Does continuing medical education improve the way physicians conduct theirpractice?

OBJECTIVES: Physicians practicing in France are required to participate in continuing education programs in accordance with the code of deontology and the offical decree on controlling medical expenditures. We reviewed the li terature to analyze the efficacy of such training on the way physicians con duct their practice. METHODS: We examined the following educational methodologies: diffusion of educational documents or guidelines, conferences and presentations, interve ntions by opinion leaders, direct visits at the physician's office. The ana lysis was based solely on publications issuing from work considered to be v alid in accordance with the Cochrane collaboration: intervention trials, ch ronological series, before-after studies with control group. RESULTS: The diffusion of educational material or more format continuing ed ucation programs do not appear to have an effect on the way physicians cond uct their practice, interventions by opinon leaderrs have a demonstrated im pact but are rarely judged clinically significant Visits to the physician's office by specially trained health care workers have an effect but this mo de of education is costly. CONCLUSIONS: The conventional strategies, such as simple information diffus ion and continuing education programs, developed to promote an evolution of clinical practices appear to be the least effective methodologies. (C) 199 9, Masson, Paris.