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February 15, 2006

Internet-Based Continuing Medical Education—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;295(7):758-759. doi:10.1001/jama.295.7.758-b

In Reply: Dr Cook questions the utility of “multifaceted” studies and reports that such studies have been widely criticized. On the contrary, multifaceted educational approaches,1 as distinguished from “multifactorial” studies cited by Cook,2,3 were specifically incorporated because of their effectiveness. Multifaceted interventions in CME, designs using 3 or more educational approaches, are associated with increased likelihood of positive outcomes (79%) compared with 2-method (64%) and 1-method (60%) designs.1 As to distinguishing the effect unique to each contributing element (eg, reinforcement, viewing preference), Cook misreads the intentions of our study. While changes in knowledge and other nonbehavioral end points have been demonstrated, no previous controlled studies have shown changes in physician behavior using Web-based interventions. The intent, therefore, was not to distinguish among the educational elements, but to determine if efficacy could be demonstrated at all. Only because efficacy was observed did we discuss at length individual components whose contributions may offer opportunities for exploration in subsequent investigations.

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