Evidence for the effectiveness of CME. A review of 50 randomized controlled trials.

OBJECTIVE To assess the impact of diverse continuing medical education (CME) interventions on physician performance and health care outcomes. DATA SOURCES Using continuing medical education and related phrases, we performed regular searches of the indexed literature (MEDLINE, Social Science Index, the National Technical Information Service, and Educational Research Information Clearinghouse) from 1975 through 1991. In addition, for these years, we used manual searches, key informants, and requests to authors to locate other indexed articles and the nonindexed literature of adult and continuing professional education. STUDY SELECTION From the resulting database we selected studies that met the following criteria: randomized controlled trials; educational programs, activities, or other interventions; studies that included 50% or more physicians; follow-up assessments of at least 75% of study subjects; and objective assessments of either physician performance or health care outcomes. DATA EXTRACTION Studies were reviewed for data related to physician specialty and setting. Continuing medical education interventions were classified by their mode(s) of activity as being predisposing, enabling, or facilitating. Using the statistical tests supplied by the original investigators, physician performance outcomes and patient outcomes were classified as positive, negative, or inconclusive. DATA SYNTHESIS We located 777 CME studies, of which 50 met all criteria. Thirty-two of these analyzed physician performance; seven evaluated patient outcomes; 11 examined both measures. The majority of the 43 studies of physician performance showed positive results in some important measures of resource utilization, counseling strategies, and preventive medicine. Of the 18 studies of health care outcomes, eight demonstrated positive changes in patients' health care outcomes. CONCLUSION Broadly defined CME interventions using practice-enabling or reinforcing strategies consistently improve physician performance and, in some instances, health care outcomes.

[1]  T. Louis,et al.  A Randomized Controlled Trial of Quality Assurance in Sixteen Ambulatory Care Practices , 1985, Medical care.

[2]  M. Chassin,et al.  A randomized trial of medical quality assurance. Improving physicians' use of pelvimetry. , 1986, JAMA.

[3]  J. Eisenberg.  Sociologic influences on decision-making by clinicians. , 1979, Annals of internal medicine.

[4]  P. Jennett,et al.  The effects of continuing medical education on family doctor performance in office practice: a randomized control study , 1988, Medical education.

[5]  Cecilia Conrath,et al.  The Modern Practice of Adult Education, Andragogy versus Pedagogy, Malcolm S. Knowles. New York: Association Press, 1970. 376 pp. $12.95 Hardbound , 1971 .

[6]  P. Chang,et al.  Effect of cost education, cost audits, and faculty chart review on the use of laboratory services. , 1983, Archives of internal medicine.

[7]  K Magruder-Habib,et al.  Improving Physicians' Recognition and Treatment of Depression in General Medical Care: Results From a Randomized Clinical Trial , 1990, Medical care.

[8]  L Curry,et al.  Continuing medical education in Maritime Canada: the methods physicians use, would prefer and find most effective. , 1981, Canadian Medical Association journal.

[9]  D. Davis,et al.  Attempting to ensure physician competence. , 1990, JAMA.

[10]  C. Woodward,et al.  A randomized controlled trial assessing the impact of problem-based versus didactic teaching methods in CME. , 1988, Research in medical education : proceedings of the ... annual Conference. Conference on Research in Medical Education.

[11]  D. Cohen,et al.  Influence of Simple Computerized Feedback on Prescription Charges in an Ambulatory Clinic: A Randomized Clinical Trial , 1986, Medical care.

[12]  H C Sox,et al.  Modifying test-ordering behavior in the outpatient medical clinic. A controlled trial of two educational interventions. , 1985, Archives of internal medicine.

[13]  E. R. Stinson,et al.  Survey of health professionals' information habits and needs. Conducted through personal interviews. , 1980, JAMA.

[14]  S. Abrahamson,et al.  Effectiveness of continuing medical education: a review of the evidence. , 1979, Evaluation & the health professions.

[15]  C. McDonald,et al.  Reminders to physicians from an introspective computer medical record. A two-year randomized trial. , 1984, Annals of internal medicine.

[16]  R B Haynes,et al.  Does a mailed continuing education program improve physician performance? Results of a randomized trial in antihypertensive care. , 1986, JAMA.

