Effectiveness of the six-step approach guided online training program to improve knowledge of Mycoplasma pneumoniae pneumonia among pediatricians: a pretest-posttest study
Original Article

Effectiveness of the six-step approach guided online training program to improve knowledge of Mycoplasma pneumoniae pneumonia among pediatricians: a pretest-posttest study

Jiayu Wang1#, Qing Wang2#, Yi Wang3,4, Yonghao Gui1,3,5, Quan Lu3,6, Yong Yin7, Jianhua Zhang8, Libo Wang2, Xiaoyan Dong6, Yingwen Wang9, Yingzi Ye3,10, Hong Xu11, Danping Gu3, Wen He2, Guodong Ding8, Xiaobo Zhang2,3

1National Health Commission (NHC) Key Laboratory of Neonatal Diseases, Fudan University, Children’s Hospital of Fudan University, Shanghai, China; 2Department of Respiratory Medicine, Children’s Hospital of Fudan University, Shanghai, China; 3Shanghai Pediatric Clinical Quality Control Center, Shanghai, China; 4Department of Neurology, Children’s Hospital of Fudan University, Shanghai, China; 5Cardiovascular Center, Children’s Hospital of Fudan University, Shanghai, China; 6Department of Respiratory Disease, Children’s Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China; 7Department of Respiratory Medicine, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; 8Department of Respiratory Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; 9Department of Nursing, Children’s Hospital of Fudan University, Shanghai, China; 10Department of Infectious Disease, Children’s Hospital of Fudan University, Shanghai, China; 11Department of Nephrology, Children’s Hospital of Fudan University, Shanghai, China

Contributions: (I) Conception and design: X Zhang; (II) Administrative support: Yi Wang, Y Gui, Q Lu, Y Ye, D Gu, X Zhang; (III) Provision of study materials or patients: Y Yin, J Zhang, L Wang, X Dong, Yingwen Wang, H Xu, W He, G Ding; (IV) Collection and assembly of data: J Wang, Q Wang; (V) Data analysis and interpretation: J Wang, Q Wang; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

#These authors contributed equally to this work.

Correspondence to: Xiaobo Zhang, MD. Center for Pediatric Clinical Quality Control of Shanghai, Shanghai, China; Department of Respiratory Medicine, Children’s Hospital of Fudan University, 399 Wanyuan Road, Shanghai 201102, China. Email: zhangxiaobo0307@163.com.

Background: In 2023, China witnessed an earlier and more widespread outbreak of Mycoplasma pneumoniae pneumonia (MPP). To address this situation, an online training program was designed to enhance the knowledge of MPP among pediatricians in Shanghai, China.

Methods: An online training program on the diagnosis and treatment of MPP, guided by Kern’s six-step approach, was developed by the Shanghai Pediatric Clinical Quality Control Center. A pre- and post-training survey was conducted using a 20-item self-administered questionnaire to investigate the pediatricians’ knowledge of MPP. A linkage mechanism was established to match pretest/posttest questionnaires using personal identifiers. Paired t-tests and McNemar tests were performed to measure the differences, as appropriate, between pre- and post-training groups. A higher survey score indicated better knowledge.

Results: There were 289 participants performed pre- and post-tests. The average age of the respondents was 38.7 years (standard deviation: 8.9). Over 80% of the participants were primary (32.5%) and intermediate (47.8%) pediatricians. Those from specialized hospitals accounted for the highest proportion (41.5%). The post-training group achieved significantly higher total scores than the pre-training group (91.3 vs. 67.7, t=22.48, P<0.001), regardless of the professional titles or hospital levels (all P<0.001). The accuracy rates of each question increased significantly in the post-training group (all P<0.001).

Conclusions: The online training program effectively enhanced pediatricians’ understanding of diagnosing and treating MPP. It is recommended to maintain continuous education and training targeting all healthcare providers.

Keywords: Mycoplasma pneumoniae pneumonia (MPP); pretest-posttest study; Kern’s six-step approach; online training

Submitted Feb 22, 2024. Accepted for publication May 07, 2024. Published online May 24, 2024.

doi: 10.21037/tp-24-53

Highlight box

Key findings

• The post-training group demonstrated significantly improved knowledge of Mycoplasma pneumoniae pneumonia (MPP) compared to the pre-training group, regardless of professional titles or hospital levels.

