（2）LTBI护理领域报告的置信度变化。
结果：一百三十名参与者完成了知识评估。那些随机接受LTBI-ASSIST工具的人在基于案例的知识评估中表现更好，平均得分为75.9％（95％CI：70.6-81.1），与仅接受指南组的57.4%(52.8-62.0)相比(p<0.001)。同样，LTBI-ASSIST组报告了更高的置信度变化（以评估后的置信度减去评估前的置信度来衡量），与对照组相比，在LTBI护理的七个领域中的六个领域。
结论：LTBI-ASSIST可以有效地补充现有指南，以教育医学学员和帮助提供者找到基于证据的指南。指南支持的临床实践中遇到的问题的答案。
背景：NIH临床试验登记号。NCT05772065。
