Development and evaluation of a CD-ROM computer program to teach residents telephone management

Under managed care, telephone management is crucial to pediatric practice, but an effective method is needed to teach residents telephone skills. Our objective was to design an interactive CD-ROM program to teach residents an organized, consistent approach to telephone complaints and to determine whether use of the program was associated with better subsequent telephone management than reading the same information.

The general pediatric ambulatory center of a tertiary care children's hospital.

A total of 24 PL-2 and PL-3 pediatric residents.

A randomized, prospective, controlled comparison was conducted of resident management of two telephone calls: a 5-year-old with cough and trouble breathing, and a 7-year-old with fever. Thirteen residents were randomized to the computer group and 11 to the reading control group. Intervention. Scripts, scoring, and feedback for 10 CD-ROM-simulated calls were developed from texts and pediatrician survey using a modified Delphi technique. Volunteers acted out the caller's role in scenario scripts and were recorded onto a CD-ROM. The computer simulated calls by recognizing questions typed in a free-form format and answering with a voice response. Feedback was provided for omissions in history-taking and errors in assessment, triage, and home management. The computer group worked through the CD-ROM calls while the control group had equal time to read the same information. Evaluation Measures. A trained, standardized patient acted as the mother in pretest calls placed at the beginning of the month and posttest calls at the end. Calls were recorded and scored in a blinded manner using scoring templates and on interpersonal skills using the Patient Perception Questionnaire.

Pretest scores for the two calls were similar in the computer versus the control group (cough, 70.33% +/- 8.36 vs 68.46% +/- 6.73; fever, 75.64% +/- 9.82 vs 73.59% +/- 9.06). Posttest scores were significantly higher in the computer group than in the control group on both calls (cough, 79.08% +/- 8.17 vs 69 +/- 13.3; fever: 83.33% +/- 9.96 vs 70.35% +/- 9.66). Interpersonal skills also were similar pretest (19 +/- 3.4 vs 20 +/- 2.7). There was modest improvement in both groups without a statistically significant difference in posttest scores (24.2 +/- 2.9 vs 22.5 +/- 3.1).

Use of this CD-ROM telephone management program was associated with better postintervention telephone management. The program augments faculty instruction by teaching a consistent, general approach to telephone management.