What is known and what is new?

• Kern’s six-step guided online training programs is effective in enhancing knowledge among healthcare providers.

• This study showed the effectiveness of a tailored online training program for pediatricians in enhancing their knowledge of MPP diagnosis and treatment. The program was effective across different professional titles and hospital levels, indicating its broad applicability.

What is the implication, and what should change now?

• Continuous education and training targeted at all healthcare providers, including pediatricians, is crucial in combating MPP outbreaks.

• Online training programs can be a cost-effective and efficient way to disseminate knowledge and enhance clinical skills.

Introduction

Mycoplasma pneumoniae (MP) is one of the most common causes of community-acquired pneumonia (CAP) in children (1), with up to 10% of MP-infected children developing Mycoplasma pneumoniae pneumonia (MPP) (2). MPP outbreaks may occur every 3 to 7 years and last for up to 2 years (3,4), with the latest occurrence documented in 2019. Notably, nationwide non-pharmaceutical interventions (NPI) against coronavirus disease 2019 (COVID-19), such as strict face mask-wearing and population movement restrictions, have prevented the spread of MP and led to a decrease in MPP incidence over the past 3 years (5). However, this may result in insufficient immunity. With downgraded NPIs and a growing susceptible population (6), the year 2023 witnessed an earlier and more widespread outbreak of MPP in China, with cases increasing from April and reaching a peak from October to November (7).

Although most MPP cases are mild and self-limiting, approximately 0.5–2.0% of cases are accompanied by severe complications, requiring early detection and intervention (8,9). Macrolide antibiotics are the primary clinical treatment for MPP. However, macrolide-resistant mycoplasma pneumonia (MRMP) has emerged widely in recent years, especially in Asian countries, driven by variations in the 23S rRNA gene (10). The macrolide resistance of MPP exceeded 90% between 2009 and 2012 in Beijing (11). Due to the challenges posed by antibiotic resistance and the rising prevalence of severe cases, there is an imperative need for effective MPP management. The first step should involve training pediatricians to enhance their understanding of MPP, particularly in early detection and treatment, especially for macrolide-unresponsive, refractory, and severe cases.

However, traditional in-person training faces constraints such as limited faculty and resources, and the difficulty of gathering everyone at the same time. In contrast, online training in medical education, accelerated by the COVID-19 pandemic, has overcome these obstacles and become mainstream (12). It has demonstrated convenience and flexibility, thus attracting as many participants as possible (13). Kern’s six-step approach is a systematic approach to online curriculum development and is suitable for establishing short educational sessions (14). Based on this framework, we designed an online training program tailored for pediatricians from all levels of hospitals in Shanghai. This study aimed to evaluate the impact of the training program on enhancing the pediatricians’ understanding of MPP. We present this article in accordance with the STROBE reporting checklist (available at https://tp.amegroups.com/article/view/10.21037/tp-24-53/rc).

Methods

Study design

This study was conducted in two stages. In the first stage, Kern’s six-step approach guided online training program was designed by experts from the Shanghai Pediatric Clinical Quality Control Center (SPCQCC). In the second stage, pediatricians from all levels of hospitals (i.e., primary, secondary, tertiary, and specialized) were invited to take part in this online training program. Subsequently, pre- and post-training anonymous questionnaires were sent to these participants.

Designing and implementing an online training program

To further standardize the diagnosis and treatment process of MPP in Shanghai, SPCQCC convened a multidisciplinary team of experts from pediatric respiratory, critical care, and infectious diseases. The contents of the online training program were based on the latest clinical guidance for the management of pediatric MPP and CAP (15,16), focusing on MPP diagnostic criteria and treatment modalities. Figure 1 summarizes Kern’s framework and outlines the key aspects of the curriculum design.

Figure 1 Key aspects of the online training program guided by Kern’s six-step approach. MPP, Mycoplasma pneumoniae pneumonia.

Step 1: problem identification and general needs assessment

Limited research exists regarding optimal training methods for healthcare professionals in the diagnosis and treatment of MPP. Preliminary studies suggest a positive impact of online training in CAP for medical workers, indicating potential application. Therefore, an online training program was developed on the platform of the Tencent Meeting, where all pediatricians from Shanghai had access to this program.

