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The Teaching Immunization for Medical Education (TIME) Project

Richard Kent Zimmerman, MD, MPH; William H. Barker, MD; Raymond A. Strikas, MD; Ellen R. Ahwesh, MA; Tammy A. Mieczkowski, MA; Janine E. Janosky, PhD; Steven L. Kanter, MD

JAMA. 1997;278(9):705-711.

Abstract
Context.
—Vaccines are underused in the United States, resulting in needless morbidity. Many experts have concluded that clinician education is critical to increasing the nation's vaccination rates.

Objective.
—To develop and evaluate case-based curricular materials on immunizations that promote preventive medicine skills.

Design.
—Before-and-after trial of an educational intervention.

Setting and Participanst.
—Medical schools and primary care residency programs from 20 institutions across the United States participated in the Teaching Immunization for Medical Education (TIME) project.

Intervention.
—A multidisciplinary team developed learning objectives, abstracted clinical cases, and created case-based modules that use contextual learning and small-group interaction to solve clinical and public health problems. The case-based methods are multistation clinical teaching scenarios (MCTS) and problem-based learning (PBL).

Main Outcome Measures.
—Knowledge gained by learners from pretest to posttest and the overall ratings of the sessions by learners and facilitators based on evaluation questionnaires.

Results.
—Pretest and posttest results were obtained on a total of 1122 learners for all modules combined. For the MCTS method, mean scores increased from the 10-item pretest to the posttest by 3.1 items for measles, 3.8 for influenza, 1.8 for hepatitis B, 3.9 for pertussis, 1.9 for adult vaccination, 1.9 for childhood vaccination, and 2.6 for Haemophilus influenzae type b (P<.01 for each). For the PBL method, mean scores increased by 3.4 items for measles, 3.3 for influenza, 2.6 for hepatitis B, and 2.5 for pertussis (P<.01 for each). Most learners (MCTS, 98%; PBL, 89%) and most facilitators (MCTS, 97%; PBL, 100%) rated the sessions overall as very good or good.

Conclusions.
—Use of TIME modules increases knowledge about immunizations, an essential step to improving vaccination practices of future clinicians. Given the realities of decreased faculty time and budgets, educators face major challenges in developing case-based curricula that prepare learners for the 21st century. Nationally tested libraries of cases such as the TIME modules address this dilemma.

Author Affiliations
for the TIME Development Committee

From the Department of Family Medicine and Clinical Epidemiology (Drs Zimmerman and Janosky and Mss Ahwesh and Mieczkowski), Office of Medical Education (Dr Kanter), University of Pittsburgh School of Medicine, Pittsburgh, Pa; the Department of Community and Preventive Medicine, University of Rochester, Rochester, NY (Dr Barker); and the National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Ga (Dr Strikas).

Footnotes
Members and organizations of the TIME committees are listed at the end of this article. Dr Barker is chair of the Association of Teachers of Preventive Medicine Advisory Committee for the TIME Project.

This work was presented in part at the 30th National Immunization Conference, Washington, DC, April 9, 1996; Prevention 97, Atlanta, Ga, March 22, 1997; and the 30th Annual Spring Conference of the Society of Teachers of Family Medicine, Boston, Mass, May 5, 1997.

Reprints: Richard Kent Zimmerman, MD, MPH, Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, M-200 Scaife Hall, Pittsburgh, PA 15261 (e-mail: zimmer+@pitt.edu).

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