EJEL Volume 7 Issue 3
December 2009
Special Issue for ICEL 2008
Toronto, Canada
Guest Editors: Florin Salajan and Avi Hyman

Efficacy of Teaching Clinical Clerks and Residents how to Fill Out the Form 1 of the Mental Health Act Using an e-Learning Module

Sarah Garside, Anthony Levinson, Sophie Kuziora, Michael Bay and Geoffrey Norman
McMaster University, Hamilton, Ontario, Canada

Background: Every physician in Ontario needs to know how to fill out a Form 1 in order to legally hold a person against their will for a psychiatric assessment. These forms are frequently inaccurately filled out, which could constitute wrongful confinement and, in extreme circumstances, could lead to fines as large as $25,000. Training people to fill out a Form 1 accurately is a large task, and e-learning (Internet-based training) provides a potentially efficient model for health human resources training on the Form 1.

Objective: In this study, we looked at the efficacy of an e-learning module on the Form 1 by comparing baseline knowledge and skills with post-test performance.

Methods: Seven medical students and fifteen resident physicians were recruited for this study from within an academic health sciences setting in Hamilton, Ontario, Canada (McMaster University). The intervention took place over one hour in an educational computing lab and included a pretest (with tests of factual knowledge, clinical reasoning, and demonstration of skill filling out a Form 1), the e-learning module intervention, and a post-test. The primary outcome was the change between pre- and post-test performance. A scoring system for grading the accuracy of the Form 1 was developed and two blinded raters marked forms independently. Participants were randomly assigned to one of two sequences of assessments (A then B vs B then A), with a balanced design determining which test the participants received as either the pretest or post-test. Inter-rater reliability was determined using the Intraclass Correlation. Repeated measures analysis of variance was conducted.

Results: The Intraclass Correlation (ICC) as the measure for inter-rater reliability was 0.98. For all outcome measures of knowledge, clinical reasoning, and skill at filling out the Form 1 there was a statistically significant improvement between pretest and post-test performance (knowledge, F(1,21) 54.5, p<0.001; clinical reasoning, F(1,21) 9.39, p=0.006; Form 1 skill, F(1,21) 15.7, p=0.001). Further analysis showed no significant differences or interactions with other variables such as between raters, the order of assessment, or trainee type.

Conclusions: Under laboratory conditions, this e-learning module demonstrated substantial efficacy for training medical students and residents on the theory and practice of filling out the Form 1 of the Mental Health Act. e-Learning may prove to be an efficient and cost-effective medium for training physicians on this important medico-legal aspect of care. Further research is required to look at the longer-term impact of training and broader implementation strategies across the province for medical trainees and practicing physicians.

Keywords: medicine, skills, training, healthcare, education, psychiatry

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