Step 2: targeted needs assessment

There is no documented training program focusing on MPP for pediatricians. Therefore, a preliminary survey was conducted to understand knowledge gaps, and face-to-face communication was initiated with experts to gather their opinions on priority educational areas for MPP. Recognizing the difficulties in self-learning and offline gatherings for pediatricians with tight schedules, an online curriculum design with shareable teaching materials was implemented. Finally, a focused curriculum was designed with seven themes during the evening period for maximum participation.

Step 3: goals and objectives

The objective was to establish a structured approach, ensuring that primary and secondary hospitals acquired fundamental diagnostic and therapeutic knowledge for treating mild cases and facilitating timely referrals for severe cases. Simultaneously, tertiary hospitals should demonstrate proficiency in MPP management, develop the capacity to promptly identify severe cases, conduct pathogen testing, and administer medication judiciously.

Step 4: educational strategies

Our curriculum included two key educational components: (I) formal and online learning modules; and (II) interactive sessions with presenters after each course. The MPP curriculum integrated theoretical knowledge and clinical case studies, utilizing diverse teaching methods such as text, images, and videos.

Step 5: implementation

First, we initiated a pre-training survey (Appendix 1) to gauge baseline knowledge and skills on MPP. Course arrangement and the presenter’s academic rank are shown in Table S1. Each session focused on one specific theme and was limited to 25 minutes for high-quality output. All of these courses were delivered by pediatric respiratory experts from top hospitals in China. After the training, each participant completed the post-training survey, which included knowledge evaluation and formal feedback.

Step 6: evaluation and feedback

An immediate assessment of MPP knowledge was achieved using a post-training questionnaire survey. The 20-item electronic questionnaire was divided into three dimensions: the mechanism (1 item), diagnosis (10 items), and treatment (9 items) sections, with 5 single-choice and 15 multiple-choice questions. Each correct answer earned 5 points, resulting in a total maximum score of 100. Participants provided feedback including satisfaction with the training program, and whether they would recommend the training program to other pediatricians.

In the current analysis, we excluded participants who resubmitted the survey and those who had no available data on age, hospital level, or professional title. Then, a linkage mechanism was established to match pretest/posttest questionnaires using personal identifiers.

The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study protocol was approved by the ethics committee of the Children’s Hospital of Fudan University (No. 2022-44). A letter from SPQCC was sent to participants to inform them about the significance and use of the questionnaire, and informed consent was deemed to be given after completion of the questionnaire.

Statistical analysis

The continuous variables with normal distributions were expressed as mean with standard deviation (SD). The categorical data were expressed as n (%). We also stratified the participants according to professional titles and hospital levels. One-way analysis of variance was used to compare differences in total scores among more than two groups. Paired t-tests and McNemar tests were performed to investigate the differences as appropriate between pre- and post-training groups. All data were analyzed using R version 3.6.2. A P value of <0.05 was considered statistically significant.

Results

In total, 494 and 593 participants were included in the pre-training and post-training groups respectively. This resulted in 289 records matched for pretest-posttest analysis (i.e., before-after study) (Figure 2).

Figure 2 Flowchart of the study participants.

Table 1 summarizes the main characteristics of participants matched for pretest and posttest analysis. The average age of the respondents was 38.7 years (SD: 8.9; range: 23.0–59.0 years). Over 80% of the participants were primary (32.5%) and intermediate (47.8%) pediatricians. Those from specialized hospitals accounted for the highest proportion (41.5%).

Table 1

Baseline characteristics of the study participants

Variables Overall (n=289)
Age, years, mean (SD) 38.7 (8.9)
Professional title†, n (%)
   Primary 94 (32.5)
   Intermediate 138 (47.8)
   Associate senior 42 (14.5)
   Senior 15 (5.2)
Hospital level, n (%)
   Primary 35 (12.1)
   Secondary 74 (25.6)
   Tertiary 60 (20.8)
   Specialized 120 (41.5)

†, pediatricians in China are often classified as “primary”, “intermediate”, “associate senior”, and “senior” grades according to their skill levels and specialization. SD, standard deviation.