[17]  J. Donaldson,et al.  Evaluation of continuing medical education programs: A selected literature, 1984‐1988 , 1991 .

[18]  M. Watts.  On the third segment of health professions education , 1989 .

[19]  L. Solberg,et al.  A randomized trial to increase smoking intervention by physicians. Doctors Helping Smokers, Round I. , 1989, JAMA.

[20]  G H Guyatt,et al.  A Consumer's Guide to Subgroup Analyses , 1992, Annals of Internal Medicine.

[21]  M. Becker,et al.  Improving pediatricians' compliance-enhancing practices. A randomized trial. , 1988, American journal of diseases of children.

[22]  J E Rodnick,et al.  Promoting cancer prevention activities by primary care physicians. Results of a randomized, controlled trial. , 1991, JAMA.

[23]  D. Brown,et al.  The effectiveness of continuing medical education in changing the behavior of physicians caring for patients with acute myocardial infarction. A controlled randomized trial. , 1985, Annals of internal medicine.

[24]  G. Bole,et al.  Evaluation of an educational program for primary care practitioners, on the management of osteoarthritis. , 1985, Arthritis and rheumatism.

[25]  Stephen B. Soumerai,et al.  Improving Drug-Therapy Decisions through Educational Outreach , 1983 .

[26]  H. Wechsler,et al.  The physician's role in health promotion--a survey of primary-care practitioners. , 1983, The New England journal of medicine.

[27]  C J McDonald,et al.  Delayed Feedback of Physician Performance Versus Immediate Reminders to Perform Preventive Care: Effects on Physician Compliance , 1986, Medical care.

[28]  K L Coltin,et al.  Feedback reduces test use in a health maintenance organization. , 1986, JAMA.

[29]  D L Sackett,et al.  A randomized trial of continuing medical education. , 1982, The New England journal of medicine.

[30]  P. R. Manning.  Changing and Learning in the Lives of Physicians , 1990 .

[31]  T C Chalmers,et al.  The importance of beta, the type II error and sample size in the design and interpretation of the randomized control trial. Survey of 71 "negative" trials. , 1978, The New England journal of medicine.

[32]  R. Richards.  Physicians' Self-Directed Learning: A New Perspective for Continuing Medical Education. I. Reading. , 1986 .

[33]  H. Goldberg,et al.  The effect of computerized feedback coupled with a newsletter upon outpatient prescribing charges. A randomized controlled trial. , 1988, Medical care.

[34]  B. Skipper,et al.  Physician behavior modification using claims data: tetracycline for upper respiratory infection. , 1982, The Western journal of medicine.

[35]  G. Bole,et al.  Evaluation of a continuing education program in rheumatoid arthritis. , 1980, Arthritis and rheumatism.

[36]  G. Guyatt,et al.  Measurement of health status. Ascertaining the minimal clinically important difference. , 1989, Controlled clinical trials.

[37]  J. Avorn,et al.  Economic and Policy Analysis of University-based Drug “Detailing , 1986, Medical care.

[38]  R. Putnam,et al.  Physicians' participation in establishing criteria for hypertension management in the office: will patient outcomes be improved? , 1989, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[39]  R. Worth,et al.  Concurrent quality assurance in hospital care. Report of a study by Private Initiative in PSRO. , 1978, The New England journal of medicine.

[40]  D. Bertram,et al.  The Evaluation of Continuing Medical Education: A Literature Review , 1977, Health education monographs.

[41]  H. Anderson,et al.  Randomized controlled trial of small group education on the outcome of chronic asthma in general practice. , 1989, The Journal of the Royal College of General Practitioners.

[42]  B. Littenberg,et al.  Does Cost Information Availability Reduce Physician Test Usage?: A Randomized Clinical Trial With Unexpected Findings , 1982, Medical care.

[43]  L. Stein.  The effectiveness of continuing medical education: eight research reports. , 1981, Journal of medical education.

[44]  R. Hiss,et al.  Continuing education in pulmonary disease for primary-care physicians. , 2015, The American review of respiratory disease.

[45]  J. LoGerfo,et al.  Teaching sigmoidoscopy to primary care physicians: a controlled study of continuing medical education. , 1983, The Journal of family practice.

