上海市嘉定区医疗机构继续医学教育现状调查

上海市自1996年起试行继续医学教育,为了解本区开展继续医学教育以来,各级医疗机构继续医学教育的实施情况。进一步探讨如何强化管理机制,使继续医学教育规范化、科学化,提高继续医学教育的实用性。对本辖区内18所医疗机构进行了调查。1对象与方法1.1对象本区18家二级、一级医院的分管院长、医教科长、继续教育专职干部、临床科主任以及中级以上的医师。1.2内容对嘉定区近3年的继续医学教育情况进行调查:①继续医学教育的组织管理;②继续医学教育的有效性评价;③继续医学教育培训的费用来源、使用和项目收费标准。1.3方法采用社会调查法中个…     

做好继续医学教育的建议

本文提出现阶段我国继续医学教育仍然存在一些问题,如继续医学教育发展不平衡、继续医学教育重视不够、考核体制有待完善、少数项目质量不高等。解决对策是：创造条件,为基层卫生技术人员提供有效的继续医学教育;建立健全继续医学教育制度,完善配套政策,实施全员性在职教育：利用网络平台,使继续医学教育形式灵活多样,内容丰富多彩：加强继续医学教育信息交流,积极开展国际间交流与合作。     

做好继续医学教育的建议

本文提出现阶段我国继续医学教育仍然存在一些问题,如继续医学教育发展不平衡、继续医学教育重视不够、考核体制有待完善、少数项目质量不高等。解决对策是:创造条件,为基层卫生技术人员提供有效的继续医学教育;建立健全继续医学教育制度,完善配套政策,实施全员性在职教育;利用网络平台,使继续医学教育形式灵活多样,内容丰富多彩;加强继续医学教育信息交流,积极开展国际间交流与合作。     

深圳市继续医学教育需求现状分析

目的对深圳市继续医学教育项目及医务人员继续医学教育需求情况进行分析,旨在了解深圳市继续医学教育需求现状,为政府制定继续医学教育政策提供参考。方法以调查问卷的方式调查医务人员678名并分析已有资料,统计学上主要采用描述性分析方法。结果从各学科项目数与人数的比例来看,护理学的比例最低,为1：609;其次是药学、医学检验、全科医学和口腔医学;而公共卫生与预防医学的项目与人数的比例最高,为1：31。从医务人员继续教育需求上看,最愿意的继续教育方式是进修（占36％）,然而,由于经费不足、语言障碍等原因,医务人员进修比例不高;同时,参加国际学术会议的次数和机会不多。结论继续医学教育应合理化构成、丰富形式、提高实用性和针对性。     

扬州地区6所医院继续医学教育项目管理情况分析及对策

通过统计分析扬州地区6所医院在2014—2018年国家级、省级继续医学教育项目申报、举办情况,并与6所医院卫技人员总数、诊疗人次做对比,总结出继续医学教育项目开展的情况,反映出医疗单位继续教育工作开展的情况,继续教育工作的开展能有力地促进医院的发展;分析了继续医学教育开展中存在的主要问题,提出了认识继续医学教育工作的重要性,增加管理人员配备,提高管理人员继续医学教育管理水平,加大继续医学教育经费投入及管理者应横向联系,加强业务交流等主要措施。     

某所2008—2012年继续医学教育数据分析

目的：发现继续医学教育工作中存在的问题,提出对策,以利于继续医学教育工作的提高。方法对首都儿科研究所继续医学教育管理系统（ ICME）提供的2008-2012年度卫生技术人员参加继续医学教育学习与完成情况进行回顾性分析。结果在2008-2012年度中仅2008年参加率和达标率低于95％,其余4年参加率和达标率均超过95％;参加Ⅱ类学分学习的人次远远高于参加Ⅰ类学分的人次,所级继续医学教育学习为主要学习形式;本单位对继续医学教育的需求逐渐增加;继续医学教育项目中临床内容占69．9％,医患关系、法律法规、健康教育等项目仅占11．9％。结论以需求为导向,不断丰富内容、开展多种形式灵活的继续医学教育。     

河北省继续医学教育评估与发展对策研究

对河北省继续医学教育制度实施评价和教育质量分析,认为全省已基本落实了继续医学教育政策和制度。存在的主要问题是继续医学教育项目的供给量不足,与学分需求的矛盾突出。应进一步提高项目质量,调整学分结构,增加I类比重,开展Ⅱ类学分项目,规范学分登记管理。     