Table 2 shows the difference in the total score among various professional titles and hospital levels before and after the training. In the pre-training group, the total score varied across professional titles, with scores of 66.6, 66.6, 71.7, and 73.3, respectively, showing an increase with higher levels of professional titles, although not statistically significant (F=1.60, P=0.19). A similar trend was observed among hospital levels (F=1.79, P=0.15). In the post-training group, no significant difference was observed either in the professional title (F=0.66, P=0.58) or in the hospital level (F=0.81, P=0.49).

Table 2

Differences of the total score in different professional titles and hospital levels in pre- and post-training groups

Variables N Pre-training group Post-training group
Total score† F P Total score† F P
Overall 289 67.7 (17.1) 91.3 (12.6)
Professional title‡ 1.60 0.19 0.66 0.58
   Primary 94 66.6 (19.3) 92.3 (12.2)
   Intermediate 138 66.6 (14.7) 91.4 (12.6)
   Associate senior 42 71.7 (18.6) 90.1 (11.9)
   Senior 15 73.3 (18.5) 88.0 (16.8)
Hospital level 1.79 0.15 0.81 0.49
   Primary 35 62.7 (14.5) 93.0 (12.8)
   Secondary 74 66.2 (13.8) 89.6 (12.4)
   Tertiary 60 70.2 (12.8) 91.1 (10.8)
   Specialized 120 68.9 (21.0) 92.0 (13.5)

†, values are presented as mean (standard deviation). ‡, pediatricians in China are often classified as “primary”, “intermediate”, “associate senior”, and “senior” grades according to their skill levels and specialization.

Table 3 shows the results of stratified analyses. The total score of the post-training group was significantly higher than that in the pre-training group (91.3 vs. 67.7, t=22.48, P<0.001), regardless of the professional titles or hospital levels (all P<0.001). Nevertheless, there were some exceptions. For example, in the diagnosis section, no significant difference was observed among senior pediatricians (45.3 vs. 40.7, t=1.86, P=0.08).

Table 3

Score comparisons between pre-training and post-training groups in different professional titles and hospital levels

Variables Total (20-item, full mark =100) Diagnosis (10-item, full mark =50) Treatment (9-item, full mark =45)
Pre-training group Post-training group Difference (post − pre) t P Pre-training group Post-training group Difference (post − pre) t P Pre-training group Post-training group Difference (post − pre) t P
Total score 67.7 (17.1) 91.3 (12.6) 23.6 (21.5–25.7) 22.48 <0.001 38.1 (8.6) 46.8 (5.4) 8.7 (7.6–9.7) 16.47 <0.001 25.2 (10.0) 39.7 (8.1) 14.5 (13.2–15.7) 22.57 <0.001
Professional title†
   Primary 66.6 (19.3) 92.3 (12.2) 25.6 (21.5–29.8) 12.35 <0.001 37.2 (9.3) 47.2 (4.9) 9.9 (8.0–11.9) 9.93 <0.001 25.0 (10.7) 40.3 (7.6) 15.3 (13.0–17.6) 13.27 <0.001
   Intermediate 66.6 (14.7) 91.4 (12.6) 24.8 (22.0–27.5) 17.75 <0.001 37.9 (8.1) 46.7 (5.6) 8.8 (7.3–10.3) 11.97 <0.001 24.2 (8.9) 39.8 (8.1) 15.5 (13.8–17.3) 17.34 <0.001
   Associate senior 71.7 (18.6) 90.1 (11.9) 18.5 (13.2–23.7) 7.06 <0.001 39.9 (8.9) 46.8 (4.9) 6.9 (4.6–9.2) 5.98 <0.001 27.6 (10.7) 38.5 (8.0) 10.8 (7.3–14.4) 6.18 <0.001
   Senior 73.3 (18.5) 88.0 (16.8) 14.7 (6.9–22.4) 4.07 <0.001 40.7 (7.3) 45.3 (6.9) 4.7 (–0.7–10.1) 1.86 0.08 28.3 (12.2) 38.0 (10.8) 9.7 (4.9-14.4) 4.38 0.001
Hospital level
   Primary 62.7 (14.5) 93.0 (12.8) 30.3 (23.7–36.8) 9.38 <0.001 35.0 (8.7) 47.1 (5.6) 12.1 (8.5–15.8) 6.83 <0.001 23.0 (8.4) 41.0 (7.6) 18.0 (14.3–21.7) 9.99 <0.001
   Secondary 66.2 (13.8) 89.6 (12.4) 23.4 (20.1–26.7) 14.10 <0.001 38.0 (7.6) 46.2 (6.0) 8.2 (6.3–10.2) 8.55 <0.001 23.8 (8.1) 38.6 (7.6) 14.8 (12.8–16.8) 14.70 <0.001
   Tertiary 70.2 (12.8) 91.1 (10.8) 20.9 (16.9–24.9) 10.42 <0.001 38.8 (7.3) 46.7 (4.3) 7.8 (5.7–9.9) 7.49 <0.001 26.9 (7.5) 39.4 (7.9) 12.5 (10.0–15.0) 10.05 <0.001
   Specialized 68.9 (21.0) 92.0 (13.5) 23.2 (19.5–26.8) 12.59 <0.001 38.8 (9.5) 47.1 (5.4) 8.4 (6.7–10.0) 10.00 <0.001 25.8 (12.2) 40.0 (8.6) 14.2 (11.9–16.5) 12.42 <0.001

