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      Continuing medical education for general practitioners: a practice format

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          Abstract

          Introduction

          Our current knowledge-based society and the many actualisations within the medical profession require a great responsibility of physicians to continuously develop and refine their skills. In this article, we reflect on some recent findings in the field of continuing education for professional doctors (continuing medical education, CME). Second, we describe the development of a CME from the Academic Center for General Practice (ACHG) of the KU Leuven.

          Methods

          First, we performed a literature study and we used unpublished data of a need assessment performed (2013) in a selected group of general practitioners. Second, we describe the development of a proposal to establish a CME programme for general practitioners.

          Results

          CME should go beyond the sheer acquisition of knowledge, and also seek changes in practice, attitudes and behaviours of physicians. The continuing education offerings are subject to the goals of the organising institution, but even more to the needs and desires of the end user.

          Conclusions

          Integrated education is crucial to meet the conditions for efficient and effective continuing education. The ACHG KU Leuven decided to offer a postgraduate programme consisting of a combination of teaching methods: online courses (self-study), contact courses (traditional method) and a materials database.

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          Most cited references41

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          Systematic review: the relationship between clinical experience and quality of health care.

          Physicians with more experience are generally believed to have accumulated knowledge and skills during years in practice and therefore to deliver high-quality care. However, evidence suggests that there is an inverse relationship between the number of years that a physician has been in practice and the quality of care that the physician provides. To systematically review studies relating medical knowledge and health care quality to years in practice and physician age. English-language articles in MEDLINE from 1966 to June 2004 and reference lists of retrieved articles. Studies that provided empirical results about knowledge or a quality-of-care outcome and included years since graduation or physician age as explanatory variables. We categorized studies on the basis of the nature of the association between years in practice or age and performance. Overall, 32 of the 62 (52%) evaluations reported decreasing performance with increasing years in practice for all outcomes assessed; 13 (21%) reported decreasing performance with increasing experience for some outcomes but no association for others; 2 (3%) reported that performance initially increased with increasing experience, peaked, and then decreased (concave relationship); 13 (21%) reported no association; 1 (2%) reported increasing performance with increasing years in practice for some outcomes but no association for others; and 1 (2%) reported increasing performance with increasing years in practice for all outcomes. Results did not change substantially when the analysis was restricted to studies that used the most objective outcome measures. Because of the lack of reliable search terms for physician experience, reports that provided relevant data may have been missed. Physicians who have been in practice longer may be at risk for providing lower-quality care. Therefore, this subgroup of physicians may need quality improvement interventions.
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            Instructional design variations in internet-based learning for health professions education: a systematic review and meta-analysis.

            A recent systematic review (2008) described the effectiveness of Internet-based learning (IBL) in health professions education. A comprehensive synthesis of research investigating how to improve IBL is needed. This systematic review sought to provide such a synthesis. The authors searched MEDLINE, CINAHL, EMBASE, Web of Science, Scopus, ERIC, TimeLit, and the University of Toronto Research and Development Resource Base for articles published from 1990 through November 2008. They included all studies quantifying the effect of IBL compared with another Internet-based or computer-assisted instructional intervention on practicing and student physicians, nurses, pharmacists, dentists, and other health professionals. Reviewers working independently and in duplicate abstracted information, coded study quality, and grouped studies according to inductively identified themes. From 2,705 articles, the authors identified 51 eligible studies, including 30 randomized trials. The pooled effect size (ES) for learning outcomes in 15 studies investigating high versus low interactivity was 0.27 (95% confidence interval, 0.08-0.46; P = .006). Also associated with higher learning were practice exercises (ES 0.40 [0.08-0.71; P = .01]; 10 studies), feedback (ES 0.68 [0.01-1.35; P = .047]; 2 studies), and repetition of study material (ES 0.19 [0.09-0.30; P or=89%) in most analyses. Meta-analyses for other themes generally yielded imprecise results. Interactivity, practice exercises, repetition, and feedback seem to be associated with improved learning outcomes, although inconsistency across studies tempers conclusions. Evidence for other instructional variations remains inconclusive.
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              AMEE Guide No. 25: The assessment of learning outcomes for the competent and reflective physician.

              Two important features of contemporary medical education are recognized. The first is an emphasis on assessment as a tool to ensure quality in training programmes, to motivate students and to direct what they learn. The second is a move to outcome-based education where the learning outcomes are defined and decisions about the curriculum are based on these. These two trends are closely related. If teachers are to do a better job of assessing their students, they need an understanding of the assessment process, an appreciation of the learning outcomes to be assessed and a recognition of the most appropriate tools to assess each outcome. Assessment tools selected should be valid, reliable, practical and have an appropriate impact on student learning. The preferred assessment tool will vary with the outcome to be assessed. It is likely to be some form of written test, a performance test such as an OSCE in which the student's competence can be tested in a simulated situation, and a test of the student's behaviour over time in clinical practice, based on tutors' reports and students' portfolios. An assessment profile can be produced for each student which highlights the learning outcomes the student has achieved at the required standard and other outcomes where this is not the case. For educational as well as economic reasons, there should be collaboration across the continuum of education in test development as it relates to the assessment of learning outcomes and in the implementation of a competence-based approach to assessment.
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                Author and article information

                Journal
                Postgrad Med J
                Postgrad Med J
                postgradmedj
                pmj
                Postgraduate Medical Journal
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0032-5473
                1469-0756
                April 2016
                5 February 2016
                : 92
                : 1086
                : 217-222
                Affiliations
                Department of Public Health and Primary Care, Academic Centre of General Practice, KU Leuven-University of Leuven , Leuven, Belgium
                Author notes
                [Correspondence to ] Professor Birgitte Schoenmakers, Department of Public Health and Primary Care, Academic Centre of General Practice, KU Leuven-University of Leuven, Kapucijnenvoer 33, Box 7001, Leuven 3000, Belgium; Birgitte.schoenmakers@ 123456med.kuleuven.be
                Article
                postgradmedj-2015-133662
                10.1136/postgradmedj-2015-133662
                4819632
                26850504
                24d39b2a-4838-4540-9b23-1465e0a4a22e
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 28 July 2015
                : 10 January 2016
                : 18 January 2016
                Categories
                1506
                Quality Improvement Report
                Custom metadata
                unlocked

                Medicine
                education & training (see medical education & training),medical education & training,primary care

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