Facilitating learning and change in physicians: Implications for a system of continuing medical education in Europe

Abstract

In the presence of conflicting evidence, recent research has altered the view ofthe nature of continuing medical education (CME) in North America. These changes in perspective have brought about a new focus and draniatic implications for the ways that learning activities should be planned, managed and recognized. These changes have also fostered opportunities for new and better ways to identify and award credit for CME. In the late 1970s and early 1980s, the high cost of CME and increasing efforts to account for the impact of CME on physicians behavior and patient health led to hundreds of published evaluation studies. Most of these studies were modelled on traditional niedical research. They were directed toward a test of the hypothesis that, as CME participation increases, changes in practice will increase. The results of these investigations were divided almost equally between those that documented a true difference after a CME program and those that did not. Little progress was made in evaluating the true consequences of CME [l]. One study drew considerable attention because of its careful design. Sibley and colleagues [2] used a randomized control-group design to study the effectiveness of a CME program on 16 family physicians in Canada. Data on patient-care consequences were extensive, as were analyses. The authors described a difference of 10% more changes in patient care among respondents who participated in CME compared with those who did not. However, this level