using the internet to provide targeted ehdi education for physicians robert c. cicco, m.d. -...

Using the Internet to Provide Targeted EHDI Education for Physicians

Robert C. Cicco, M.D.- Pediatric Advisor, PA EPIC-EHDI Program

Neonatologist, West Penn Hospital, Pittsburgh, PA

Diane L. Sabo, Ph.D. - Director of Audiology and Communication Disorders,

Children’s Hospital of Pittsburgh, Pittsburgh, PA

Associate Professor, University of Pittsburgh

Agenda• Importance of educating physicians

• Unique problems of reaching physicians in PA

• Advantages of online learning

• Using adult learning principles

• Creating the educational program

• Group Exercise

• Developing resource material

• Marketing

• Funding an online learning experience

Why physician education?

• Essential for success of the program

• Families refer to their Primary Care Physician (PCP) for advice

• Key component to follow up is PCP

EDHI Education for Physicians

• Knowledge of the state program and program goals

• Knowledge of the guidelines

• Physician role in the EHDI process• Continual reminder of the importance

of early diagnosis and treatment

Goal: Find best way to get physicians to recognize the importance of EHDI

Barriers:

• Geographical uniqueness of PA – state has large urban centers in east and west with large rural mid-section and north central area.

• Large number of small hospitals with birthing centers.

• “Old School” disbelievers still exist

Pennsylvania’s 3-year EPIC-EHDI project was . . .

• Conceived as a multi-faceted outreach strategy to inform pediatricians and PCPs about the importance of EHDI consistent with the Medical Home model.

• An outgrowth of an existing PA AAP Medical Home grant.

• Proposed as a key feature in PA DOH’s grant application to HRSA/MCHB for UNHSI funding as the primary means of program outreach to physicians.

• Formulated in cooperation with PA AAP using multi-disciplinary input from PA DOH’s Infant Hearing Screening Advisory Committee.

PA’s EPIC-EHDI Initiative is a multi-faceted educational approach, utilizing . .

• Hospital-Based Grand Rounds Presentations• Mentoring and Technical Assistance• Audio Teleconference • Training Video• Web Based Learning Cases and Resource Information • Parent Packets available in offices

This concept allows educational goals to be achieved in a number of learning formats.

Web Based Learning

• Easy access to learning experience

• Immediate access to resource material to assist with learning

• Learners can work through cases at their own pace

• Potential for on line discussion with other users

• Allows use of multimedia audio and visual files, if desired

Adult Learning Principles• What motivates the adult learner?

– Achievement and competency– Active engagement in the learning process– Management of their own learning experience– Ability to utilize what is learning in practical

setting– Active participation in the learning experience– Ability to interact with peers– Immediate feedback regarding their performance

Creating The Educational Program

• Online-EHDI created in collaboration with University of Pittsburgh Health Sciences Internet Learning program and Child Development Unit

• Four cases with learning objectives for each case• SHORT cases designed to take learner no more

than 30 minutes to complete• PRACTICAL cases designed to emphasize

specific common barriers to effective diagnosis and treatment

• Presented in stages so that learner can think through issues that present at different times in the child’s course

Creating The Educational Program

• Challenge learners to answer open ended questions about their thought process and management plans

• Faculty comments and answers accessible only after case completed

• Pre and post testing with minimum required on post test in order to receive CME

• Links to references and resources contained in faculty comments

Creating The Educational Program

• Group Exercise

The Cases: Jamiel

• Two week old did not pass initial hospital screen

• Found to have moderate to severe SNHL

• Mother with possible perinatal depression

• Stresses physician’s role in assuring proper follow up with diagnostic testing, medical workup and initiation of treatment

The Cases: Ismael

• Two month old diagnosed with profound bilateral SNHL

• Family inquires about the value of CI for their child

• Stresses physician role in completing medical evaluation and referral to EI

• Educates physician about criteria for CI• Discusses cultural variation in caring for a child

with hearing loss

The Cases: Maria

• Seven month old raised in a two language family• Child is new to practice with a history of a

persistent middle ear effusion treated with recurrent courses of antibiotics

• Ultimately diagnosed with mixed conductive and SNHL

• Stresses physician role in following and treating middle ear effusion

• Discusses language development in bilingual households

The Cases: Susan• 2.5 month old fourth child• NICU graduate -- PCP not identified before D/C• Family contacted by state EHDI personnel after failing

to follow up on unilateral “did not pass” • Mother concerned state may involve CYF• Child found to have severe loss in one ear• Stresses to physician the importance of unilateral loss• Stresses to physician the role of DOH in EHDI• Discusses ways to address financial and social parental

concerns surrounding a child with hearing loss

Enhancements• Discussion Board:

– Will allow all participants to see the answers of others and create opportunity for discussions regarding specific management strategies, treatment plans, ways of addressing problems, etc.

• New Cases:– The child who passes the newborn screen but presents with

parental concerns about language and hearing– The child who passes the newborn screen but has high risk

factors– Child with mild hearing loss– Deaf child with deaf parents– ??? Others

Resource Material• Resource sections for both parents and health care

providers• Contains multiple links to other websites• Includes reference materials such as flow sheets,

roadmaps, sample audiograms and parent handouts• Pennsylvania specific information• Links to other more detailed educational

opportunities• Must have plan to provide ongoing update

Marketing• Critical element of program implementation• Although designed for physicians, audiologists also

benefit from the information• General Marketing

– Flyers, email, PAAAP NewsFax, general mailing to physicians and audiologists

• Opportunities for targeting marketing– To physicians with new patients not passing the newborn

screen from state EHDI personnel– To physicians from audiologists in reports

• Need to allot appropriate funding for ongoing marketing activities

Costs• Time for development of cases• Time for development and maintenance of

resources• Website development (in our case minimized

by utilization of existing UPMC educational site)

• CME• Marketing Activities

Take Home Points• Internet provides opportunity to reach learners

efficiently and overcomes geographic barriers• Case based learning allows for different aspects of

hearing loss and management to be presented• Learning experience should be practical

information that is relevant to day-to-day practice• As areas of deficits in knowledge are identified,

allows for customizations of the cases to highlight new learning goals

• Marketing strategies, both general and targeted, are critical to long term success

To Log On:

• https://cme.hs.pitt.edu• Create an account and log on• Click on “All Modules”• Click on “Early Hearing Detection and Intervention”