Abstract

Professional trainings through the use of webinar format are widely used, but participant feedback is seldom studied. In the spring of 2013, 83 nephrology social workers participated in weekly webinar trainings to learn how to implement Symptom Targeted Intervention (STI) into their clinical practice. At the end of the project, participants were asked to complete an online questionnaire to provide feedback on the perceived value and effectiveness of the trainings. Sixty-eight participants completed the questionnaire. The results indicate that social workers found the webinar trainings to be very useful and wanted the trainings to continue beyond the project. Based on participant feedback, clinical training and case presentation through the use of ongoing webinars is a useful education modality for nephrology professionals, but more research is indicated to evaluate how best to utilize webinars to maximize learning.

Introduction

Webinars are widely used by corporations for conferencing and employee training because of their convenience and affordability.1 Since there is no travel time involved and the time commitment is minimal, it is a viable training option during the work day. The barriers to use are low, requiring only a computer, the Internet and a phone to participate.2 Despite their widespread use, webinars are still somewhat new, and neither the pedagogical merits nor participant perception of the utility of webinars have been widely studied.1

The use of teleconference to provide clinical supervision and training is common in many professions including teaching, nursing, and medicine,3,4 but there are no references in the literature to ongoing clinical training and supervision for professional social workers through the use of webinars or teleconference technology.

In a 2011 project outcome evaluation (POE) examining the use of STI, participants observed that patients experienced a 51% improvement in physical component summary (PCS) and a 64% improvement in mental component summary (MCS) scores on the KDQOL-36. STI techniques reduced severity of depression as measured by the CES-D in 72.1% of patients.6

The literature suggests that the use of ongoing consultation and mentoring is a critical component to the training and support of clinicians as they learn new clinical interventions.7 As part of the 2011 STI POE, telephonic case supervision was provided, but there was no quantitative or qualitative feedback from the participants as to the value of these training calls.5, 6

In 2013, social workers in a large dialysis organization replicated the 2011 STI POE. The participating social workers were asked to evaluate the usefulness of STI training and case supervision through the use of ongoing webinars.

Methods

Participants

Eighty-three participants were asked to complete an online survey about their experiences and opinions of the webinars. Sixty-three out of the 83 participants completed the online questionnaire. The participants were master’s level social workers employed by a large dialysis organization (LDO), who participated in a STI project outcome evaluation. HIPPA confidentiality guidelines were followed, and no patient identifying information was shared.

Procedures

As part of the STI training process, the social workers participated in hour-long training calls that were offered twice a week for seven consecutive weeks. The number of participants on the calls ranged from 20 to 75, and participation was voluntary. The calls were structured and focused. In the first half hour, there was a formal power point presentation designed to teach STI interventions (see Table 1). In the second half hour, selected pre-submitted cases were reviewed and discussed.

The second half of the calls featured formal clinical case presentations. The participants submitted case studies in advance. They were asked to provide information about the targeted symptom, interventions attempted, and clinical questions. They were also asked to reflect on effectiveness of their clinical interactions with the patient. Participants were encouraged to present their cases orally on the call, although this was not a requirement. During the weekly calls, a total of 15 cases were discussed.

During the case presentations, the interventions used were highlighted and alternate interventions were proposed and modeled during the calls. In addition to examining the specific content of the case, the underlying clinical process was addressed with a focus on the social worker’s thoughts and feelings about the patient and situation, examining how these thoughts and feelings were impacting the relationship and case progression. The unspoken and often unconscious process was made explicit and conscious through questioning and discussion. The parallel process was normalized and specific suggestions were made regarding the case.

Measures

At the conclusion of the weekly calls, participants were invited to provide their feedback on the helpfulness and feasibility of the webinars. They were emailed a link to an online questionnaire and were asked to answer questions about the calls.

Would you recommend these trainings to other social workers?
This question was a yes/no question with an option for comments. Sixty-five respondents answered the question with 3 abstaining. Sixty-three participants or 96.2% of the respondents would recommend these trainings to other social workers. Two participants would not recommend these calls.

McCool-table1

Would you participate if these calls continued?
During the last few calls, there was discussion of continuing the calls after the end of the STI project outcome evaluation. This question sought to find out if there were enough people interested to warrant more calls. The majority of respondents, 70.31%, or 49 participants, wanted the calls to continue.

