Table 1.
Success of the Test Items and the Tutorial for Each Learning Objective
| Guideline | Proportion correct on pretest* | Proportion correct on posttest at 0, 1-day† | Importance rating‡ |
|---|---|---|---|
| Topic | |||
| Learning objective | |||
| Hypertension management in adults with diabetes | |||
| •Blood pressure targets | |||
| Identify how blood pressure goals differ for patients with DM | 0.81 | 1.0 | 5.9 |
| Identify specific blood pressure goals recommended by the ADA | 0.48 | 0.79 | 6.0 |
| Identify the evidence for achieving blood pressure goals§ | 0.55 | 0.24 | 5.8 |
| •Nondrug management of blood pressure | |||
| Identify the role of sodium restriction | 0.66 | 0.69 | 5.2 |
| Identify how should exercise be prescribed | 0.47 | 0.52 | 5.8 |
| Identify the evidence for the benefits of weight loss | 0.36 | 0.76 | 5.6 |
| •Drug management of blood pressure | |||
| Identify when drug management of hypertension should be initiated | 0.50 | 0.79 | 6.0 |
| Identify the strategy that the ADA recommends for initial drug therapy of high blood pressure | 0.42 | 0.63 | 5.6 |
| Identify the antihypertensive medications that have been proven to improve outcomes for diabetes patients | 0.56 | 0.59 | 5.9 |
| Identify which antihypertensive agents have proven superior to others in direct comparisons | 0.32 | 0.46 | 5.8 |
| Dyslipidemia management in adults with diabetes | |||
| •Lipid testing | |||
| Identify dyslipidemia patterns that are associated with type 2 DM and their significance | 0.31 | 0.82 | 5.6 |
| Identify the intervals at which patients with DM should have lipid testing | 0.24 | 0.38 | 5.9 |
| •Lipid management | |||
| Identify the lipid goals recommended by the ADA | 0.74 | 0.93 | 5.8 |
| Identify the role of lifestyle modification in treating dyslipidemias among patients with diabetes | 0.53 | 0.69 | 5.7 |
| Identify what should trigger initiation of lipid-lowering medication§ | 0.72 | 0.62 | 5.8 |
| Identify the ADA recommendation for treating LDL elevations | 0.94 | 0.93 | 6.0 |
| Identify the ADA recommendation for treating low HDL levels | 0.52 | 0.71 | 5.6 |
| Identify the ADA recommendation for treating elevated triglycerides | 0.38 | 0.57 | 5.7 |
| Identify the ADA recommendation for treating combined dyslipidemias§ | 0.55 | 0.52 | 5.8 |
| Identify the special considerations necessary in using niacin therapy for dyslipidemias | 0.23 | 0.83 | 5.8 |
Each learning objective was assessed by 2 test items. For each subject, one of these items was randomly selected for the pretest and then the other item was used on the posttest. For the 8 knowledge items in which multiple responses could be selected, partial credit was given for each correct response to a maximum score of 1 point if all responses were correct for the item.
*Mean proportion correct for the learning objective when assessed on the pretest. (About half of subjects were assessed with 1 item and about half with the other item for the learning objective).
†Mean proportion correct for the learning objective when assessed on the posttest among the subgroup of 29 subjects who were tested immediately or 1 day after the tutorial.
‡Mean rating of the learning objective’s importance for “providing excellent overall diabetes care” on a scale from 1 (“extremely unimportant”) to 7 (“extremely important”) given by subjects after viewing the guideline passage, pretest answer, and explanation.
§Learning objectives for which the items and tutorial, in combination, appeared to malfunction with performance significantly worse after the tutorial (within 1 day) than it was on the pretest. In most cases, this effect appeared to be because of potentially confusing questions. These learning objectives were excluded from the final knowledge scale