Physician preferences for continuing medical education with a focus on the topic of antimicrobial resistance: Society for Healthcare Epidemiology of America.

OBJECTIVE: To determine the type of media preferred for continuing medical education (CME) and to assess the factors that affect physician preferences for CME in general and on the special topic of antimicrobial resistance. DESIGN: A voluntary survey of the membership of the Society for Healthcare Epidemiology of America, Inc. (SHEA). METHODS: SHEA, in collaboration with other medical societies and with technical assistance from the Centers for Disease Control and Prevention, designed and mailed the survey to its membership. The survey included questions about media used, preferred, and of interest to try for CME delivery in general and on the topic of antimicrobial resistance in specific. The survey also included demographic and general questions, such as work environment, percentage of time in direct patient care, and experience treating patients with antimicrobial-resistant pathogens. RESULTS: 225 SHEA members completed the survey. The majority of physicians were in clinical practice (59%) and worked in a hospital (57%). The median year of graduation from medical school was 1979 (range, 1951-1999). CME subject matter (46%) was ranked as the most important factor affecting media preference. Journal articles (52%) were the most frequently used educational medium; local grand rounds (53%) and regional meetings (53%) were the most preferred media. CD-ROM (56%) and the Internet (46%) were selected as media of greatest interest to try. On the topic of antimicrobial resistance, the most frequently used and the preferred medium was journal articles (67% and 87%, respectively). Most (94%) had received an educational update on current antimicrobial resistance issues within the past year. Stratification of the data by graduation date revealed no significant differences in the medical education media used most (F=0.59, degrees of freedom [dfl=4, P=.6715) or preferred by SHEA members in general or on the topic of antimicrobial resistance (F=1.99, df=4, P=.0982). CONCLUSIONS: This study provides an understanding of how physicians learn, prefer to learn, and implement best practices for optimal patient outcomes in decreasing the spread of antimicrobial resistance.     

Skills and topics in continuing medical education for rural doctors

BACKGROUND: Organizations that fund and produce continuing medical education (CME) activities must have up-to-date information on the needs of their participants. The paper describes a method for assessing priorities for the provision of facilities to rural doctors in Australia for educational topics and skills upgrades. It uses an instrument designed to establish a measure of knowledge and skills that records the difference between the "current felt need" and "desired level of competence." METHODS: A questionnaire was sent to all identifiable rural doctors throughout Australia, including participants in various types of practice. The resulting dataset is designed for future dissection and comparison of subsets by gender, practice size, rurality, and style of practice (whether procedural). It seeks to deliver a prioritized list of educational topics based on subjective gap analysis with weighting on the degree to which the need is unmet. RESULTS: There was considerable consonance between the major "felt needs" and other measures of need. IMPLICATIONS: In spite of statistical deficiencies, which would be corrected in future work, the method offers a new instrument to prioritize the use of resources for CME delivery.     

Interactive on-line continuing medical education: physicians' perceptions and experiences

INTRODUCTION: Although research in continuing medical education (CME) demonstrates positive outcomes of on-line CME programs, the effectiveness of and learners' satisfaction with interpersonal interaction in on-line CME are lower Defined as faculty-learner or learner-learner interpersonal interaction, this study explores physicians' perceptions of and experiences in interactive on-line CME and factors influencing these. METHODS: Focus groups and interviews were undertaken by three Canadian universities. Using purposive sampling, we recruited physicians based on their experiences with interactive on-line CME. Content analysis was applied first, followed by a comparative analysis to confirm themes and findings. RESULTS: Physicians based their perceptions of interactive on-line CME by comparing it with what they know best, face-to-face CME. Although perceptions about access and technical competency remained important, two other themes emerged. The first was the capacity of on-line CME to meet individual learning preferences, which, in turn, was influenced by the quality of the program, the degree of self-pacing or self-direction, opportunity for reflection, and educational design. The second was the quality and quantity of interpersonal interaction, which was shaped by perceptions of social comfort, the educational value of interactions, and the role of the facilitator. Prior experience with on-line CME moderated perceptions. DISCUSSION: The extent that on-line CME programs reflected characteristics of high-quality CME and individual learning preferences appeared to shape perceptions about it. It is important to incorporate the characteristics of effective CME into the design and implementation of interactive on-line programs, considering diverse learning preferences, providing faculty development for on-line facilitators, and grounding this work in learning theory.     

