Studies show impact of pioneering online and hybrid health education programs

According to the findings from two recent studies, a pair of unique USC virtual health education offerings are delivering their lessons effectively while expanding access.

The courses, developed through the Keck School of Medicine of USC’s Primary Care Initiative, reach different audiences. The Addiction Medicine course is an elective for third- and fourth-year medical students. Meanwhile, bilingual classes in healthy cooking and exercise reach the community served by the Wellness Center at the LAC +USC Medical Center.

Both offerings moved online due to the coronavirus pandemic, and survey results demonstrate that both were well-received by learners. A study in the Journal of Addictive Diseases showed that, across those who took in-person and online classes, Keck School of Medicine students reported improvements in their knowledge about and comfort in treating people with substance use disorders. The Health Education Journal published a study in which online participants in the nutrition and exercise class responded with high satisfaction and the intent to make healthy lifestyle changes.

Both virtual courses have continued alongside a return to in-person instruction.

“I don’t think they’re mutually exclusive,” said Jo Marie Reilly, MD, MPH, director of the Primary Care Initiative, co-author of both studies and corresponding author of the Journal of Addictive Diseases paper. “There’s nothing quite the same as experiencing a patient visit in person, but the virtual course breaks barriers to access we’ve had in the past. These two ways of learning are quite complementary.”

The hybrid approach likewise strikes a balance for people taking the nutrition and exercise class, according to Isabel Edge, MD, corresponding author of the Health Education Journal study.

“In person, the classes are very communal, and participants enjoy that,” said Edge, clinical assistant professor of family medicine and assistant director of the Primary Care Initiative. “But the virtual format makes our capacity essentially unlimited. The benefits compensate for some of what’s lost not being there in the room.”

Educators address a pressing need in addiction medicine training

Reilly, professor of clinical family medicine at the Keck School of Medicine, says the launch of the addiction medicine course in 2017 was motivated by the opioid epidemic. There is an acute need for primary care physicians trained in substance use disorders because they are the doctors who provide much of the screening and treatment for such disorders.

With the pandemic, course organizers took the challenge of going virtual in March 2020 as a new learning opportunity. To their knowledge, theirs is the only online medical school class integrating training in medication-assisted therapy, attendance in virtual addiction recovery group meetings and viewings of critically acclaimed films about addiction, alongside the conventional textbooks and research literature.

“We wanted to birth something that gave students a really multifaceted way of looking at addictions,” Reilly said. “The idea is to use multiple modalities to excite them about the subject matter.”

The course covers everything from pharmacology to the impact on relationships to disparities faced by BIPOC and LGBT populations. The inclusion of medication-assisted therapy training is key. In general, this training is required for a newly licensed doctor to receive a waiver to prescribe Suboxone, a medication used to treat opioid use disorder. Reilly notes that physicians trained and confident in medication-assisted therapy are in short supply.

The Journal of Addictive Diseases study examined responses to an optional survey, given before and after the course to 86 students who took it between August 2019 and December 2021 — roughly four out of five of whom had completed the class online. Afterward, students felt knowledgeable about more substance use disorders and more ways to treat them. They reported improvements in their ability to screen people for substance use disorders, to deliver behavioral therapy and to connect patients with appropriate community resources.

In addition to students interested in primary care, the class attracts those interested in specialties such as surgery and emergency medicine. A forthcoming fellowship in addiction medicine at LAC+USC Medical Center creates an additional Keck School of Medicine training opportunity in substance use disorders.

“Substance abuse disorder is a challenging and complex medical illness that is often ignored and under resourced in treatment,” Reilly said. “We need to really empower and equip students to take these skills with them into their practices.”

Service learning enables medical students to promote community health

As far as the organizers of the virtual nutrition and exercise class can determine, it is similarly one-of-a-kind. Led by first- and second-year medical students and supervised by faculty, 14 weekly sessions per semester are delivered in both English and Spanish, including step-by-step cooking demonstrations from a bilingual chef.  

The program features healthy meals that are culturally appropriate for the primarily Latinx population it serves. And because participants tend to come from lower-income communities, recipes are chosen with low cost and easy availability of ingredients in mind.

“Students learn the importance of tailoring lifestyle recommendations to individual patients’ preferences and resources,” Edge said. “It emphasizes for our students that doctors’ recommendations need to be realistic.”

Surveying 130 participants in virtual classes conducted between September 2020 and April 2021, the investigators behind the Health Education Journal study found that 99% reported high satisfaction with the class itself and 98% planned to make healthy nutrition and exercise choices based on what they learned. There was also an overall preference among participants for virtual courses over in-person. Lack of childcare and transportation, as well as COVID risk, were identified as barriers to physically attending classes.

While the study showed unequivocal benefits to community participants, Edge notes that this service-learning project is a vital training opportunity for Keck School of Medicine students as well.

“We’re taught in medical school that you need to counsel patients about eating better and getting enough exercise, but how exactly do you do that?” she said. “Leading the class gives students experience doing it in a way that’s likely to inspire change. We’re hopeful this is going to make them more compassionate, holistic doctors.”

About the studies

Ilana Greenberg of USC is a co-author of both studies. Alexander Sun of USC and Randolph Holmes of the Los Angeles Centers for Alcohol and Drug Abuse are co-authors of the Journal of Addictive Diseases study. Wendy Silva of USC is a co-author of the Health Education Journal publication.