UMMS Affiliation

Center for Integrated Primary Care; Department of Family Medicine and Community Health

Publication Date


Document Type



Alternative and Complementary Medicine | Behavioral Medicine | Health Information Technology | Health Psychology | Health Services Administration | Integrative Medicine | Medical Education | Mental and Social Health | Primary Care | Psychiatry and Psychology


BACKGROUND: Internet education is increasingly provided to health professionals, but little is known about the most effective strategies for delivering the content. The purpose of this study is to compare four strategies for delivering an Internet-based (e-) curriculum on clinicians' knowledge (K), confidence (CONF), and communication (COMM) about herbs and other dietary supplements (HDS).

METHODS: This national randomized 2 x 2 factorial trial included physicians, pharmacists, nurses, nutritionists and trainees in these fields. Participants were randomly assigned to one of four curriculum delivery strategies for 40 brief modules about HDS: a) delivering four (4) modules weekly over ten (10) weeks by email (drip-push); b) modules accessible on web site with 4 reminders weekly for 10 weeks (drip-pull); c) 40 modules delivered within 4 days by email (bolus-push); and d) 40 modules available on the Internet with one email informing participants of availability (bolus-pull).

RESULTS: Of the 1,267 enrollees, 25% were male; the average age was 40 years. The completion rate was 62%, without significant differences between delivery groups. There were statistically significant improvements in K, CONF and COMM scores after the course (P < 0.001 for all), although the difference in COMM was small. There were no significant differences in any of the three outcomes by delivery strategy, but outcomes were better for those who paid for continuing education credit.

CONCLUSION: All delivery strategies tested similarly improved K, CONF, COMM scores about HDS. Educators can use the strategy that is most convenient without diminishing effectiveness. Additional curricula may be necessary to make substantial changes in clinicians' communication practices.


Dietary Supplement, Continue Medical Education, Patient Encounter, Delivery Strategy, Continue Education

Rights and Permissions

© 2006 Kemper et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

DOI of Published Version



BMC Med Educ. 2006 Jan 11;6:2. doi: 10.1186/1472-6920-6-2. Link to article on publisher's site

Journal/Book/Conference Title

BMC medical education


At the time of publication, Paula Gardiner was not yet affiliated with the University of Massachusetts Medical School.

Related Resources

Link to Article in PubMed

PubMed ID