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Impact of online education on intern behaviour around joint commission national patient safety goals: a randomised trial
  1. Tim J Shaw1,
  2. Luise I Pernar2,
  3. Sarah E Peyre3,
  4. John F Helfrick4,
  5. Kaitlin R Vogelgesang4,
  6. Erin Graydon-Baker5,
  7. Yves Chretien6,
  8. Elizabeth J Brown4,
  9. James C Nicholson1,
  10. Jeremy J Heit7,
  11. John Patrick T Co8,
  12. Tejal Gandhi7
  1. 1Workforce Education and Development Group, University of Sydney, Sydney, Australia
  2. 2Department of Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
  3. 3The Center for Experiential Learning, University of Rochester Medical Center, Rochester, New York, USA
  4. 4Partners Healthcare International, Boston, Massachusetts, USA
  5. 5York Hospital, York, Maine, USA
  6. 6Harvard Medical School, Boston, Massachusetts, USA
  7. 7Partners Healthcare, Boston, Massachusetts, USA
  8. 8Graduate Medical Education, Partners Healthcare, Boston, Massachusetts, USA
  1. Correspondence to Dr Tim J Shaw, Workforce Education and Development Group, K01, The University of Sydney, NSW 2006, Australia;{at}


Purpose To compare the effectiveness of two types of online learning methodologies for improving the patient-safety behaviours mandated in the Joint Commission National Patient Safety Goals (NPSG).

Methods This randomised controlled trial was conducted in 2010 at Massachusetts General Hospital and Brigham and Women's Hospital (BWH) in Boston USA. Incoming interns were randomised to either receive an online Spaced Education (SE) programme consisting of cases and questions that reinforce over time, or a programme consisting of an online slide show followed by a quiz (SQ). The outcome measures included NPSG-knowledge improvement, NPSG-compliant behaviours in a simulation scenario, self-reported confidence in safety and quality, programme acceptability and programme relevance.

Results Both online learning programmes improved knowledge retention. On four out of seven survey items measuring satisfaction and self-reported confidence, the proportion of SE interns responding positively was significantly higher (p<0.05) than the fraction of SQ interns. SE interns demonstrated a mean 4.79 (36.6%) NPSG-compliant behaviours (out of 13 total), while SQ interns completed a mean 4.17 (32.0%) (p=0.09). Among those in surgical fields, SE interns demonstrated a mean 5.67 (43.6%) NPSG-compliant behaviours, while SQ interns completed a mean 2.33 (17.9%) (p=0.015). Focus group data indicates that SE was more contextually relevant than SQ, and significantly more engaging.

Conclusion While both online methodologies improved knowledge surrounding the NPSG, SE was more contextually relevant to trainees and was engaging. SE impacted more significantly on both self-reported confidence and the behaviour of surgical residents in a simulated scenario.

  • Education
  • graduate
  • safety
  • quality of healthcare
  • graduate medical education
  • health professions education
  • patient safety
  • Information technology
  • medical education
  • continuous quality improvement

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  • All those listed as authors are qualified for authorship, and all who are qualified to be authors are listed as authors on the byline.

  • Funding This project was partially supported by a grant from Partners Healthcare. A small grant was awarded to JH as an intern to fund use of software.

  • Competing interests None.

  • Ethics approval The ethics approval was provided by Partners Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.