Motivation of general practitioners attending postgraduate education.

BACKGROUND: The 1990 Contract encouraged general practitioners to participate in continuing medical education by providing a financial incentive. AIM: The study was designed: to determine the motivation of general practitioners attending education events; and to compare motivation and reasons for attendance pre- and post-Contract at commercial and non-commercial meetings, and at the different educational categories of Disease Management (DM), Health Promotion (HP) and Service Management (SM). METHOD: Two structured questionnaires were used. The first was sent to all general practitioners in the West of Scotland and asked about motivation pre-1990 Contract and the second, post-Contract, looked at motivation and reasons for attending a course as part of post course assessment. This latter was part of a much larger study evaluating continuing medical education. RESULTS: A total of 1161 practitioners responded to questionnaire I and 552 general practitioners attended 27 randomly selected postgraduate meetings. Finance was a motivator in 3.8% pre-Contract, and this increased to 33.3% post-Contract and was the most commonly stated reason for attendance in 81.3%. Financial incentive had the biggest influence on those attending HP sessions (91.5%), then SM (87.2%) and finally DM (78.6% (chi 2 = 8.68; P < or = 0.013). It was also important to 73% attending drug-company-sponsored meetings compared with 83.7% going to non-commercial ones. Interest was a good motivator both pre- and post-Contract, but more so for DM than other categories and drug company as opposed to non-commercial meetings (chi 2 = 9.4; P < 0.002). Lack of knowledge became a less-important motivator post-Contract, and doctors felt least knowledgeable in SM (62.2%), as opposed to DM (57.9%) and HP (23.6%) (chi 2 = 38.8; P < 0.001, with each differing significantly from both others). Doctors found the topics provided by the pharmaceutical companies more interesting (chi 2 = 9.4; P < 0.002) and the hospitality provided more alluring than scheme meetings (chi 2 = 28.6; P < 0.001). CONCLUSIONS: Finance has a major effect on attendance at postgraduate meetings but may not be a good incentive for learning. Planning for education must take into account the different motivational factors for the different categories. Reasons for attending commercial meetings differ from non-commercial ones and these events should be closely monitored.     

Characteristics of general practitioners who are high attenders at educational meetings.

The characteristics of general practitioners in the west of Scotland who are high attenders at meetings accredited for the postgraduate education allowance were studied. One hundred and seventy one principals in general practice (9.5%) had attended more than 35 half-day sessions of accredited education between 1 April 1989 and 31 December 1990 and 34 doctors (1.9%) had attended more than 45 half-day sessions. The highest percentage of the doctors worked in Greater Glasgow and Lanarkshire. The doctors who were high attenders were relatively more likely to be women, to be members of the Royal College of General Practitioners and to work in a training practice. The majority of the doctors had been qualified for between 10 and 30 years and worked in group practices of three or more doctors. The characteristics of high attenders contrast markedly to doctors who are low attenders. That there were such a large number of high attenders at educational meetings is encouraging.     

General practitioners'' views on continuing medical education.

BACKGROUND. The 1990 contract for general practitioners altered the provision of continuing medical education. AIM. This study set out to examine doctors' experiences of postgraduate education before and after the contract and their preferences for the provision of postgraduate education. METHOD. In 1991 a structured questionnaire was sent to 1959 doctors registered on the database held by the west of Scotland postgraduate office. RESULTS. An 82% response rate was obtained. Eighty eight questionnaires had to be excluded. Of 1523 respondents, 74% were entitled to study leave under the terms of their practice agreement, an increase of 15% since the introduction of the contract. When attending courses 11% reported that they always employed a locum (32% occasionally). Those who did so were more likely to be general practitioners in rural areas than in urban or mixed areas. Almost all respondents (1485, 98%) had participated in postgraduate education since April 1990. Lectures remained popular (47% of respondents indicated it was their preferred or most preferred choice) while distance learning and practice based learning were least preferred. Evening meetings and afternoon meetings were the most popular, and Wednesday and Thursday were reported to be the most suitable days for educational meetings. CONCLUSION. Organizing education for a large number of people is difficult, but individuals' preferences and difficulties have emerged which must be taken into account when doing so. In terms of attendance, postgraduate education seems to have been a success although its value in influencing quality of care is more doubtful. Perhaps the development of personal education plans may make learning more useful and relevant.     

