期刊论文详细信息
BMC Research Notes
Improving knowledge and changing behavior towards guideline based decisions in diabetes care: a controlled intervention study of a team-based learning approach for continuous professional development of physicians
Martin R Fischer1  Lisa Kühne-Eversmann1 
[1] Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ziemssenstr. 1, Munich 80336, Germany
关键词: Objective behavior change;    Guideline adherence;    Postgraduate education;    Continuing medical education;    Continuing professional development;    Team-based learning;   
Others  :  1145041
DOI  :  10.1186/1756-0500-6-14
 received in 2012-08-02, accepted in 2013-01-07,  发布年份 2013
【 摘 要 】

Background

Continuing Professional Development (CPD) courses should ideally improve a physician’s knowledge and change their professional behavior in daily practice towards a best clinical practice reference model and guideline adherence. Interactive methods such as team-based learning and case-based learning, as compared to lectures, can impart sustainable knowledge and lead to high satisfaction among participants. We designed an interactive case-based CPD-seminar on diabetes care using a team-based learning approach to evaluate whether it leads to an improvement of short-term knowledge and changing of behavior towards guideline based decisions and how this learning approach is perceived by participants.

Methods

Questionnaires and an electronic voting system were used to evaluate motivation, acceptance and knowledge of voluntary participants. Furthermore, we analyzed data on index diagnostic tests and referrals of patients with diabetes of participating physicians over a period of six months before and after the course in comparison with a matched control group in a quasi-experimental design.

Results

Participants (n=103) rated the interactivity and team-based discussions as the main reasons for enhanced learning. They also expected that the course would change their professional behavior. Participants scored a mean of 43.9% right answers before and 62.6% after the course (p<0.001). The referral to diabetes specialists increased by 30.8% (p<0.001). Referral for fundoscopy also increased (8.5%, n.s.) while it dropped in the control group. Furthermore, the participating physicians tested their patients more often for microalbuminuria (7.1%, n.s.).

Conclusions

Our team-based learning CPD-approach was highly accepted and resulted in an increase of short-term knowledge. It significantly increased the referral to diabetes specialists in daily practice whereas all other key professional behavior indicators did change but not significantly.