Determining physicians' performance. Continuing medical education and other interacting variables.

Participation in formal continuing medical education (CME) is required by many organizations and state governments as the foremost means of assuring the quality of medical care. Analysis of the literature reveals that CME in all its forms is effective in improving competence, i.e., the ability to provide good care. However, that competence is not regularly reflected in physicians' habitual performance in the care of patients. A number of factors are known to narrow the gap between competence and performance, including clear specification of standards, individual feedback on actual performance, and a professional environment conductive to the maintenance of high standards. In the presence of such factors, CME can improve physicians' performance when directed to objectively identified deficiencies. However, public assurance of the quality of medical care can only be provided through certification that individual physicians' performance conforms to contemporary valid standards.     

Videoconferences for rural physicians' continuing health education

The University of Alberta uses videoconferencing to link physicians in interactive continuing health education. We examined evaluations of 29 videoconferences for rural practitioners during the programme year September 2003-May 2004. The evaluation form, completed by participants following the presentation, used both quantitative and qualitative methods of data collection. The average attendance for the videoconference sessions was 40 people. A total of 593 evaluations were collected (response rate 51%). The audience were very satisfied with the programme and felt that the sessions were relevant to their practice. The interactive discussion component was rated very highly. Most respondents stated that they would change their practice based on the information discussed. It is clear from our survey that videoconferencing is useful in overcoming the barriers of distance and that small physician numbers create a positive environment for adult learning.     

Systems-based framework for continuing medical education and improvements in translating new knowledge into physicians' practices

Concerns about health care costs and quality are focusing increasing attention on physicians and their continuing medical education (CME). These concerns have produced several calls for "a new definition, " "a new vision, " "repositioning, " "reinventing, " and "transforming" CME. However, differences in conceptualizations and vocabularies have introduced appreciable confusion in recommending changes. This article uses a systems-based approach to describe and analyze the processes involved in translating new information into physicians' practices. The article (1) introduces a conceptual framework that links physician learning and performance to systems for information, education, implementation, and regulation in the context of the larger health care system; (2) uses the framework to identify concerns and opportunities for the major types of systems immediately relevant to CME; and (3) uses the framework to suggest broader implications for CME, including the nature of process for changing physicians' practices, needed improvements, priorities in performing research, and implications for CME professionals.     

Evaluation of a family-oriented continuing medical education course for general practitioners

OBJECTIVE: To explore the long-term effects of a 2-year Family Systems Medicine course. Fifteen experienced GPs participated in the training programme. SETTING: Continuing Education Centre, University of Tampere, Department of Public Health Science and General Practice, University of Oulu, Finland. METHODS: The participants assessed the development of their professional skills on the Doherty-Baird scale and filled in 2 questionnaires. The material obtained from the application form and 2 questionnaires was analysed using the grounded theory method. RESULTS: The reasons for taking part in the course seemed to be the constant increase in the workload, problems caused by the demands for change and adaptation, stress and exhaustion. Furthermore, 10 health centres out of 15 had adopted the population-based practice, which requires different working methods compared to the old routines. Some trainees reported that their family-centred working methods improved during the course. A year after the end of the training, all of the GPs who had participated were using such methods in their daily practice. Half of the participants felt that they had also improved the functioning of their working group by making it more family-oriented. The significance of multi-professional collaboration was one of the most important insights during the course. CONCLUSION: The 2-year family-oriented training programme provided GPs with systemic thinking and with new skills, including the ability to work with families. The programme raised awareness of the need for multi-professional collaboration in the primary care settings.     

The market and educational principles in continuing medical education for general practice

In an attempt to increase participation by established general practitioners (GPs) in continuing medical education (CME) the Department of Health in 1990 created an allowance (the Postgraduate Education Allowance, PGEA) to be spent by GPs on the educational provision of their choice. Although the PGEA has increased attendance by established GPs at educational activities, the market created in CME provision has favoured low cost activity of questionable value. This paper examines criteria for the validation of general practice CME, based on the principles of adult learning, which could be used to manage this market. Failure to adopt an appropriate validating process could lead to the PGEA becoming discredited and the imposition of periodic reaccreditation as a means of enforcing participation by GPs in CME.     