Institutional leadership and faculty response: fostering professionalism at the University of Pennsylvania School of Medicine.

Fostering professionalism requires institutional leadership and faculty buy-in. At the University of Pennsylvania School of Medicine, policies and educational programs were developed to enhance professionalism in three areas: conduct of clinical trials, relations with pharmaceutical manufacturers, and the clinical and teaching environment. Responsible conduct of clinical trials has been addressed with mandatory online education and certification for clinical investigators, but some still fail to recognize conflicts of interest. Activity of pharmaceutical representatives has been strictly regulated, meals and gifts from pharmaceutical companies prohibited, and the role of the pharmaceutical industry in the formulary process and in continuing medical education curtailed. Some faculty members have resented such restrictions, particularly in regard to their opportunity to give paid lectures. Professionalism in the clinical and teaching environment has been addressed with interdisciplinary rounding, experiential learning for medical students and residents in small groups, increased recognition of role models of professionalism, and active management of disruptive physicians. Leadership has been exerted through policy development, open communications, and moral suasion and example. Faculty members have expressed both their support and their reservations. Development of communication strategies continues, including town hall meetings, small groups and critical incident narratives, and individual feedback. The understanding and endorsement of faculty, staff, and trainees are an essential element of the professionalism effort.     

Demographic characteristics of general practitioners attending educational meetings.

There are many factors which influence general practitioners' behaviour with regard to attendance at education meetings. The demographic characteristics of general practitioners in the west of Scotland attending educational meetings were studied over a two year period. A total of 1672 doctors had attended sufficient sessions to claim their postgraduate education allowance and of these 1551 (93%) responded to the questionnaire. Overall attendance at meetings did not vary between age groups, but older doctors (those born before 1935) attended the highest mean number of education sessions on disease management and the lowest mean number on service management and health promotion. Doctors in rural areas attended fewer meetings than those in urban areas with the largest difference in the disease management category. Doctors from smaller practices attended significantly fewer sessions on service management than those from larger practices. There was no difference between sexes regarding the mean total number of education sessions attended but men attended significantly more sessions on service management and women attended more on health promotion. Full-time doctors attended more service management sessions than part-time doctors. Those who were widowed or divorced attended fewer sessions in total, the differences being greatest in service management and health promotion. Multiple regression analysis showed that location of practice, whether working full time or part time and marital status had a small but statistically significant bearing on overall attendance at meetings. Although the differences are small, these factors should be noted by education providers, negotiators and government.     

Oncology nurses' knowledge, practice, and educational needs regarding cancer genetics.

This study evaluated oncology nurses' knowledge of cancer genetics and related topics, and identified current practice patterns and perceived educational needs in this area. A 54-item study questionnaire was mailed to a random sample of 1,200 Oncology Nursing Society (ONS) members and 75 members of the ONS-Cancer Genetics Special Interest Group; 656 (51%) of those eligible responded. After exclusions, we analyzed 573 responses. Most respondents were Caucasian, female, and worked in hospital or outpatient settings. Half were staff nurses and 8% specialized in cancer genetics. Respondents with higher levels of nursing education or with continuing education in cancer genetics, who worked in positions other than staff nurses, and whose primary practice area was cancer genetics had significantly higher mean scores overall on questions measuring knowledge of cancer genetics and related areas. Higher perceived educational needs to improve knowledge or practice related to cancer genetics at basic, intermediate or advanced levels were associated with all or some of the following variables: lower education; hospital/ outpatient or managed care/private practice settings; lack of continuing education in cancer genetics, and positions other than advanced practice nurses. Although nearly half of the respondents had received patient inquiries regarding cancer genetics, only 35% were aware of referral resources and 26% had made such referrals. These findings may be used to develop targeted educational approaches that prepare oncology nurses to incorporate cancer genetics into any level of practice.     

General practitioners' attendance at courses accredited for the postgraduate education allowance.

