mCME project V.2.0: randomised controlled trial of a revised SMS-based continuing medical education intervention among HIV clinicians in Vietnam

Abstract

Background: Continuing medical education (CME) is indispensable, but costs are a barrier. We tested the effectiveness of a novel mHealth intervention (mCME V.2.0) promoting CME among Vietnamese HIV clinicians.

Methods: We enrolled HIV clinicians from three provinces near Hanoi. The 6-month intervention consisted of (1) daily short message service multiple-choice quiz questions, (2) daily linked readings, (3) links to online CME courses and (4) feedback messages describing the performance of the participant relative to the group. Control participants had equal access to the online CME courses. Our primary endpoint was utilisation of the online CME courses; secondary endpoints were self-study behaviour, performance on a standardised medical exam and job satisfaction.

Results: From 121 total HIV clinicians in the three provinces, 106 (87.6%) enrolled, and 48/53 intervention (90%) and 47/53 control (89%) participants completed the endline evaluations. Compared with controls, intervention participants were more likely to use the CME courses (risk ratio (RR) 2.3, 95% CI 1.4 to 3.8, accounting for 83% of course use (P<0.001)). Intervention participants increased self-study behaviours over controls in terms of use of medical textbooks (P<0.01), consulting with colleagues (P<0.01), searching on the internet (P<0.001), using specialist websites (P=0.02), consulting the Vietnam HIV/AIDS treatment guidelines (P=0.02) and searching the scientific literature (P=0.09). Intervention participants outperformed controls on the exam (+23% vs +12% score gains, P=0.05) and had higher job satisfaction.

Conclusion: The mCME V.2.0 intervention improved self-study behaviour, medical knowledge and job satisfaction. This approach has potential for expansion in Vietnam and similar settings.

Trial registration number: NCT02381743.

Keywords: health education and promotion; health policy; public health; randomised control trial.

Figure 1

Conceptual model for how the mobile continuing medical education (CME) intervention might improve medical knowledge. In this schema, we hypothesise that there is a weak and a strong pathway leading to improved knowledge. The weak pathway is driven by the content within the short message service (SMS) messages themselves, which are necessarily brief and hence limited in volume of information they can provide. The strong pathway assumes instead that the SMS messages are important primarily as a cue to action that encourage self-study on the topics presented in the messages. This means going beyond the message to explore related content on that topic, which could be via use of the linked readings or the CME courses in the intervention. But this also encompasses any of many appropriate strategies for self-study, as preferred by each participant. We refer to this process of studying beyond the SMS messages as ‘lateral learning’.

Figure 2

Example of a hypothetical daily short message service (SMS) quiz sequence The cartoon depicts the sequence for a daily SMS quiz question. An intervention participant receives a four-item multiple choice question (A), keys in their response (B) and then receives an automatically generated reply from the server congratulating for correct answers or encouraging better luck next time by providing the correct answer (C). In all cases, the final message contains a hyperlink to further technical reading on that same topic, typically 1–3 paragraphs in length. In most cases, these readings were based on the Vietnam HIV/AIDS Treatment Guidelines 2015 handbook.

Figure 3

Participant flow diagram within the mobile continuing medical education study. The figure depicts the randomisation into intervention/control groups, the timing of baseline/endline assessments, the duration of the study and study attrition affecting the proportion that returned for the endline assessments.

Figure 4

Impact of the mobile continuing medical education intervention on the frequency of self-study during the trial. The figure compares the frequency that intervention and control participants reported ‘Daily’ or ‘Many times per week’ use of each self-study modality.

Figure 5

Impact of the mobile continuing medical education intervention on reported changes in self-study behaviours. The figure summarises the proportion of intervention or control participants who reported that their use of the specified self-study modalities had increased compared with prior to the study.

Figure 6

Impact of the mobile continuing medical education intervention on job satisfaction. Job satisfaction was measured at endline among intervention and control participants. The figure summarises the proportion in each group who reported that they ‘agreed’ or ‘strongly agreed’ with each of the item statements.