Developing curricula to promote preventive medicine skills. The Teaching Immunization for Medical Education (TIME) Project. TIME Development Committee
R. K. Zimmerman, W. H. Barker, R. A. Strikas, E. R. Ahwesh, T. A. Mieczkowski, J. E. Janosky and S. L. Kanter
Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, Pa 15261, USA. zimmer+@pitt.edu
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 PARTICIPANTS: 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.