Sample comments from feedback survey
Most of the participants suggested that they appreciated clinical training provided by the webinars. Representative comments included, “The calls elevated the clinical skills of all those who attended;” “I really enjoyed the mentoring calls and the opportunity to focus on developing clinical skills.”A few participants suggested that the calls were too basic: “I have already been extensively trained in cognitive behavioral therapy….I am just at a different level of training.”

Many participants suggested that discussing specific cases was the most helpful element of the webinars. Representative comments included: “I think the case discussions were the best part of the call. It demonstrated actual application of the STI concepts;” “It was very interesting to hear about actual patients, their issues and reactions to the interventions. It was interesting to hear about the multiple interventions that could be useful for the same patient (different ways of going about helping the patient).” There were a few participants who did not like the case presentations. “I did not find the case discussion as useful. Given that time is an issue for me I would make participation in the case discussion optional.”

McCool_Chart1

Some participants commented that the formal review of the clinical interventions and concepts was helpful: “The slides were helpful to me in remembering/reviewing concepts and interventions.” A few participants suggested that the PowerPoint training was redundant. “Sometimes it felt like she was just going over the exact same stuff in the manual.” “I don't feel the PowerPoint is necessary, but it is nice to have an outline.”

Many participants commented that they received emotional support from the webinar trainings and became more confident using STI as a result. Representative comments included, “I felt I was guided well and became less apprehensive w/each conference/mentoring call;” “I feel more confident in being able to assist with interventions as needed.” One participant suggested that members might receive more emotional support in smaller group sizes. “The large group call was somewhat intimidating, and I was leery to share or contribute to case discussion.”

Discussion

The results of the survey suggest that the majority of the participants benefited from the calls, found them helpful in learning how to implement STI into their daily clinical practice, and would recommend them to other social workers. The majority of participants found the case discussions more helpful than the explicit teaching element, although various participants mentioned that reviewing the clinical concepts was valuable. In future webinars, altering the ratio of time spent on explicit teaching through Power Point versus case discussion needs to be considered.

McCool_chart2

Offering the calls twice a week and on different treatment days was appreciated, but in future projects calls should be offered at various times in the day to accommodate participants in every time zone. Anecdotal feedback suggests that the times of the calls limited the level of participation from participants on the East Coast. The calls should also be recorded so that participants who are unable to participate in the calls can listen to the recording at their convenience on a later date. The trainers regret that these calls were not recorded.

From the perspective of the trainers, one successful element of these calls was the manner in which cases were submitted and presented. In these case conferencing calls, unlike in the original STI pilot study, the actual case presentations were formally submitted days before the actual calls. This allowed time for the trainer to consider different clinical angles and issues, resulting in calls that were more clinically substantial than in the original STI pilot study. Formal case presentation also lends itself well to a thoughtful consideration and discussion of the parallel process. Although the trainers believe that formal case presentation is more effective than informal case presentation, there is no empirical evidence to support this belief. Future research may examine the effectiveness of formal versus informal case presentations.

McCool_chart3

Limitations of this study included the use of self-reported data collection and the potential for response bias from students. The participants were all from the same LDO and there was no demographic data collected on the participants. Since 68 out of the 83 participants of the calls answered the questionnaires, it is possible there is selection bias and that the data is more positive than it would have been had all 83 participants answered the questionnaire. Participants were not asked to provide the number of webinars in which they participated and neither participation nor level of engagement in the calls was monitored.

Conclusion

The results indicate ongoing case discussion and training, as well as mentoring calls via webinar, is a useful educational format for nephrology social workers. This structured webinar training format may also benefit other professionals covering different topics, but more research is indicated to evaluate how best to utilize webinars to maximize learning.

References

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5. McCool M, Johnstone S, Sledge R, et al. The promise of Symptom Targeted Intervention to manage depression in dialysis patients. Nephrol News Issues, Vol. 25 No. 6:32-3, 35-7, 2011

6. Sledge R, Aebel-Groesch K, McCool M, et al. The promise of symptom-targeted intervention to manage depression in dialysis patients: improving mood and quality of life outcomes.Nephrol News Issues. Vol. 25 No. 7:24-8, 30-1, 2011

7. Sholomskas D, Syracuse G, Rounsaille BJ, et al. We don’t train in vain: a dissemination trial of three strategies of training clinicians in cognitive-behavioral therapy. J Consult Clin Psycho 73:106-115, 2005