Resident Evaluation of a Web-based Integrative Medicine Cur

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Resident Evaluation of a Web-based Integrative Medicine Cur

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Resident Evaluation of a Web-based Integrative Medicine Curriculum: The Function of Formative Evaluation

Ben Kligler, M.D., Patricia Lebensohn, M.D., Sally Dodds, Ph.D., Raymond Teets, M.D., & Victoria Maizes, M.D.


Presentation Objectives

The objectives of this presentation are to:Describe the function of formative evaluation for curriculum development.Review the results from learners’ evaluation of the Integrative Medicine in Residency curriculum.Describe the procedures used in applying feedback from learners’ evaluations to guide curriculum changes and revisions.


Integrative Medicine in Residency (IMR) is…

Competency-based, online, 200-hour, curriculum.In-depth training in Integrative Medicine.Incorporated through all 3 years of Family Medicine residency.Piloted at 8 residencies nationwide.Seamless, online evaluation of the curriculum and the residents.Responds to ACGME competency requirements.Evaluation developed simultaneously with the curriculum.


University of Arizona

University of Texas Medical Branch

Hennepin County

Carolinas Medical Center

Beth Israel


Maine Medical Center

University of Connecticut

IMR Program Locations


Tools in Integrative Medicine

Prevention and Wellness

Women’s Health

Chronic Illness


Acute Care

IMR Curriculum Units


Introduction to Integrative Medicine

Prevention and Wellness:U.S. Preventive Health ServicesNutrition and Diet Supplements for PreventionPhysical ActivitySleep Stress and Mind-Body Medicine SpiritualityClinical IntegrationTools in Integrative Medicine:Integrative Medicine Intake and Care Plan BotanicalsMind-Body MedicineManual Medicine Introduction to Energy Medicine and Whole Systems Practice ManagementMotivational Interviewing for Behavioral Change Acute Care:Acute Back Pain,Urinary Tract Infection,Gastroenteritis,Otitis Media,Vaginitis,Atypical Chest Pain,Upper Respiratory Infection

Pediatric Topics:ADD/ADHDChronic Pain SyndromeAsthma and AllergiesWomen’s Health Topics: PMS/PMDD Dysmenorrhea Menopause Fibromyalgia Osteoporosis Depression Eating Disorders Pregnancy and LactationChronic Illness: Cardiovascular DiseaseType II DiabetesOsteoarthritis Rheumatoid ArthritisObesity Irritable Bowel SyndromeChronic Back PainSpecial Topics:HIV/AIDS Cancer SurvivorshipEnvironmental Medicine

Units and Courses


IMR: Educational Methods

Needs assessment informed curriculum design.Web-based curriculum written and edited by Integrative Medicine educators.Competencies aligned with the ACGME Outcomes Project.Flexible modular format to meet the needs of residency schedules.Case-based, interactive learning and streaming video.Experiential exercises and process-oriented group activities at the residency sites.A community of learners through online dialogues with faculty and peers. Emphasis on teaching and promoting physician well-being and self-care.


IMR User Interface

Online portfolios

Flexible modular format

Resources and Links

Direct Observation Checklists



“When the cook tastes the soup, that’s formative; when the guests taste the soup, that’s summative.” - Robert Stakes

What is Formative Evaluation?


Formative Evaluation…

Helps form and strengthen programs by:Examining the need for them,Their delivery or technologyThe quality of their implementationAssessing their organizational contexts, procedures, and resources (Scriven, 1991).Methods emphasize data collection and analysis prior to completion.


Why Use Formative Evaluation in the IMR?

Medical knowledge in Integrative Medicine is dynamic, evolving rapidly; revisions are largely driven by new information.Distributed, web-based curricula requires feedback from learners to be successful.In the IMR, formative methods include:Preliminary needs assessmentFeedback from resident evaluation of courses


1. IMR Needs Assessment(Benn, Maizes, Guerrera, Sierpina, Cook, & Lebensohn, 2009)

Methods222 faculty and residents from 8 family medicine programs (60.2% response rate).Online survey w/ structured and open-ended questions.ResultsPreferred IM be woven throughout all curriculum areas (67%).Top topics: Nutrition, Supplements, and Physician Wellness.Top curricular areas for IM enhancement: Chronic illness, behavioral health, and outpatient medicineViewed IM central to family medicine training, patient care, and the field of family medicine (84%). Top challenges: Limitations in time, resources, and acceptance.


2. IMR Course Evaluations

Measures assess learners’ ratings of the course in:Meeting course objectivesClinical utility of the courseTime needed to complete the courseFunctionality of the online technologyAnalyzed when 50% of pilot residents complete a course.Ratings < 8o% and open-ended comments targeted for review.Review of 01 pilot group suggested Likert-type response categories be changed from 4 to 5 points to increase precision and variability.


Resident Demographics

2011 (n = 67)2012 (n = 64)Controls (n = 31)Sex Female Male64%36%64%36%45%55%Mean Age range32 (27 – 43)32(24 – 56)30(26 – 38)Marital Status Married Live w/ partner Single Unk.45%13%27%15%27% 6%34%33%58%10%32%0%Graduate Status US MD US DO FMG Unk.51%18%27% 4%41%26%28% 5%55%16%16%13%


Did Course Meet Learning Objectives?Year 01 Content

*Currently, data are available for 4 courses for the 2012 class.


Clinical Utility of the Course?Year 01 Content

*Currently, indicators are available for 4 courses for the 2012 class.


How Smooth was the Online Technology?Year 01 Content

*Currently, indicators are available for 4 courses for the 2012 class.


Meet Learning Objectives?

Clinical Utility?

Year 02 Course Evaluations

Courses currently at 50% threshold


Year 02 Course EvaluationsCourses currently at 50% threshold

Smooth Online technology?


Length of Time SpentYear 01 &Year 02 Content

ClassCourse< 1 hr1-2 hr2-3 hr3-4 hr4-5 hr5-6 hr2011 Introduction34%44%13%5%4%201234%36%26%4%2011 Supplements 32%35%12%12%5%3%201250%36%9%5%2011 Nutrition & Diet13%25%31%16%6%7%201221%42%29%4%4%2011 Physical Activity61%38%2%201266%28%7%2011 Stress & Mind Body 34%43%17%3%2%2011 Spirituality 72%26%2%2011 Sleep & Health 94%6%2011 Preventive Services 59%32%7%2011 Clinical Integration17%38%21%8%9%8%2011 Allergy/Asthma 11%43%27%11%3%5%2011 ADHD 48%48%4%2011 Pediatric Pain 55%27%14%4%2011 PMD/PMDD 53%40%7%

Year 1



What Residents Say…

I enjoyed the interactive nature of the modules.The tools are amazing!Did an excellent job of relating spirituality to health care.I think sleep is one thing most neglected in health care topics. This course has rightly identified it.The ability to self reflect as well as think about our patients.I loved the video lecture – very engaging and interesting.This is a very comprehensive topic.Great links and resources.The seven cases. Great way to pull all of these courses together!

The buttons aren’t working.There was a lot of data in this module [Nutrition and Diet], but not enough interactive learning.Too lengthy and too in-depth.Some links were not available.Too many resources were given and I did not have enough time to thoroughly review them.Too much reading, too many links, and too many videos.




University of ArizonaPilot SitesEmily SherbrookeVictor Sierpina, M.D.Paula CookSelma Sroka, M.D.Rhonda HallquistMary Guerrera, M.D.Tieraona Low Dog, M.D.Dael Waxman, M.D.Craig Schneider, M.D.John Woytowicz, M.D.








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