An analysis was undertaken in the northern half of the South Western Regional Health Authority of general practitioners' attendance at courses accredited for the postgraduate educational allowance over one year. A total of 358 courses provided 2341 hours of accredited education and produced a total general practitioner attendance of 50,389 hours. The mean attendance per principal in the area was 49.2 hours although the region may be a net importer of attenders from outside the area. Of the 50,389 total hours of attendance, 28.3% were in health promotion, 48.2% in disease management and 23.5% in service management. Course provision and attendance varied considerably over the year. September, October and November accounted for 42.7% of the total hours of attendance, compared with 6.8% in June, July and August. Courses of two to four days or of one week duration accounted for 48.3% of total attendance hours; 10.1% of total attendance hours were at commercially organized courses and 5.6% at courses organized by practices. A total of 66.1% of attendance hours were in postgraduate centres and 6.8% in the practice. Courses with more than 30 participants accounted for 15.9% of courses attended. A total of 174 general practitioners and others organized courses, 21 of them influencing 33,521 hours of general practitioner education. The study shows that in this area, there was an encouraging provision, range and uptake of continuing education courses for general practitioners. The concentration of educational activities in postgraduate centres underlines the need for increased provision for developing educational skills for clinical tutors.     

Oncology nurses' knowledge,practice, and educational needs regarding cancer genetics

This study evaluated oncology nurses' knowledge of cancer genetics and related topics, and identified current practice patterns and perceived educational needs in this area. A 54‐item study questionnaire was mailed to a random sample of 1,200 Oncology Nursing Society (ONS) members and 75 members of the ONS‐Cancer Genetics Special Interest Group; 656 (51%) of those eligible responded. After exclusions, we analyzed 573 responses. Most respondents were Caucasian, female, and worked in hospital or outpatient settings. Half were staff nurses and 8% specialized in cancer genetics. Respondents with higher levels of nursing education or with continuing education in cancer genetics, who worked in positions other than staff nurses, and whose primary practice area was cancer genetics had significantly higher mean scores overall on questions measuring knowledge of cancer genetics and related areas. Higher perceived educational needs to improve knowledge or practice related to cancer genetics at basic, intermediate or advanced levels were associated with all or some of the following variables: lower education; hospital/outpatient or managed care/private practice settings; lack of continuing education in cancer genetics, and positions other than advanced practice nurses. Although nearly half of the respondents had received patient inquiries regarding cancer genetics, only 35% were aware of referral resources and 26% had made such referrals. These findings may be used to develop targeted educational approaches that prepare oncology nurses to incorporate cancer genetics into any level of practice. © 2001 Wiley‐Liss, Inc.     

Guidelines for interactions between clinical faculty and the pharmaceutical industry: one medical school's approach.

A productive and ethical relationship between the pharmaceutical industry and physicians is critical to improving drug discovery and public health. In response to concerns about inappropriate financial relationships between the pharmaceutical industry and physicians, national organizations representing physicians or industry have made recommendations designed to reduce conflicts of interest, legal exposure, and dissemination of biased information. Despite these initiatives, the prescribing practices of physicians may be unduly influenced by the marketing efforts of industry and physicians may inadvertently distribute information that is biased in favor of a commercial entity. Moreover, physicians may be vulnerable to prosecution through federal anti-kickback and false claims statutes because of potentially inappropriate financial relationships with pharmaceutical companies. Since academic medical centers have a critical role in establishing professional standards, the faculty of Yale University School of Medicine developed guidelines for the relationships of faculty with the pharmaceutical industry, which were approved in May 2005. Input from clinical faculty and from representatives of the pharmaceutical industry was utilized in formulating the guidelines. In contrast to existing recommendations, the Yale guidelines, which are presented as an Appendix here, ban faculty from receiving any form of gift, meal, or free drug sample (for personal use) from industry, and set more stringent standards for the disclosure and resolution of financial conflict of interest in Yale's educational programs. The growing opportunities for drug discovery, the need to use medications in a more evidence-based manner, and preservation of the public trust require the highest professional standards of rigor and integrity. These guidelines are offered as part of the strategy to meet this compelling challenge.     

Postgraduate education allowance: educational attainment of subscribers and non-subscribers to a centrally organized educational scheme.