【 授权许可】

   
2013 Küehne-Eversmann and Fischer; licensee BioMed Central Ltd.

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【 参考文献 】
  • [1]Davis D, O'Brien MA, Freemantle N, Wolf FM, Mazmanian P, Taylor-Vaisey A: Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? JAMA 1999, 282(9):867-874.
  • [2]Forsetlund L, Bjørndal A, Rashidian A, Jamtvedt G, O'Brien MA, Wolf F, Davis D, Odgaard-Jensen J, Oxman AD: Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2009, 15(2):CD003030.
  • [3]Davis D, Galbraith R: Continuing Medical Education Effect on Practice Performance: Effectiveness of Continuing Medical Education: American College of Chest Physicians Evidence-Based Educational Guidelines. Chest 2009, 135:42S-48S.
  • [4]Davis D: Does CME work? An analysis of the effect of educational activities on physician performance or health care outcomes. Int J Psychiatry Med 1998, 28(1):21-39.
  • [5]Marinopoulos SS, Dorman T, Ratanawongsa N, Wilson LM, Ashar BH, Magaziner JL, Miller RG, Thomas PA, Prokopowicz GP, Qayyum R, Bass EB: Effectiveness of continuing medical education. Evid Rep Technol Assess (Full Rep) 2007, 149:1-69.
  • [6]O’Neil KM, Addrizzo-Harris DJ: Continuing Medical Education Effect on Physician Knowledge Application and Psychomotor Skills: Effectiveness of Continuing Medical Education: American College of Chest Physicians Evidence-Based Educational Guidelines. Chest 2009, 135:37S-41S.
  • [7]Sohn W, Ismail AI, Tellez M: Efficacy of educational interventions targeting primary care providers’ practice behaviours: An overview of published systematic reviews. J Public Health Dent 2004, 64(3):164-172.
  • [8]Oxman AD, Thomson MA, Davis DA, Haynes RB: No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. Can Med Assoc J 1995, 153(10):1423-1431.
  • [9]Smits PB, Verbeek JH, de Buisonjé CD: Problem based learning in continuing medical education: A review of controlled evaluation studies. BMJ 2002, 324:153-156.
  • [10]Kiessling A, Henriksson P: Efficacy of case method learning in general practice for secondary prevention in patients with coronary artery disease: Randomised controlled study. BMJ 2002, 325:877-880.
  • [11]Kiessling A, Lewitt M, Henriksson P: Case-based training of evidence-based clinical practice in primary care and decreased mortality in patients with coronary heart disease. Ann Fam Med 2011, 9:211-218.
  • [12]Michaelsen LK: Team-Based Learning: A Transformative Use of Small Groups. Westport Conn and London: Praeger; 2002.
  • [13]Williams B: Case-based learning – a review of the literature: is there scope for this educational paradigm in prehospital education? Emerg Med J 2005, 22:577-581.
  • [14]Bloom BS: Effects of continuing medical education on improving physician clinical care and patient health: a review of systematic reviews. Int J Technol Assess Health Care 2005, 21(3):380-385.
  • [15]Kühne-Eversmann L, Eversmann T, Fischer MR: Team- and case-based learning to activate participants and enhance knowledge: an evaluation of seminars in Germany. J Contin Educ Health Prof 2008, 28(3):165-171.
  • [16][http://www.deutsche-diabetes-gesellschaft.de] webcite
  • [17]Möbes J: Compliance: Neue Positionen am Beispiel des Diabetes mellitus. Z Allg Med 2003, 79:238-243.
  • [18]Collins J: Audience response systems: technology to engage learners. J Am Coll Radiol 2008, 5(9):993-1000.
  • [19]Jensen JV, Ostergaard D, Faxholt AK: Good experiences with an audience response system used in medical education. Dan Med Bull 2011, 58(11):A4333.
  • [20]Gerlach FM, Beyer M: Ärztliche Fortbildung aus der Sicht niedergelassener Ärztinnen und Ärzte—representative Ergebnisse aus Bremen und Sachsen-Anhalt [Continuing medical education from the view of ambulatory care physicians--representative outcomes and needs in Bremen and Saxony-Anhalt. Z Arztliche Fortbildung und Qualität 1999, 93:581-589.
  • [21]Stancic N, Mullen PD, Prokhorov AV, Frankowski RF, McAlister AL: Continuing medical education: What delivery format do physicians prefer? J Contin Educ Health Prof 2003, 23:162-167.
  • [22]Kelly MH, Murray TS: General practitioners’ view on continuing medical education. Br J Gen Pract 1994, 44:469-471.
  • [23]Qureshi NN, Hatcher J, Chaturvedi N, Jafar TH, Hypertension Research Group: Effect of general practitioner education on adherence to antihypertensive drugs: cluster randomised controlled trial. BMJ 2007, 335(7628):1030.
  • [24]Premi J, Shannon S, Hartwick K, Lamb S, Wakefield J, Williams J: Practice-based small-group CME. Acad Med 1994, 69(10):800-802.
  • [25]Chan DH, Leclair K, Kaczorowski J: Problem-based small-group learning via the Internet among community family physicians: a randomized controlled trial. MD Comput 1999, 16(3):54-58.
  • [26]Heale J, Davis D, Norman G, Woodward C, Neufeld V, Dodd P: A randomized controlled trial assessing the impact of problem-based versus didactic teaching methods in CME. Res Med Educ 1988, 27:72-77.
  • [27]Barnett SM, Ceci SJ: When and where do we apply what we learn? A taxonomy for far transfer. Psychol Bull 2002, 128(4):612-637.
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