上海市继续医学教育调查及对策研究

１９９９年随机抽取上海市三级、二级、一级医院各１０年,开展了继续医学教育的现况调查,找出了存在的主要问题,提出了医学教育的发展方向：（１）继续医学教育培训还需加强管理和规范;（２）继续医学教育还需注重实效,（３）继续医学教育应注意完善学分制。     

我院继续医学教育效果评估和探讨

为总结我院实施继续医学教育十年来的经验，探讨继续医学教育发展的方向，我们对1996－2000年我院开展继续医学教育的效果进行了调查和评估。结果表明：我市现行的继续医学教育的培训实施细则是可行的，其操作性强，通过率高。但 存在一些问题：一是目前部，省制定的CMEI类学分活动形式少，经费贵。二是现行的CME考核制度对部分卫技人员缺乏约束力。三是CME培训内部陈旧。四是CME尚未与专业技术服务评聘紧密挂钩。就这些问题提出了相应的对策建议。     

我国继续医学教育面临的问题及对策

文章针对当前我国继续医学教育所面临的主要问题：继续医学教育涵义不统一;继续教育缺乏竞争激励机制;继续医学教育管理人才匮乏;地继续医学教育活动缺乏统一管理;教学手段一及时继续医学教育缺乏 法规及规章制度。提出提高广大医务人员对继续医学教育的认识水平;抓好毕业后继续教育;加强管理、制度健全、政策配套等措施是确保继续医学教育深入开展的关键所在。     

Shifting the culture of continuing medical education: what needs to happen and why is it so difficult?

A revolution in health care is occurring as a result of changes in the practice of medicine and in society. These include changing demographics and the pattern of disease; new technologies; changes in health care delivery; increasing consumerism, patient empowerment, and autonomy; an emphasis on effectiveness and efficiency; and changing professional roles. The issues raised by these changes present challenges for the content and delivery of the whole continuum of medical education. The ways in which continuing medical education (CME) needs to respond to these challenges are outlined. The Informed Shared Decision Making (ISDM) Project at the University of British Columbia is used as a case study to illustrate some of the practical problems in providing CME that address these current trends in health care, is effective, and is attractive to physicians. Two particular problems are posed: how to respond to a demonstrated need when there is no perceived need on the part of physicians and how to enable change agents on the margins to develop allies and get ownership from stakeholders and opinion leaders on the inside. Two strategies for change are discussed: the substantive incorporation of CME into the continuum of medical education and the involvement of patients in the planning and delivery of CME. A final challenge is raised for the leaders of CME to define and agree what "shifting the culture of CME" means and to make a commitment of time and energy into making it happen.     

Teaching performance improvement: an opportunity for continuing medical education

Practicing physicians generally are not engaged in either the methods of performance improvement for health care or the measurement and reporting of clinical outcomes. The principal reasons are lack of compensation for such work, the perception that the work of performance improvement adds no value and is a waste of time, the lack of knowledge and skill in the use of basic tools for outcomes measurement and performance improvement, the failure of medical educators to teach these skills, and the inability of mentors to model their use in practice. In this article, an overview of the history of quality improvement or performance improvement in general and the adoption of two methods of improvement (Plan-Do-Study-Act and SIX SIGMA) by health care is given. Six simple tools that are easy to understand and use and could be used in every continuing medical education (CME) program are then explained and illustrated. Postgraduate medical educators and CME program directors must step up to the challenge of teaching these skills. By learning to include them in planning, evaluation, policy making, and needs assessments of CME programs, the skills of every physician could be improved. Additional goals of every CME program could be accountability for outcomes, reduction of errors, alignment of incentives, and advocacy for the very best in evidence-based health care. To develop activities that affect physician practice and population health, CME professionals must partner with performance improvement experts for needs assessment and evaluation of outcomes data. An understanding of performance improvement principles helps those in performance improvement and those in CME to determine which educational activities might be expected to influence physician competency and performance.     

