A STANDARDIZED-PATIENT ASSESSMENT OF A CONTINUING MEDICAL-EDUCATION PROGRAM TO IMPROVE PHYSICIANS CANCER-CONTROL CLINICAL SKILLS

Background. Although continuing medical education (CME) has long been used to inform physicians and teach specific skills, its efficacy in m any areas is not well established. This randomized controlled trial as sessed the effects of differing educational techniques on the cancer-c ontrol skills of 57 physicians. Method. The CME program was part of th e Cancer Prevention in Community Practice Project in Hanover, New Hamp shire, and was implemented in 1988. The program used several methods i n its presentation, including interactive small-group discussion, role playing, videotaped clinical encounters, lecture presentations, and t rigger tapes. Measurements included cross-sectional observations made by unannounced standardized patients (SPs) who, one year after the CME program, assessed 25 physicians who had participated in the program a nd 32 physicians who had not. To measure consistency in the SPs' perfo rmances and accuracy in assessing the physicians' performances, most i nteractions were audiotaped using a hidden microphone. Pearson chi-squ are, Fisher exact two-tailed test, and kappa coefficients were used fo r analysis. Results. Significantly higher ratings were found for the C ME physicians in two areas: breast cancer risk-factor determination (d etermined maternal history: 80% versus 52%, p = .03; determined age at first period: 16% versus 0%, p = .02), and smoking cessation counseli ng (providing written material: 32% versus 9%, p = .03). The CME physi cians were rated higher on all 19 study variables in the target areas of early detection of breast cancer and smoking cessation. The results show that the physicians' performances were better in those areas whe re the CME program had used performance-based learning, such as role p laying or viewing and discussing a videotaped role-play encounter. Con clusion. The educational techniques that rehearsed or portrayed clinic al applications seem to have increased the physicians' performances of cancer-control clinical activities. The standardized-patient instrume nt seems to be particularly useful in evaluating interventions that ad dress specific skills training.