Values are presented as mean (standard deviation) or estimate (95% confidence interval). †, pediatricians in China are often classified as “primary”, “intermediate”, “associate senior”, and “senior” grades according to their skill levels and specialization.

Table 4 demonstrates the results of each question in the two groups. The findings showed that respondents in the post-training group grasped better knowledge than those in the pre-training group (all P<0.001). Over 90% of the respondents in the pre-training group answered correctly in questions such as (I) Q3: extra-pulmonary manifestations of MP infection (91.0%), (II) Q10: imaging manifestations of severe pneumonia (94.1%), and (III) Q13: first line antibiotics for MPP (98.3%). However, the following questions exhibited a failing grade (<60%): (I) Q4: which of the following statement can confirm the diagnosis of MPP (47.8%); (II) Q6: when should plastic bronchitis be considered? (42.2%); (III) Q11: relative contraindications for bronchoscopy (20.1%); (IV) Q12: indications for corticosteroids in MPP (30.4%); (V) Q19: anticoagulation can be considered for severe patients with D-dimer elevated × normal upper limit (34.6%); and (VI) Q20: greatest benefit from thrombolytics if given within × hours of PE symptoms (37.7%). The accuracy rates of these questions increased significantly in the post-training group (all P<0.001).

Table 4

Performance on each question using the McNemar test for paired data

Category Questions Pre-training group (% correct) Post-training group (% correct) χ2 P
1. Mechanism What are the pathogenesis mechanisms of refractory MPP 88.2 97.6 23.52 <0.001
2. Diagnosis Macrolide-unresponsive MPP refers to children who have undergone standard treatment with macrolide antibiotics but still have persistent fever, worsening clinical signs and pulmonary imaging after † 77.9 95.5 38.82 <0.001
3. Diagnosis Extra-pulmonary manifestations of MP infection include 91.0 97.9 16.67 <0.001
4. Diagnosis Which of the following statement can confirm diagnosis of MPP 47.8 86.5 99.56 <0.001
5. Diagnosis Imaging manifestations of MPP include 77.5 96.2 39.41 <0.001
6. Diagnosis When should plastic bronchitis be considered? 42.2 75.4 64.00 <0.001
7. Diagnosis Intrapulmonary complications of MPP include 75.4 96.2 51.43 <0.001
8. Treatment Indications for bronchoscopy in MPP 72.7 89.6 29.64 0.001
9. Diagnosis Clinical manifestations of severe pneumonia include 88.2 95.8 12.10 <0.001
10. Diagnosis Imaging manifestations of severe pneumonia 94.1 99.7 14.22 <0.001
11. Treatment Relative contraindications for bronchoscopy 20.1 72.0 133.93 <0.001
12. Treatment Indications for corticosteroids in MPP 30.4 79.6 127.62 <0.001
13. Treatment First line antibiotics for MPP† 98.3 100.0 NA NA
14. Treatment Antibiotics for resistant MPP often include 70.2 90.7 44.06 <0.001
15. Treatment Besides anti-infectives, other treatment of MPP includes 73.4 96.5 59.85 <0.001
16. Treatment Indications for IVIG 66.4 94.1 72.73 <0.001
17. Diagnosis Acute pulmonary embolism triad includes 88.6 96.9 16.94 <0.001
18. Diagnosis First line test for pulmonary embolism diagnosis† 79.6 95.8 41.68 <0.001
19. Treatment Anticoagulation can be considered for severe patients with D-dimer elevated × normal upper limit† 34.6 87.5 141.87 <0.001
20. Treatment Greatest benefit from thrombolytics if given within × hours of PE symptoms† 37.7 83.0 112.16 <0.001