Organizational change in management of hepatitis C: evaluation of a CME program

INTRODUCTION: Effective treatment regimens exist for the hepatitis C virus (HCV); however, clinicians are often resistant to evaluation or treatment of patients with alcohol or substance abuse problems. We describe a continuing medical education (CME) program for clinicians in a nationwide health care system, with emphasis on current treatment practices, multispecialty collaboration, and organizational change. METHODS: Quantitative measures were used to assess changes in knowledge and treatment confidence, and site-specific organizational changes were qualitatively evaluated. The CME program included a preassessment of current HCV knowledge and care; a 2-day preceptorship; and follow-up with coaching calls at 1, 3, and 6 months. Program attendees included 54 medical and mental health providers from 28 Veterans Affairs Medical Centers. RESULTS: Knowledge following the CME program increased significantly. In 93% of the sites, there were organizational changes such as HCV support group-initiated group education, in-service training, improvement in patient notification or scheduling processes, hiring of new clinical staff, development of a business plans, and discussions about changes with administration. Of all sites, 15 (54%) changed existing antiviral treatment protocols, 18 (64%) established collaborative relationships, and almost half (13/28) established regular use of depression and alcohol use screening tools. Major barriers to change included lack of administrative support or resources (or both) and difficulty collaborating with mental health colleagues. DISCUSSION: This multifaceted CME program with follow-up coaching calls significantly increased individual knowledge and confidence scores and resulted in improved clinic processes and structures. Organizational change was facilitated by the development of an action plan. The major change agent was a nurse; the primary deterrent was an administrator.     

Continuing medical education: the paradigm is changing

With the realization that lifelong learning is more than attending conferences, the potential for greatly expanding effective continuing medical education (CME) has never been more encouraging. Databases from groups and individual managed care practices and advances in information technology are providing major opportunities toward this goal by identifying specific information deficits and promoting practice-linked education. The National Committee for Quality Assurance (NCQA) standards, requiring audited Health Plan Employer Data and Information Set (HEDIS) reports, are a step forward in the development of CME linked closely to practice. The optimal educational use of practice data to improve clinical outcomes will require research to determine the best methods. HEDIS standards will probably continue to deal with common problems of omission rather than with those caused by physicians' lack of knowledge, which will require other approaches. Development of these methods will provide rich opportunities for demonstration studies. The spectacular advances in information technology, especially the almost limitless capabilities of the Internet and electronic mail, offer boundless possibilities of information sources and enhanced communication among physicians about puzzling patients. The further implementation of the electronic medical record with computerized reminders and other clinical information delivered at the point of need will trigger major advances. An appealing user-friendly, practice-linked, and self-directed CME is on the horizon, promising to help the practicing physician optimize patient care.     

A continuing medical education lecture and workshop, physician behavior, and barriers to change.

BACKGROUND: Continuing medical education (CME) is undertaken with the intention that it will affect the practice of medicine at the level of choices made by individual physicians. Inherent in this effort is the assumption that CME is sufficient to effect a change in physician behavior. METHODS: To further examine the relationship between a CME activity and physician behavior, we conducted a study of behavior and barriers to change associated with a CME lecture and workshop on breast cancer risk assessment and treatment. Using the assessment of learning outcomes model of the International Association of Continuing Education and Training, we developed an instrument for assessing physician behavior and barriers to change. RESULTS: Throughout the United States and Canada, the instrument was administered on-site immediately after a CME activity implemented at 79 hospitals and cancer centers. It was administered again 6 months after the CME activity. There were 1,244 responses collected from 4,537 participants. This study reports the survey findings of 176 physician-paired responses to both the first and second waves of surveys. Some physicians changed their behavior with regard to performing risk assessments on all of their eligible patients. Ninety-two of the 176 physicians indicated that they had changed their practice regarding the use of tamoxifen therapy. Twenty-one physicians indicated that they were already using tamoxifen in their practice setting. Three influential barriers to change were identified: a lack of consensus among colleagues and peers, lack of time for assessment and patient counseling, and lack of reimbursement by the patient's insurance companies. FINDINGS: The CME activity was effective in changing the self-reported behavior of some physicians. Others attended the CME activity to obtain more information or to become more skilled about a procedure they had already implemented. Because of formidable barriers, it is unlikely that a single educational intervention will be sufficient to effect a change in the clinical practices of all physicians who participate in a CME activity.     

Promoting physician preventive practices: needs assessment for CME in breast cancer detection.