Performance-based assessment in continuing medical education for general practitioners: construct validity

The use of performance-based assessment has been extended to postgraduate education and practising doctors, despite criticism of validity. While differences in expertise at this level are easily reflected in scores on a written test, these differences are relatively small on performance-based tests. However, scores on written tests and performance-based tests of clinical competence generally show moderate correlations. A study was designed to evaluate construct validity of a performance-based test for technical clinical skills in continuing medical education for general practitioners, and to explore the correlation between performance and knowledge of specific skills. A 1-day skills training was given to 71 general practitioners, covering four different technical clinical skills. The effect of the training on performance was measured with a performance-based test using a randomized controlled trial design, while the effect on knowledge was measured with a written test administered 1 month before and directly after the training. A training effect could be shown by the performance-based test for all four clinical skills. The written test also demonstrated a training effect for all but one skill. However, correlations between scores on the written test and on the performance based test were low for all skills. It is concluded that construct validity of a performance-based test for technical clinical skills of general practitioners was demonstrated, while the knowledge test score was shown to be a poor predictor of competence for specific technical skills.     

Web-based continuing medical education. (II): Evaluation study of computer-mediated continuing medical education

BACKGROUND: Over the years, various distance learning technologies and methods have been applied to the continuing medical education needs of rural and remote physicians. They have included audio teleconferencing, slow scan imaging, correspondence study, and compressed videoconferencing. The recent emergence and growth of Internet, World Wide Web (Web), and compact disk read-only-memory (CD-ROM) technologies have introduced new opportunities for providing continuing education to the rural medical practitioner. This evaluation study assessed the instructional effectiveness of a hybrid computer-mediated courseware delivery system on dermatologic office procedures. METHODS: A hybrid delivery system merges Web documents, multimedia, computer-mediated communications, and CD-ROMs to enable self-paced instruction and collaborative learning. Using a modified pretest to post-test control group study design, several evaluative criteria (participant reaction, learning achievement, self-reported performance change, and instructional transactions) were assessed by various qualitative and quantitative data collection methods. RESULTS: This evaluation revealed that a hybrid computer-mediated courseware system was an effective means for increasing knowledge (p < .05) and improving self-reported competency (p < .05) in dermatologic office procedures, and that participants were very satisfied with the self-paced instruction and use of asynchronous computer conferencing for collaborative information sharing among colleagues.     

Marketing issues in continuing medical education.

Marketing is an important component of continuing medical education (CME). However, marketing is more than the identification of methods to recover costs of delivering programming. It focuses on meeting the needs and desires of physician participants, identifying an appropriate location, satisfying the goals of a sponsoring institution, and making an effect on the quality of care given by receivers and deliverers of CME. This paper discusses these issues as well as describes results of a survey designed to gather opinions on CME activities from alumni of training programs of a large, referral-based, multispecialty group practice. The data suggest that CME programs should be targeted to certain specialty groups as determined by field of training rather than practice specialty. Physicians' preferences for CME activities held at resort settings should be considered. Finally, participation in CME may itself be a marketing tool for a sponsoring institution to increase referrals.     

Continuing medical education and continuing medical education accreditation in Spain

Nearly all Spanish physicians are employed by public or private institutions, and employers are enabling the continuing medical education (CME) of physicians. In view of coexisting CME accreditation systems in Spain, we conclude that a common approach is needed. We recommend establishing formal relationships with American and European systems to ensure consistent accreditation and mutual recognition of CME credits and improvement in accreditation.     

Patient-management problems as a learning tool for the continuing medical education of general practitioners

The value of Patient-Management Problems (PMPs as a learning tool for continuing medical education was studied by using two frequently seen cardiovascular problems (angina and high blood pressure) and a province-wide sample of full-time general practitioners. The results indicate that PMPs can be a motivating and effective means of CME for the general practitioner; that knowledge was gained through the successive resolution of three pmps; that corrective feedback enhanced learning; and, that most of the knowledge gained on the paper cases was transferred to practice as reported by the participants on a questionnaire. Furthermore, while cueing may be a confounding factor when PMPs are used for evaluation purposes, it was shown to facilitate learning in the present learning context.