Residents often work in remote locations or on schedules that do not permit them to attend formal didactic conferences. To address this problem, the curriculum is almost entirely Web-based, which allows asynchronous learning at times and locations convenient to the residents. The Web-based components include 11 short didactic segments in Microsoft PowerPoint® format with voice/text narration and photo/video images; outpatient clinical case scenarios that mirror the clinical encounter for residents to work through and apply knowledge and skills learned in the didactic sessions (Table 2); reference materials; and links to outside resources.

Additionally, adult learners tend to have preferred learning styles (primarily visual, auditory, or kinesthetic), thus curricula targeted at adults must include all three styles of presentation. The Web-based components address the needs of visual and auditory learners well, but do not have a kinesthetic component. Therefore, the curriculum will also include hands-on practice of relevant clinical skills such as pneumatic otoscopy (critical for accurate diagnosis of otitis media), and effective patient communication skills.

First, the didactic section on patient education describes common patient understandings of when and how to use antibiotics; addresses misconceptions about what patients with respiratory infections really expect from their office visit; explains the advantages and disadvantages of various forms of patient education; and illustrates crucial communication skills that can help clinicians educate their patients about antibiotic use. Second, the online cases include some scenarios in which antibiotics are not indicated. Those cases include questions about how to negotiate with the patient about not prescribing antibiotics. Third, one conference session for the residents focuses on negotiation and patient education.

Physicians often express concern about their skills at negotiating with patients about antibiotic use, and have misconceptions about when patients truly want antibiotics as opposed to simply a more complete understanding of their illness and how to treat it symptomatically (Linder & Singer, 2003; Mangione-Smith, McGlynn, Elliott, Krogstad, & Brook, 1999; Mangione-Smith, McGlynn, Elliott, McDonald, Franz, & Kravitz, 2001; van Duijn, Kuyenhoven, Welschen, den Ouden, Slootweg, & Verheij, 2002). We present information about proven negotiating techniques; effective use of written patient education materials to improve retention and decrease time needed to educate patients; and how to elicit the patient’s true agenda for an office visit. We discuss other evidence-based techniques such as delayed prescribing (Arroll, Knealy, & Kerse, 2003) to reduce antibiotic use. We then divide into groups of three to role play clinical scenarios The observer/timer times the encounter, which should be limited to two minutes, and takes notes on body language, phrasing, and other features of the communication. The patient and physician describe their responses to the encounter, and the observer then reviews the encounter. Practice such as this enhances the residents’ confidence in their ability to negotiate with and educate patients as needed.