Needs assessment for a continuing medical education (CME) intervention directed at increasing breast cancer screening of women 50 years of age and older included a survey of target primary care physicians (n = 370) to explore areas of interest for CME in breast cancer detection and to establish baseline screening practices. The survey was completed at community hospital department meetings or by mail with a response rate of 87% (n = 323). Strategies for enhancing response rate and participation in planning included involvement of local physician organizations, use of a focus group of physicians, and attendance at community hospital department meetings. Survey results indicated that the topics of greatest interest for CME included improving patient compliance, risk factors, and patient education. A total of 48% of physician respondents reported referring all their asymptomatic female patients 50 years of age and older for regular screening mammograms; 63% indicated that they perform breast examinations on all such women regularly. Physician concerns that were reported to influence physical breast examination or referral for mammography are discussed, as well as current use of related office systems (e.g., for recall reminders and/or breast self-examination instruction). The results of a survey of women in the target age group residing in the same community are also reviewed in terms of mammography utilization (e.g., the proportion who had a screening mammogram within the last year was 19%) and specific concerns about mammography. The lack of a doctor's recommendation was the most common reason given (45%) for never having had a mammogram. The uses of the data from both surveys for CME program planning are discussed, including the content and design of the programs, along with organizational aspects and strategies for enhancing attendance.     

Need for comprehensive women's health continuing medical education among primary care physicians

BACKGROUND: The Council on Graduate Medical Education's (COGME) Fifth Report on Women and Medicine states that "changes in undergraduate and graduate medical education, in addition to continuing medical education, are needed to address adequately the comprehensive health needs of women." Primary care physicians (PCPs) who completed residency training prior to the establishment of new guidelines for women's health education are dependent on continuing medical education (CME) to update their knowledge and skills. METHODS: Primary care physicians attending a university-based CME program in family medicine were surveyed (n = 300) about their need for CME in women's health topics. Responses were analyzed using chi-square analysis and Pearson correlations. Topics of interest were compared with women's health competencies published in 1997 by the American Board of Internal Medicine (ABIM) and in 1997 by the American Academy of Family Physicians (AAFP). RESULTS: Of 30 women's health topics listed, 22 were of interest to 50% or more of respondents and 11 were of very high interest (p < .05). Respondents most interested in women's health CME were most likely to believe CME would reduce the number of referrals currently required to evaluate women's breast problems. Topics of interest also align well with ABIM and AAFP competencies in women's health. CME in comprehensive women's health care is therefore of high interest to our respondents and topics of greatest interest are identified. IMPLICATIONS: Areas of interest correlate well with new requirements by ABIM and AAFP and should be targeted by CME programs.     

A survey of physicians who care for older persons in Southwest China

Objective

The aim of this survey is to determine the main barriers of geriatric health care from the physicians’ point of view and compare the improvement before and after the Continue Medical Education (CME) provided by International Association of Gerontology and Geriatrics (IAGG).

Design

Cross-sectional survey.

Setting and Participants

Five hundred samples were generated using systematic random sampling from the address lists of physicians in Southwest China who had received the IAGG CME or been trained in Sichuan Association of Geriatrics (SAG) CME.

Measurements

The interview instrument examined demographics and information on geriatric education.

Results

Of the 500 physician sampled, 461(92.2 percent) responded. 34.3 percent of the respondents reported that over 70 percent of their patients were older persons. 76.8 percent of the respondents felt that they lacked geriatric knowledge. Only 15.6 percent of the respondents had geriatric curriculum before graduation, and 26.0 percent received geriatric trainings after graduation. Most physicians felt that “Language barrier” and “Insufficient geriatric education in undergraduate medical school and postgraduate education” were the main challenges in practicing geriatric medicine. Geriatric training and knowledge are inadequate due to the lack of geriatric curriculums in medical schools and CME for physicians who practice geriatrics. With the help of IAGG, CME in Southwest China provided more workshops on geriatric progress in year 2011 than in year 2007–2010. Eighty percent of the physicians acknowledged that the IAGG CME was helpful for their clinical practice. The physicians paid more attention to geriatric syndromes rather than age-related pathophysiology alone.

Conclusion

CME provided by geriatric associations is helpful. Collaboration between different geriatric societies such as IAGG and SAG may be a good model for spreading geriatric knowledge and should be considered by medical educational administration.