Context Although physicians report spending a considerable amount of time in
continuing medical education (CME) activities, studies have shown a sizable
difference between real and ideal performance, suggesting a lack of effect
of formal CME.
Objective To review, collate, and interpret the effect of formal CME interventions
on physician performance and health care outcomes.
Data Sources Sources included searches of the complete Research and Development Resource
Base in Continuing Medical Education and the Specialised Register of the Cochrane
Effective Practice and Organisation of Care Group, supplemented by searches
of MEDLINE from 1993 to January 1999.
Study Selection Studies were included in the analyses if they were randomized controlled
trials of formal didactic and/or interactive CME interventions (conferences,
courses, rounds, meetings, symposia, lectures, and other formats) in which
at least 50% of the participants were practicing physicians. Fourteen of 64
studies identified met these criteria and were included in the analyses. Articles
were reviewed independently by 3 of the authors.
Data Extraction Determinations were made about the nature of the CME intervention (didactic,
interactive, or mixed), its occurrence as a 1-time or sequenced event, and
other information about its educational content and format. Two of 3 reviewers
independently applied all inclusion/exclusion criteria. Data were then subjected
to meta-analytic techniques.
Data Synthesis The 14 studies generated 17 interventions fitting our criteria. Nine
generated positive changes in professional practice, and 3 of 4 interventions
altered health care outcomes in 1 or more measures. In 7 studies, sufficient
data were available for effect sizes to be calculated; overall, no significant
effect of these educational methods was detected (standardized effect size,
0.34; 95% confidence interval [CI], −0.22 to 0.97). However, interactive
and mixed educational sessions were associated with a significant effect on
practice (standardized effect size, 0.67; 95% CI, 0.01-1.45).
Conclusions Our data show some evidence that interactive CME sessions that enhance
participant activity and provide the opportunity to practice skills can effect
change in professional practice and, on occasion, health care outcomes. Based
on a small number of well-conducted trials, didactic sessions do not appear
to be effective in changing physician performance.