Impact of formal continuing medical education - Do conferences, workshops,rounds, and other traditional continuing education activities change physician behavior or health care outcomes?

Context Although physicians report spending a considerable amount of time i n continuing medical education (CME) activities, studies have shown a sizab le difference between real and ideal performance, suggesting a lack of effe ct of formal CME. Objective To review, collate, and interpret the effect of formal CME interv entions on physician performance and health care outcomes. Data Sources Sources included searches of the complete Research and Develop ment Resource Base in Continuing Medical Education and the Specialised Regi ster of the Cochrane Effective Practice and Organisation of Care Group, sup plemented by searches of MEDLINE from 1993 to January 1999. Study Selection Studies were included in the analyses if they were randomiz ed controlled trials of formal didactic and/or interactive CME intervention s (conferences, courses, rounds, meetings, symposia, lectures, and other fo rmats) in which at least 50% of the participants were practicing physicians . Fourteen of 64 studies identified met these criteria and were included in the analyses. Articles were reviewed independently by 3 of the authors. Data Extraction Determinations were made about the nature of the CME interv ention (didactic, interactive, or mixed), its occurrence as a 1-time or seq uenced event, and other information about its educational content and forma t. Two of 3 reviewers independently applied all inclusion/exclusion criteri a. Data were then subjected to metaanalytic techniques. Data Synthesis The 14 studies generated 17 interventions fitting our criter ia. Nine generated positive changes in professional practice, and 3 of 4 in terventions altered health care outcomes in 1 or more measures. In 7 studie s, sufficient data were available for effect sizes to be calculated; overal l, no significant effect of these educational methods was detected (standar dized effect size, 0.34; 95% confidence interval [CI], -0.22 to 0.97). Howe ver, interactive and mixed educational sessions were associated with a sign ificant effect on practice (standardized effect size, 0.67; 95% CI, 0.01-1. 45). Conclusions Our data show some evidence that interactive CME sessions that enhance participant activity and provide the opportunity to practice skills can effect change in professional practice and, on occasion, health care o utcomes. Based on a small number of well-conducted trials, didactic session s do not appear to be effective in changing physician performance.