Characteristics of participants
Of the 212 participants from October 2016 to March 2017, data for 168 participants (2016 group) were available. Of the 201 participants from October 2017 to March 2018, data for 176 (2017 group) were available. The demographic characteristics of each group are presented in Table 1. The mean age was 33.9 ± 6.7 years (mean ± standard deviation) for the 2016 group and 33.7 ± 7.1 years for the 2017 group. The mean years of professional experience for each group was 4.9 ± 5.5 and 5.3 ± 6.6 years, respectively, and the male:female ratio of each group was 2.29 and 3.76, respectively. There were no significant differences between the 2016 and 2017 groups in age or years of professional experience (p = 0.52 and p = 0.15, respectively). However, there were significant differences in the gender ratio between the two groups (p = 0.049).
Clinical knowledge after the EGUIDE program in 2016
In the 2016 group, the total clinical knowledge scores on the CPG for schizophrenia at baseline and after the EGUIDE program were 33.6 ± 2.2 and 36.2 ± 1.0 points (p = 1.4 × 10–25). Although total scores improved after the program, the correct answer rates after the EGUIDE program of two questions did not reach over 90%, and these questions were classified as category 3 items: S-D5 and S-F4 (72.6% and 83.3%, respectively; Figure 2A, Additional file 1). The total clinical knowledge scores on the CPG for MDD at baseline and after the program were 31.0 ± 2.7 and 34.4 ± 1.8 points (p = 4.8 × 10–27). Although total scores improved after the program, the correct answer rates after the EGUIDE program on five questions did not reach over 90%, and these questions were classified as category 3 items: D-A1, D-B5, D-C5, D-C6 and D-D3 (56.5%, 47.6%, 71.4%, 85.7%, 78.6%, respectively; Fig 2B, Additional file 4).
Improvement of lectures for 2017
Based on the results of the 2016 group after the EGUIDE programs, lecture materials were revised for the 2017 group, with particular attention paid to questions with low correct answer rates: two questions for the schizophrenia CPG and five questions for the MDD CPG.
For S-D5, an additional slide was created that emphasized not combining psychotropics such as mood stabilizers, anxiolytics, and antidepressants with antipsychotics; this slide was included in the lecture on the management of recurrence or relapse in schizophrenia. For S-F4, emphasis was placed on the idea that modified electroconvulsive therapy (ECT) may be effective in patients with treatment-resistant schizophrenia when clozapine is not available; this information was included at the end of the lecture on the management of treatment-resistant schizophrenia. For D-A1, the need to accurately confirm the diagnostic criteria was emphasized in the lecture on the diagnosis of MDD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). For D-B5, an additional slide was created, which emphasized that adverse effects of antidepressants should be carefully considered with not only children and elderly patients with MDD but also pregnant patients with MDD in the lecture on treatment of MDD. For D-C5, it was emphasized that patient preference should be prioritized (e.g., antidepressant use is not always necessary) in the management of mild depression. For D-C6, the notion that antidepressants may be effective in patients with prior good treatment response to antidepressants and/or multiple depressive episodes was added to the lecture materials. For D-D3, in the lecture on moderate/severe depression, an additional slide was created that emphasized that benzodiazepines could be used for a short period of time.
Effects of revised lecture materials on clinical knowledge after the EGUIDE program in 2017
In the 2017 group, the total clinical knowledge scores at baseline and after the EGUIDE program with the CPG for schizophrenia were 33.2 ± 2.5 and 36.4 ± 0.8 points, respectively (p = 4.0 × 10–27). To examine the effect of the revised lecture materials on the correct answer rates after the EGUIDE program with the CPG for schizophrenia, we compared the correct answer rates for the two category C items between the 2016 group and the 2017 group (S-D5: 72.6% in 2016, 82.4% in 2017, p = 0.038; S-F4: 83.3% in 2016, 86.4% in 2017, p = 0.45; Table 2). The improvement on S-D5 did not reach statistical significance when corrected for multiple testing (Bonferroni correction, p < 0.025).
Similarly, the total clinical knowledge scores at baseline and after the EGUIDE program with the CPG for MDD were 31.4 ± 2.6 and 34.8 ± 1.6 points, respectively (p = 2.3 × 10–27). To examine the effect of the revised lecture materials on the correct answer rates after the EGUIDE program with the CPG for MDD, we compared the correct answer rates on the five category C items between the 2016 group and the 2017 group (D-A1: 56.5% in 2016, 60.8% in 2017, p = 0.44; D-B5: 47.6% in 2016, 51.1% in 2017, p = 0.52; D-C5: 71.4% in 2016, 65.9% in 2017, p = 0.30; D-C6: 85.7% in 2016, 93.2% in 2017, p = 0.033; D-D3: 78.6% in 2016, 89.2% in 2017, p = 8.0×10-3; Table 3). The difference in the correct answer rate on D-C6 after the EGUIDE program did not reach statistical significance when corrected for multiple testing, but the rate exceeded 90%. The correct answer rates on D-D3 after the EGUIDE program were significantly improved and rose to approximately 90%.