The educational attainment of general practitioners in the west of Scotland region who subscribed to a centrally organized educational scheme for the postgraduate education allowance was compared with that of their colleagues who did not subscribe to the scheme. During the year studied (1990-91) 1712 of the 1830 principals in general practice in the region had sufficient sessions to claim their postgraduate education allowance. Of these 1712 doctors the 1353 who subscribed to the educational scheme attended a mean of 15.7 educational half day sessions during the study year in comparison with a mean of 12.5 half days attended by the 359 doctors who did not subscribe to the scheme. This difference was observed in all three categories of education--disease management, service management and health promotion--and was greatest in health promotion where subscribers attended a mean of 4.7 half days and non-subscribers 3.1. The doctors who were members of the scheme had achieved a better balance of education. A higher number had attended an educational day in each of the three categories, with the increase being 10.5% for subscribers versus non-subscribers for disease management, 20.0% for service management and 39.1% for health promotion. The differences between the two groups were greater for combinations of categories and 66.6% of subscribers had attended an educational day in each of the three categories compared with 40.9% of non-subscribers. A centrally organized educational scheme for a region can give a balanced spread of education and is likely to meet the educational requirements of the new contract for general practitioners.     

Evaluation of the status of laboratory practices and the need for continuing education in medical mycology

A survey to determine the need for training in medical mycology was sent to 605 US laboratories. Training needs were determined by comparing actual laboratory mycology practices with recommended practices, documenting the extent of mycology training reported by employees, and asking respondents to specify the fungi they considered most difficult to identify. The response rate was 56.7% (with only 316 laboratories providing sufficient information). Results showed a large degree of interlaboratory variation in practices and suggested that more judicious practices could lower costs and improve clinical relevance. Only 55.6% of laboratories reported that at least 1 employee attended a formal mycology continuing education program in the 4 years before the survey. Species of dermatophytes, dematiaceous fungi, and non-Candida yeasts were the most difficult to identify. Training may be needed in basic isolation procedures and in advanced topics such as identification of problematic molds and yeasts and antifungal susceptibility testing. Educators should consider clinical relevance and cost-containment without sacrificing quality when designing courses. Support for additional mycology training may improve if hospital and laboratory administrators are alerted to potential dangers and costs involved in treating patients with invasive fungal infections.     

Improving continuing medical education and addressing the challenge of instituting reaccreditation.

The present postgraduate education allowance structure for general practitioners is unacceptable and inadequate on a number of counts. Improvements could be made in continuing medical education by involving learners more actively, through giving them greater ownership of their continuing medical education aims and by integrating it with the current moves towards reaccreditation. Current proposals for the implementation of reaccreditation are expensive, unacceptable to many in the general practice profession, and unconnected with present continuing medical education arrangements and the existing education structure. It would be more sensitive to current attitudes, more practical, a better use of existing facilities and more logical to improve continuing medical education by linking its improvement to the evaluation of reaccreditation in as acceptable and simple a way as possible. A framework is proposed, based on an annual educational general practitioner assessment visit in which a personal learning plan is developed as a focus for an individual's continuing medical education needs.     

Perceptions of the ethical acceptability of using medical examiner autopsies for research and education: a survey of forensic pathologists

BACKGROUND: Forensic pathologists face difficult moral questions in their practices each day. Consistent ethical and legal guidelines for autopsy tissue use extending beyond usual clinical and legal imperatives have not been developed in this country. OBJECTIVE: To obtain the perceptions of medical examiners regarding the ethical acceptability of autopsy tissue use for research and education. METHOD: A written, self-report questionnaire was developed and piloted by a multidisciplinary team at the University of New Mexico, Albuquerque. All individuals who attended a platform presentation at the National Association of Medical Examiners Annual Meeting in September 1997 were invited to participate. RESULTS: Ninety-one individuals completed the survey (40% of all conference registrants and approximately 75% of presentation attendees). Sixty-three percent of respondents had encountered an ethical dilemma surrounding autopsy tissue use, and one third reported some professional ethics experience. Perspectives varied greatly concerning the ethical acceptability of using autopsy tissues to demonstrate or practice techniques (eg, intubation, brachial plexus dissection) and of fulfilling requests to supply varying kinds and quantities of tissues for research and education. Most respondents indicated that consent by family members was important in tissue use decisions. Respondents agreed on the importance of basic values in education and research, such as integrity, scientific or educational merit, and formal institutional approval of a project. Characteristics of the decedent did not influence decisions to release tissues, except when the individual had died from a mysterious or very rare illness. Attributes of medical examiners, with the exception of sex, also did not consistently predict responses. CONCLUSION: Significant diversity exists in beliefs among medical examiners regarding perceptions of the appropriate use of autopsy tissues for education and research. There is need for further inquiry and dialogue so that enduring policy solutions regarding human tissue use for education and research may be developed.     

