Re-Visiting the Role of Lecture-Based CME: Does it Make a Difference in Physician Learning and Change?

講授式繼續醫學教育活動：是否影響醫師之學習與醫療實務改變

10.6145/jme.201009_14(3).0003

Marianna B. Shershneva；Min-Fen Wang；Curtis A. Olson；Julia N. Savoy；Chère C. Gibson

繼續醫學教育 ； 教育成效評鑑 ； 講授式教學法 ； 醫療實務改變 ； continuing medical education ； outcomes evaluation ； lecture ； practice change

Journal of Medical Education

14卷3期（2010 / 09 / 01）

183 - 196

英文

研究目的：講授式的繼續醫學教育活動，一直被批評為無法有效地幫助改善臨床醫療實務及病人的健康療效。這項在美國執行的研究旨在評估一個75分鐘，以講授方法為主的繼續醫學教育活動，其成效是否影響活動參與者在更年期醫療保健方面的醫病溝通實務發生改變。研究方法：本研究同時採用質性與量化資料分析以了解教育活動的成效。41位在美國提供一般醫療服務的醫師參與本研究。在15個月的資料收集期間，採用追蹤電話訪談、教育活動實地觀察、臨床案例分析及書面問卷等方法。另外，還使用360度評估法收集8位研究參與者他們的病人、醫療團隊成員及同儕醫師的觀點。研究發現：研究參與者認為個人在提供更年期保健方面的知識與技能大幅提高。在參加教育活動過後的9-14個月之間，約86%的研究參與者（35人中有30人）實踐了一個或一個以上改變個人醫療實務的承諾。我們還訪談了6位沒有參與之前評估研究階段的教育活動參加者，發現他們有類似的醫療實務改變，與360度評估法的研究發現一致。結論：一個相對較短、以講授法為主、以實務為導向、有關更年期保健方面的繼續醫學教育活動，在使用良好的教育方案規劃原則的前提下，能促使醫生在知識、技能及醫療實務等方面發生改變。

Purpose: Lecture-based continuing medical education (CME) has been criticized for very limited impact on improving clinical practice and patient outcomes. This study assesses the impact of a 75-minute presentation for primary care physicians in the United States to enhance their communication with patient regarding the risks and benefits of hormone therapy for menopausal symptoms. Methods: Data were collected from 41 primary care physicians over 15 months through multiple telephone interviews, use of clinical vignettes, presentation observations, and a written survey. A 360-degree multisource evaluation of 8 participants was conducted to obtain data from their patients, peer physicians, and healthcare team members. Quantitative and qualitative data were analyzed to document educational outcomes. Results: Participants reported significant increases in their knowledge, skills, and confidence as related to menopausal care. At 9-14 months post-event, 85.7% (30 of 35) participants implemented one or more of their commitments to practice change. The 360-degree evaluation findings supported participants' claims of change, when 360-questions matched change statements. Meanwhile, we interviewed 6 conference attendants who did not participate in the previous evaluation phases. They reported similar practice changes to the rest of participants. Conclusions: A relatively short lecture-based, practice-oriented CME on menopausal care utilizing sound educational principles can precipitate changes in knowledge, skills and clinical practice. This study invites the CME community to re-visit the role of lecture-based CME and shift the discussion to consider under what conditions it can be expected to be more or less effective for physicians' learning and practice change.

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