†, these are single-choice questions. MPP, Mycoplasma pneumoniae pneumonia; MP, Mycoplasma pneumoniae; IVIG, intravenous immunoglobulin; PE, pulmonary embolism; NA, not applicable.

Discussion

This study was conducted to evaluate the effectiveness of an MPP-oriented training program for pediatricians. Before the training, a preliminary survey was conducted at different levels of hospitals in Shanghai, revealing knowledge and skill limitations in specific areas. To address this problem, a training program was designed using Kern’s six-step approach for curriculum development. To the best of our knowledge, this is the first study to assess the knowledge of MPP among pediatricians and the difference between post-training and pre-training groups. The findings support the effectiveness of implementing an online training program for pediatricians to improve their MPP-related knowledge. The program has also been shown to be effective in improving the knowledge of MPP among pediatricians.

Although no previous training studies focused on MPP, a training program related to ventilator-associated pneumonia found that nurse-led education significantly enhanced nurses’ understanding and adherence to ventilator care bundle practices (17). Similarly, in a study involving 300 community pharmacists, a knowledge questionnaire about asthma was used to evaluate their knowledge before and after a 4-h training program. The study found that a short training program was effective in improving the knowledge of the pharmacists (18). Both two studies used a pretest-posttest design and conducted paired sample t-tests to assess the improvement of the training program, aligning closely with the outcomes of our study.

The results of our study indicated that certain areas were well-understood by all the participants, such as radiological manifestations of severe pneumonia. This can be attributed to the experience gained during the COVID-19 pandemic, in which healthcare workers became quite familiar with pneumonia-related knowledge (19). Moreover, respiratory disease training programs have been conducted in Shanghai in the past 3 years (13), adhering to the guidelines established by the World Health Organization (20) and the Chinese National Health Commission for the diagnosis and treatment of pediatric CAP (16).

A statistically significant difference was observed in the following areas between the two groups: MPP detection methods, bronchoscopy, and corticosteroid indications. Firstly, detection of MP can be achieved by culture, serology, or molecular-based methods and each of these methods possesses advantages and disadvantages, such as speed, sensitivity, and specificity (21-24). It is noted that limited access to testing tools in certain hospitals may contribute to the knowledge gaps. Secondly, flexible bronchoscopy with bronchoalveolar lavage plays a role in the timely detection of infections and improves the recovery of lung damage in MPP patients (25). Due to the hierarchical medical system in Shanghai, many hospitals, including primary and secondary hospitals may lack the license to perform bronchoscopy for children, limiting access to the tool and relevant knowledge. Nevertheless, training these pediatricians is crucial for facilitating prompt patient transfers. Similarly, some pediatricians may rarely encounter severe MPP cases or complications (26) and are unfamiliar with the indications for corticosteroids.

The main strength of our study is its timely implementation in early August 2023, before the 2023 MPP peak, which may exert a positive impact on reducing the severity rate of MPP. However, several limitations must be noted. Firstly, no control group was set for this analysis. We cannot rule out the possibility of the influence of other information sources and potential confounding factors. Secondly, while these participants were from all levels of hospitals, the results of this intervention may not be representative of all pediatricians (27). Thirdly, according to a systematic review conducted by Marino et al. (28), approximately 9% of infants hospitalized with COVID-19 exhibited co-infection with MP. Despite this significant prevalence, co-infection has been overlooked in the current training, leading to a critical knowledge gap. Therefore, it is imperative that future training addresses this gap to improve the comprehensive clinical diagnosis and treatment capacity. Finally, additional survey distribution could occur at 3 and 6 months after completion of the curriculum to evaluate the interim and long-term impact of the training program.