[46]  Eugene Vayda,et al.  Opinion leaders vs audit and feedback to implement practice guidelines. Delivery after previous cesarean section. , 1991, JAMA.

[47]  R. Putnam,et al.  Impact of patient care appraisal on physician behaviour in the office setting. , 1985, Canadian Medical Association journal.

[48]  E. Ray Stinson,et al.  Survey of Health Professionals' Information Habits and Needs Through Personal Interviews. , 1978 .

[49]  L. Shulman,et al.  Medical Problem Solving: An Analysis of Clinical Reasoning , 1978 .

[50]  W. Carter,et al.  Implementing preventive care in clinical practice. II. Problems for managers, clinicians and patients. , 1981, Medical care review.

[51]  D. Avard,et al.  The use of clinical recall interviews as a method of determining needs in continuing medical education. , 1987, Research in medical education : proceedings of the ... annual Conference. Conference on Research in Medical Education.

[52]  P M Wortman,et al.  Medical Information Systems: Assessing Impact in the Areas of Hypertension, Obesity and Renal Disease , 1982, Medical care.

[53]  P. Maguire,et al.  Assessing clinical competence. , 1989, BMJ.

[54]  Lawrence W. Green,et al.  Health Education Planning: A Diagnostic Approach , 1979 .

[55]  William M. Tierney,et al.  Postgraduate Medical Education , 2008 .

[56]  D. Smith,et al.  Encouraging primary care physicians to help smokers quit. A randomized, controlled trial. , 1989, Annals of internal medicine.

[57]  J. Restuccia,et al.  The Effect of Concurrent Feedback in Reducing Inappropriate Hospital Utilization , 1982, Medical care.

[58]  R. Haynes,et al.  A critical appraisal of the efficacy of continuing medical education. , 1984, JAMA.

[59]  B. Linn.  Continuing medical education. Impact on emergency room burn care. , 1980, JAMA.

[60]  F Davidoff,et al.  Changing Test Ordering Behavior: A Randomized Controlled Trial Comparing Probabilistic Reasoning With Cost-Containment Education , 1989, Medical care.

[61]  J. Beaudry.  The Effectiveness of Continuing Medical Education: A Quantitative Synthesis. , 1989 .

[62]  G H Guyatt,et al.  Guidelines for reading literature reviews. , 1988, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[63]  T. Coates,et al.  Management of hypertension in private practice: A randomized controlled trial in continuing medical education , 1988 .

[64]  C J McDonald,et al.  The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. , 1990, The New England journal of medicine.

[65]  L. Chambers,et al.  The impact of cme an annotated bibliography assessing the effect of continuing medical education strategies on the program perception, competence and performance of physicians and on patient outcomes. , 1986 .

[66]  W E Hammond,et al.  Improving Drug Prescribing in a Primary Care Practice , 1984, Medical care.

[67]  G O Barnett,et al.  Improving Physician Performance Through Peer Comparison Feedback , 1984, Medical care.

[68]  C J McDonald,et al.  Computer predictions of abnormal test results. Effects on outpatient testing. , 1988, JAMA.

[69]  Stuart J. Cohen,et al.  The impact of reading on physicians' nonadherence to recommended standards of medical care. , 1985, Social science & medicine.

[70]  A. Jette,et al.  Improving patient function: a randomized trial of functional disability screening. , 1989, Annals of internal medicine.

[71]  L. A. Thibodeau,et al.  A trial of two strategies to modify the test-ordering behavior of medical residents. , 1980, The New England journal of medicine.

[72]  Albert R. Martin,et al.  Training physicians in counseling about smoking cessation. A randomized trial of the "Quit for Life" program. , 1989, Annals of internal medicine.

[73]  R G Wones,et al.  Failure of low-cost audits with feedback to reduce laboratory test utilization. , 1987, Medical care.

[74]  D. Taylor,et al.  A randomized trial of a family physician intervention for smoking cessation. , 1988, JAMA.

[75]  P Ours,et al.  DIABEDS: a randomized trial of the effects of physician and/or patient education on diabetes patient outcomes. , 1987, Journal of chronic diseases.