End-of-life education using the dramatic arts: the Wit educational initiative.

Caring for dying persons requires skill in interpersonal aspects of care, which may be difficult to teach using conventional educational methods. The Pulitzer Prize-winning play Wit relates the personal story of a patient dying from metastatic ovarian cancer and describes the protagonist's experience with medical care from diagnosis to death. Members of the Department of Medicine at the VA Greater Los Angeles Health care System and the David Geffen School of Medicine, UCLA developed a program that utilized Wit to educate medical students, residents, and staff providers in the humanistic elements of end-of-life care. Between February 2000 and January 2002 the Wit Educational Initiative organized on-site readings of Wit by local professional theatre companies at medical centers throughout the United States and Canada, inviting medical students, housestaff, and other providers to attend the play followed by structured discussions of the play's themes. The Initiative provided extensive support for potential program sites including publicity, providing a handbook with a step-by-step guide to organizing local programs, and feedback of postperformance survey results. The Initiative was successful in organizing performances at 32 out of 54 (59%) medical centers where a local production of Wit was identified. Survey respondents confirmed the appeal, emotional impact, and perceived relevance of drama in end-of-life education. An educational program using theatre to educate trainees in the humanistic aspects of end-of-life care was enthusiastically received by medical schools and rated highly by attendees.     

Antenatal screening tests: knowledge and practice patterns of obstetricians in Utah

We sought to assess knowledge and practices of obstetricians regarding antenatal testing and test the efficacy of continuing education via a direct mailing. In June 2004, an educational brochure entitled "New Options for Maternal Serum Screening for Birth Defects" as well as an anonymous survey pertaining to antenatal testing was sent to 241 American College of Obstetricians and Gynecologists (ACOG) Fellows and Junior Fellows residing in Utah. Data from the 85 (35%) respondents were analyzed. The majority of respondents practice obstetrics (81/85, or 95%). Of these, 67% of respondents perform sonograms routinely in their offices. Respondents were distributed evenly across all years of practice. Respondents offer HIV screening routinely (85%), but only 40% follow ACOG cystic fibrosis (CF) screening recommendations. Midtrimester serum screening is offered routinely by 89% of the respondents, but only 54% adequately understood the capabilities and limitations of the test. Questions related to the patient education brochure included in the mailing were answered correctly more often than the other questions. The brochure emphasized the usefulness of combined integrated screening for detecting Down syndrome, and 94% of respondents subsequently understood this concept. We show that in Utah, ACOG recommendations for HIV and maternal serum testing are being followed uniformly, but CF screening is still not being routinely offered. The accurate responses to questions related to an enclosed education brochure suggest that direct mailings may be useful for provider education, especially in regions where many providers practice remote from academic centers.     

Educational technology infrastructure and services in North American medical schools.

