Continuing Education Meetings and Workshops: Effects on Professional Practice and Health Care Outcomes

Abstract

[Ann Emerg Med. 2009;53:685-687.] This is a systematic review abstract, a regular feature of the Annals' Evidence-Based Emergency Medicine (EBEM) series. Each features an abstract of a systematic review from the Cochrane Database of Systematic Reviews and a commentary by an emergency physician knowledgeable in the subject area. The source for this systematic review abstract is: O'Brien MA, Freemantle N, Oxman AD, et al. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2001;(2):CD003030. The Annals' EBEM editors helped prepare the abstract of this Cochrane systematic review, as well as the Evidence-Based Medicine Teaching Points. To determine the effects of continuing educational meetings on professional practice and health care outcomes. The Cochrane Effective Practice and Organization of Care Group specialized register, MEDLINE, and the Research and Development Resource Base in Continuing Medical Education were searched. The reference list of related systematic reviews and all articles obtained were reviewed. This review was amended in 2006 from the previous one published in 2001; a formal update is currently underway. Studies were included if they were randomized controlled trials or nonequivalent group designs with nonrandom allocation. The participants of the studies were qualified health professionals or health professionals in postgraduate training (eg, resident physicians). Studies involving only undergraduate students were excluded. All types of educational activities were included (eg, meeting, conferences, lectures, workshop, seminar), and interventions were didactic, interactive, or a mixed didactic and interactive nature. Didactic intervention offered minimal participant interaction such as lectures or presentations; interactive interventions included role play, case discussion, or hands-on training in small (<10 people), moderate (10 to 19 people), or large (>19 people) participant groups. Only the studies that objectively measured health professional practice behavior or patient outcomes in the setting in which health care was provided were included. Two authors independently applied inclusion criteria, assessed the quality of each study, and extracted the data. Each study was then assigned a quality rating of protection against bias according to 3 criteria: study design, blinded outcome assessment, and completeness of follow-up. Studies were analyzed according to the type of intervention, subjective assessment of complexity of targeted behaviors, and the level of baseline compliance and protection against bias. Of the 32 studies with 35 comparisons between educational meeting and noninterventional control groups, 24 studies reported marked improvement in professional practice. There were statistically significant changes in 3 of 8 studies in the patient's outcome. Heterogeneity of effect scores ranging from negative effect to moderately large effects was observed. There was one direct comparison of educational meetings that included an interactive workshop with a didactic presentation compared to a group case-based discussion or a traditional lecture, and no differences were found between groups. In 6 of 7 randomized control trials with one of the arms being a presentation or a lecture targeted at specific behaviors, no significant differences were observed. Eleven of 19 studies reported moderate or moderately large effects, and 5 reported small effects. In 2 studies, there was no effect of the intervention. Improvement in patient outcomes was observed in 2 of 6 studies in which these were assessed. In 7 of 8 studies, there were statistically significant improvements in practice; of these, 6 studies showed moderately large effects and 1 study, a small effect. The effect scores tend to decrease as the complexity of behavior decreases. There are no sufficient data to comment on the baseline compliance to explain the variation of the results. Interactive workshops alone or with other interventions are likely to improve the professional practice and health care outcomes compared with didactic lectures alone. The benefits of these results, however, are masked by the fact that most authors did not report sufficient details about the study design (such as insufficient follow-up, blinding of the outcome measures, and concealment of allocation), smaller number, and size of the included study trials. Interactive workshops result in moderately large changes in professional practice. Didactic sessions alone are unlikely to change professional practice.