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2007 ; ä (149
): 1-69
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Effectiveness of continuing medical education
#MMPMID17764217
Marinopoulos SS
; Dorman T
; Ratanawongsa N
; Wilson LM
; Ashar BH
; Magaziner JL
; Miller RG
; Thomas PA
; Prokopowicz GP
; Qayyum R
; Bass EB
Evid Rep Technol Assess (Full Rep)
2007[Jan]; ä (149
): 1-69
PMID17764217
show ga
OBJECTIVES: Despite the broad range of continuing medical education (CME)
offerings aimed at educating practicing physicians through the provision of
up-to-date clinical information, physicians commonly overuse, under-use, and
misuse therapeutic and diagnostic interventions. It has been suggested that the
ineffective nature of CME either accounts for the discrepancy between evidence
and practice or at a minimum contributes to this gap. Understanding what CME
tools and techniques are most effective in disseminating and retaining medical
knowledge is critical to improving CME and thus diminishing the gap between
evidence and practice. The purpose of this review was to comprehensively and
systematically synthesize evidence regarding the effectiveness of CME and
differing instructional designs in terms of knowledge, attitudes, skills,
practice behavior, and clinical practice outcomes. REVIEW METHODS: We formulated
specific questions with input from external experts and representatives of the
Agency for Healthcare Research and Quality (AHRQ) and the American College of
Chest Physicians (ACCP) which nominated this topic. We systematically searched
the literature using specific eligibility criteria, hand searching of selected
journals, and electronic databases including: MEDLINE, EMBASE, the Cochrane
Database of Systematic Reviews, The Cochrane Central Register of Controlled
Trials (CENTRAL), the Cochrane Database of Abstracts of Reviews of Effects
(DARE), PsycINFO, and the Educational Resource Information Center (ERIC). Two
independent reviewers conducted title scans, abstract reviews, and then full
article reviews to identify eligible articles. Each eligible article underwent
double review for data abstraction and assessment of study quality. RESULTS: Of
the 68,000 citations identified by literature searching, 136 articles and 9
systematic reviews ultimately met our eligibility criteria. The overall quality
of the literature was low and consequently firm conclusions were not possible.
Despite this, the literature overall supported the concept that CME was
effective, at least to some degree, in achieving and maintaining the objectives
studied, including knowledge (22 of 28 studies), attitudes (22 of 26), skills (12
of 15), practice behavior (61 of 105), and clinical practice outcomes (14 of 33).
Common themes included that live media was more effective than print, multimedia
was more effective than single media interventions, and multiple exposures were
more effective than a single exposure. The number of articles that addressed
internal and/or external characteristics of CME activities was too small and the
studies too heterogeneous to determine if any of these are crucial for CME
success. Evidence was limited on the reliability and validity of the tools that
have been used to assess CME effectiveness. Based on previous reviews, the
evidence indicates that simulation methods in medical education are effective in
the dissemination of psychomotor and procedural skills. CONCLUSIONS: Despite the
low quality of the evidence, CME appears to be effective at the acquisition and
retention of knowledge, attitudes, skills, behaviors and clinical outcomes. More
research is needed to determine with any degree of certainty which types of
media, techniques, and exposure volumes as well as what internal and external
audience characteristics are associated with improvements in outcomes.
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