Conclusions

Pediatricians play an important role in preventing the outbreak of MPP in medical settings. This study suggests an overall improvement in knowledge of MPP with the implementation of Kern’s step-six approach guided online training program. Therefore, it is recommended to maintain continuous education and training targeted to all healthcare providers.

Acknowledgments

Funding: This work was supported by the Science and Technology Commission of Shanghai Municipality (No. 22511106001 and No. 23511100600 to X.Z.).

Footnote

Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://tp.amegroups.com/article/view/10.21037/tp-24-53/rc

Data Sharing Statement: Available at https://tp.amegroups.com/article/view/10.21037/tp-24-53/dss

Peer Review File: Available at https://tp.amegroups.com/article/view/10.21037/tp-24-53/prf

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-24-53/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study protocol was approved by the ethics committee of the Children’s Hospital of Fudan University (No. 2022-44). A letter from SPQCC was sent to participants to inform them about the significance and use of the questionnaire, and informed consent was deemed to be given after completion of the questionnaire.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

  1. Jiang Z, Li S, Zhu C, et al. Mycoplasma pneumoniae Infections: Pathogenesis and Vaccine Development. Pathogens 2021;10:119. [Crossref] [PubMed]
  2. Krafft C, Christy C. Mycoplasma Pneumonia in Children and Adolescents. Pediatr Rev 2020;41:12-9. [Crossref] [PubMed]
  3. Cheng Y, Cheng Y, Dai S, et al. The Prevalence of Mycoplasma Pneumoniae Among Children in Beijing Before and During the COVID-19 Pandemic. Front Cell Infect Microbiol 2022;12:854505. [Crossref] [PubMed]
  4. Lenglet A, Herrador Z, Magiorakos AP, et al. Surveillance status and recent data for Mycoplasma pneumoniae infections in the European Union and European Economic Area, January 2012. Euro Surveill 2012;17:20075. [Crossref] [PubMed]
  5. Li X, Li T, Chen N, et al. Changes of Mycoplasma pneumoniae prevalence in children before and after COVID-19 pandemic in Henan, China. J Infect 2023;86:256-308. [Crossref] [PubMed]
  6. Zhang L, Zhang Y, Duan W, et al. Using an influenza surveillance system to estimate the number of SARS-CoV-2 infections in Beijing, China, weeks 2 to 6 2023. Euro Surveill 2023;28:2300128. [Crossref] [PubMed]
  7. Zhang XB, He W, Gui YH, et al. Current Mycoplasma pneumoniae epidemic among children in Shanghai: unusual pneumonia caused by usual pathogen. World J Pediatr 2024;20:5-10. [Crossref] [PubMed]
  8. Yang B, Zhang W, Gu W, et al. Differences of clinical features and prognosis between Mycoplasma pneumoniae necrotizing pneumonia and non-Mycoplasma pneumoniae necrotizing pneumonia in children. BMC Infect Dis 2021;21:797. [Crossref] [PubMed]
  9. Zheng HQ, Ma YC, Chen YQ, et al. Clinical Analysis and Risk Factors of Bronchiolitis Obliterans After Mycoplasma Pneumoniae Pneumonia. Infect Drug Resist 2022;15:4101-8. [Crossref] [PubMed]
  10. Kim K, Jung S, Kim M, et al. Global Trends in the Proportion of Macrolide-Resistant Mycoplasma pneumoniae Infections: A Systematic Review and Meta-analysis. JAMA Netw Open 2022;5:e2220949. [Crossref] [PubMed]
  11. Zhao F, Liu G, Wu J, et al. Surveillance of macrolide-resistant Mycoplasma pneumoniae in Beijing, China, from 2008 to 2012. Antimicrob Agents Chemother 2013;57:1521-3. [Crossref] [PubMed]
  12. Beiting KJ, Chippendale RZ, Goroncy A, et al. Geriatrics Fellows Learning Online And Together (Geri-a-FLOAT): A sustainable model of learning and support. J Am Geriatr Soc 2023;71:2902-12. [Crossref] [PubMed]
