Physicians Who Diagnose and Treat Healthcare Professionals and Other Patients with Shift Work Disorder: Self-Reported Changes in Competence, Performance, and Patient Outcomes from a Brief Case-Based Online CME Activity

Background: The physiological effects of shift work disorder (SWD) know no cultural or professional bounds. The diagnosis and treatment of SWD remains a challenge for many healthcare professionals. Could a brief, online, case-based continuing medical education (CME) activity on diagnosing and treating SWD in healthcare professionals result in sustained learning and confidence, improved performance, and positive patient outcomes in healthcare professionals who complete the activity? To answer this question, we assessed the outcomes of a 0.5-credit, case-based, online CME activity launched January 2009 at www.realcme. com. Method: Immediately before and after the online activity, multiple choice knowledge and confidence rating scale questions and questions on current/planned frequencies of recommending to patients specific strategies for overcoming their excessive sleepiness were administered. Approximately 8 weeks after activity completion, an e-mail was sent to each participant including a link to a follow-up survey, which consisted of questions repeated from the pre- and post-surveys, along with open-ended questions on barriers to performance change and self-reported observations of patient outcomes and numbers of new SWD diagnoses directly related to CME activity completion. Statistical tests were used to compare aggregate pretest to posttest to follow-up survey data. Alpha was set at . 05, and P values of less than or equal to . 05 were considered statistically significant. Effect sizes (Cohen’s d) were also calculated to help characterize the size of any changes. The number of respondents at each stage was 246 to 259 (pretest), 87 to 169 (posttest) and 24 to 26 (follow-up), depending on the question. Results: The most common respondent was a physician in family medicine, general practice, or internal medicine seeing up to 11 patients with excessive sleepiness during a typical week. The CME activity had a significant immediate positive impact (pre- to posttest) on 1 of 3 knowledge areas (P = .005, with very limited erosion 8 weeks later); a large, sustained effect on confidence in ability to manage the type of patient described in the case (pretest to follow-up, P < .001, Cohen’s d = .83); and a medium to large effect (P ≤ .001, Cohen’s d = .52 to .86) on increasing mean current (pretest) to planned (posttest) frequencies of recommending optimal, evidence-based strategies recommended in the CME activity content to patients with excessive sleepiness. Statistically significant increases in mean current (pretest) to self-reported actual (follow-up) frequency of recommendations were found for 2 strategies: “exercise” and “avoidance of caffeine before bedtime” (P < .001 for each, Cohen’s d = 1.70 and 3.21, respectively). At follow-up, 10 respondents self-reported 43 new diagnoses of SWD directly attributed to new information and strategies learned from the CME activity, with 5 of these patients being healthcare professionals. Forty-five verbatim observations of patient outcomes were collected, 91% of which were positive. Conclusions: A single, brief, case-based, online CME activity had a positive immediate effect on knowledge, confidence, and competence, with retention of some effects at 8 weeks post-activity completion. Self-reported performance change was also documented, including self-reported new diagnoses of SWD directly because of the CME activity, along with self- reported observations of positive patient outcomes. Further work is needed to determine the duration of the kinds of effects found and to determine why certain intentions to change performance were realized in practice, while others were not.