Continuing education as an instrument in physicians quality management

A rheumatologic educational programe for general practitioners (GPs), based on andragogic principles, has been developed by the study group for Contin uing Education and Quality Control of the Association of Cooperative Center s of Rheumatology in the DGRh. The educational program has been tested and evaluated by a study group supported by the German Ministry of Health (FB 2 -43346-8/63) as an possible tool for quality assurance in rheumatology. Evaluation was carried out in 2 audit circles each of the KV Hessen and KV Lower Saxony. In the 4 audit circles 39 GPs and 3 trained rheumatologists, acting as "experts", participated. Using didactic materials provided by the study group, the topic "shoulder-neck pain" was discussed in all 4 audit c ircles. Questionnaires and case records according to the topic were used as evaluation tools. The evaluation was sup ported scientifically by the Scie ntific Institute of the German Medical Association (WIAD). Of patients with shoulder-neck pain (1193 pre- and 958 post-education) 2151 records were documented by the participating GPs for the evaluation of out come in respect of changes of diagnostic and therapeutic attitude. Addition ally pre- and postintervention, 10 MC questions related to the topic were u sed to measure changes in specific knowledge, and at the end of the audit c ircles participants were asked by questioaire for acceptance of the educati onal program. An index of acceptance of 9.6 points (best: 7.0 points, worst: 31.0 points) indicating an exellent acceptance of the educational program by the partic ipating GPs was recorded. The increase in specific knowledge amounted to ab out 30% in all 4 audit circles. Changes in diagnostic and therapeutic attit udes showed a better specification within the spectrum of diagnoses, a redu ction of expensive and not indicated diagnostic procedures (e.g., CT), as w ell as a reduction in the use of non-adaequate therapeutic modalities (e.g. , massage, fango, unguenta, and gels) in favor of physiotherapy and mobilis ation or local and systemic use of corticosteroids. The results of the evaluation project demonstrate that interactive learning in small groups (audit circles) based on andragogic priciples can contribu te to a better quality of care of patients with rheumatic diseases. The inn ovative concept seems to be a well-accepted alternative to formal lectures in postgraduate medical education.