Continuing Medical Education

Summary

In all professions the need for lifelong learning has evolved from a statement of goals, to an essential aspect of competent professional practice. In medicine this may be more true than for any other of the health professions. The knowledge required for practice has continued to grow exponentially, in a complex environment of change and reform in health care delivery, accompanied by broadened expectations of physician function in roles that go beyond that of medical expert.

The chapterbegins by exploring the various models which have been proposedto explain how learning and change occur in professional practice. Three ofthese models have been developed from studies of professional practice, including Schön’s model of reflective practice (1983); a theory oflearning and change (Fox, Mazmanian, & Putnam, 1989); and a double helix model (Nolen, 1988). Other models have been developed outside medicine, but are useful in explaining and predicting change, including the PRECEDE model (Green, Eriksen, & Schor, 1988). From the general educational literature, learningfrom experience has been proposed through cognitive models which involve situated learning (Lave and Wegner, 1991). The models will be presented as a means of understanding the conceptual evolution of the field, and ofproviding aframework to examine current knowledge, and to identify gaps. Existing evidence ofsupportfor these approaches willbepresented.

The next section ofthe chapter considers assessment ofeducational needs and performance among practicing physicians. Approaches included are questionnaires, focus groups, interviews, chart audit, chart-stimulated recall, and standardized patients. Relevant findingson the use and effectiveness of these methodsareprovided.

In the third section of the chapter an overview of the current evidence Of Continuing Medical Education (CME) interventions concerning the effectiveness in changing physician practice is presented. Several approaches to change are reviewed, including information dissemination through traditional formal CME approaches; printed educational materials; clinical practice guidelines; newereducational approaches such as educational outreach and small-group problem-based learning; the use oflocal opinion leaders; andauditandfeedback.

Self-directed learning. and its role in the maintenance of competence, is addressed next. Maintenance of professional competence is essentially self-directed; therefore. the theory and research about self-directed learning will be overviewed. Self-directed learning programs are discussed. including portfolio-based learning. Lastly. questions surrounding the assessment of self-directed learning outcomes are raised.

Other important influences in CMEare briefly addressed. These include information technology and the movement toward recertification and revalidation. The chapter concludes with emerging research issues and questions. and the implications ofcurrent researchfindingsfor educationalpractice.