  13. Ye Y, Shi P, Gui Y, et al. Point-of-care training program on COVID-19 infection prevention and control for pediatric healthcare workers: a multicenter, cross-sectional questionnaire survey in Shanghai, China. Transl Pediatr 2021;10:44-53. [Crossref] [PubMed]
  14. Chen BY, Kern DE, Kearns RM, et al. From Modules to MOOCs: Application of the Six-Step Approach to Online Curriculum Development for Medical Education. Acad Med 2019;94:678-85. [Crossref] [PubMed]
  15. National Health Commission. Guidelines for Diagnosis and Treatment of Mycoplasma pneumoniae Pneumonia in Children (2023 edition). Clinical Education of General Practice 2023;21:196-202.
  16. Ni X. Guidelines for the Diagnosis and Treatment of Community-acquired Pneumonia in Children (2019 edition). Clinical Education of General Practice 2019;17:771-7.
  17. Subramanian P, Choy KL, Gobal SV, et al. Impact of education on ventilator-associated pneumonia in the intensive care unit. Singapore Med J 2013;54:281-4. [Crossref] [PubMed]
  18. Nguyen TS, Nguyen TLH, Pham TTV, et al. Effectiveness of a short training program for community pharmacists to improve knowledge and practice of asthma counselling - A simulated patient study. Respir Med 2018;144:50-60. [Crossref] [PubMed]
  19. Sun Q, Yu C, Zheng Z, et al. Knowledge, attitude, and practices on COVID-19 prevention and diagnosis among medical workers in the radiology department: A multicenter cross-sectional study in China. Front Public Health 2023;11:1110893. [Crossref] [PubMed]
  20. World Health Organization. Pocket Book of Hospital Care for Children. Guidelines for the Management of Common Illnesses with Limited Resources. WHO Press, 2005:72-81.
  21. Leal SM Jr, Totten AH, Xiao L, et al. Evaluation of Commercial Molecular Diagnostic Methods for Detection and Determination of Macrolide Resistance in Mycoplasma pneumoniae. J Clin Microbiol 2020;58:e00242-20. [Crossref] [PubMed]
  22. Tang M, Wang D, Tong X, et al. Comparison of different detection methods for Mycoplasma pneumoniae infection in children with community-acquired pneumonia. BMC Pediatr 2021;21:90. [Crossref] [PubMed]
  23. Meyer Sauteur PM, Beeton ML, Uldum SA, et al. Mycoplasma pneumoniae detections before and during the COVID-19 pandemic: results of a global survey, 2017 to 2021. Euro Surveill 2022;27:2100746. [Crossref] [PubMed]
  24. Wang Y, Yu X, Liu F, et al. Respiratory microbiota imbalance in children with Mycoplasma pneumoniae pneumonia. Emerg Microbes Infect 2023;12:2202272. [Crossref] [PubMed]
  25. Wang L, Xie Q, Xu S, et al. The role of flexible bronchoscopy in children with Mycoplasma pneumoniae pneumonia. Pediatr Res 2023;93:198-206. [Crossref] [PubMed]
  26. Fan G, Guo Y, Tang F, et al. Determining the Clinical Characteristics, Treatment Strategies, and Prognostic Factors for Mycoplasma pneumoniae Encephalitis in Children: A Multicenter Study in China. J Clin Neurol 2023;19:402-9. [Crossref] [PubMed]
  27. Mack DP, Foster GA, Bouwers LM, et al. A counseling video with pre- and posttesting and checklist for oral immunotherapy consent improves participant knowledge. Ann Allergy Asthma Immunol 2020;125:468-474.e4. [Crossref] [PubMed]
  28. Marino S, Pavone P, Marino L, et al. SARS-CoV-2: The Impact of Co-Infections with Particular Reference to Mycoplasma pneumonia-A Clinical Review. Microorganisms 2022;10:1936. [Crossref] [PubMed]
Cite this article as: Wang J, Wang Q, Wang Y, Gui Y, Lu Q, Yin Y, Zhang J, Wang L, Dong X, Wang Y, Ye Y, Xu H, Gu D, He W, Ding G, Zhang X. Effectiveness of the six-step approach guided online training program to improve knowledge of Mycoplasma pneumoniae pneumonia among pediatricians: a pretest-posttest study. Transl Pediatr 2024;13(5):760-769. doi: 10.21037/tp-24-53

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