PURPOSE: To describe the current educational technology infrastructure and services provided by North American allopathic medical schools that are members of the Association of American Medical Colleges (AAMC), to present information needed for institutional benchmarking. METHOD: A Web-based survey instrument was developed and administered in the fall of 2004 by the authors, sent to representatives of 137 medical schools and completed by representatives of 88, a response rate of 64%. Schools were given scores for infrastructure and services provided. Data were analyzed with one-way analyses of variance, chi-square, and correlation coefficients. RESULTS: There was no difference in the number of infrastructure features or services offered based on region of the country, public versus private schools, or size of graduating class. Schools implemented 3.0 (SD = 1.5) of 6 infrastructure items and offered 11.6 (SD = 4.1) of 22 services. Over 90% of schools had wireless access (97%), used online course materials for undergraduate medical education (97%), course management system for graduate medical education (95%) and online teaching evaluations (90%). Use of services differed across the undergraduate, graduate, and continuing medical education continuum. Outside of e-portfolios for undergraduates, the least-offered services were for services to graduate and continuing medical education. CONCLUSIONS: The results of this survey provide a benchmark for the level of services and infrastructure currently supporting educational technology by AAMC-member allopathic medical schools.     

Clerkship directors' perceptions of the effects of managed care on medical students' education.

PURPOSE: Little is known about the effect of managed care on medical students' education. Because clerkship directors (CDs) are especially well positioned to observe any changes, this study surveyed CDs from six medical specialties about their perceptions of the effects of managed care on medical students' education. METHOD: Anonymous questionnaires were mailed to 808 CDs from departments of six medical specialties at 125 U.S. allopathic medical schools between October 1997 and March 1998. Among other questions, respondents were asked whether they had observed changes in 19 different aspects of medical students' education, whether these changes were beneficial or detrimental, and whether they believed the changes were due to managed care and/or to other factors. Results were analyzed to determine perceptions of the overall magnitude and source(s) of changes, the perceived positive versus negative effect of managed care, and whether these outcomes were statistically associated with the perceived degree of managed care's market penetration. RESULTS: Five hundred questionnaires (61.9%) were returned. For full-time and voluntary faculty teaching, faculty availability for educational administration, directors' clinical responsibilities, and quality of professional life, the most common response was that managed care had an adverse effect. For faculty's enthusiasm for teaching, directors' administrative and educational duties, and clerkship training sites, the second most common response after "not changed" was that managed care had a negative effect. The majority of respondents held negative opinions of managed care and thought that medical students did not understand it. CONCLUSIONS: CDs in six medical specialties perceived that managed care has negatively affected medical students' education. These perceptions may influence medical students' education. Measures must be taken to ensure excellent education through adequate resources and training in the context of high-quality medical care.     

A prospective before-and-after trial of an educational intervention about pharmaceutical marketing.

PURPOSE: There is increasing evidence that physicians may be compromised by their interactions with the pharmaceutical industry. The authors aimed to develop and determine the effect of an educational intervention to inform family medicine residents about pharmaceutical marketing. METHOD: Confidential, self-administered questionnaires were administered to family medicine residents at McMaster University, Hamilton, Canada, immediately before and after a two-part, 2.5-hour educational intervention. The curriculum consisted of (1) a faculty-led debate and discussion of a systematic review of physician-pharmaceutical industry interactions, and (2) an interactive workshop that included a presentation highlighting key empirical findings, a video illustrating techniques to optimize pharmaceutical sales representatives' visits, and small- and large-group problem-based discussions. Residents were asked about their attitudes toward five marketing strategies: drug samples, industry-sponsored continuing medical education, one-on-one interactions with sales representatives, free meals, and gifts worth less than CAN $10. RESULTS: A total of 37 residents responded to both questionnaires. After the intervention residents had more cautious attitudes, rating marketing strategies on a five-point Likert scale as less ethically appropriate (-0.41, p < .05) and less valuable to patients or useful to the resident (-0.39, p < .05), and reporting less intention to use them in the future (-0.44, p < .01). CONCLUSION: This intervention appears to have promoted more cautious attitudes toward pharmaceuticals marketing. Its long-term sustainability and effect on behavior remain unknown.     

Continuing educational requirements for general practitioners in Grampian.

A postal questionnaire about educational requirements achieved an 81% response from all general practitioners in Grampian. A majority of respondents felt that it was important to keep up-to-date and they were setting aside a number of hours per week to do this. Evening meetings, intensive two to three day courses and week long refresher courses were still popular, as was the idea of small groups resourced by a consultant. Newer forms of continuing education, for example, audio and videotape and distance learning were not popular. Journals still remained an important way of keeping up-to-date. These results help in planning the rational use of postgraduate resources for the future.