Extramural Continuing Medical Education

The experience of one Faculty of Medicine in developing programs of continuing medical education in community hospitals is presented. After mention of the importance of regular reading of the medical literature, and the problems created by its growing volume, the necessity of supplementary programs in community hospitals is pointed out. The different patterns of community hospital meetings that evolved to meet various circumstances in the Atlantic Provinces are detailed. A “course” consisting of six weekly evening meetings, followed by morning case presentations and discussions, has proved the most successful form of continuing medical education in community hospitals. Better than half the doctors in the community attend, and active participation is the rule. The importance of advance planning, the techniques of advance planning, and the expense of operating the program are listed. A projection is made that 46 such courses would be required to cover the four Atlantic Provinces adequately, with a staff equivalent to eight full-time teachers and a budget in excess of $200,000. The fact that this is only 7.5% of Canada''s medical population indicates the magnitude of the unmet needs of continuing medical education in this country.     

A Taxonomy of Continuing Medical Education Endeavour

Five basic forms of continuing educational endeavour by physicians are listed in rank order. These components constitute an indivisible unit bound together by self-learning. The scholarly habit of planned daily reading and study in a home library-sanctuary as an integral part of a physician''s workday heads the list. Day-to-day informal and formal colleague-association in patient care in the community and teaching hospital, in group practice and by consultation is the present major form of continuing educational endeavour. Emphasized is the sabbatical return every three to five years for three months at least to the teaching hospital to reinforce scholarly motivation and attitudes and to acquire new skills and knowledge. Attendance at scientific sessions of learned professional societies and short courses should be accompanied by presession and post-session guided reading to be undertaken in the physician''s home library-sanctuary.     

Family physician registration at locally produced short courses.

Physicians who do not take advantage of short courses that are offered within their community may miss the opportunity to learn about new services and consultants as well as to validate new information or practices with trusted colleagues. The registration patterns at short courses of all 505 family physicians in Calgary were assessed to determine whether the sociodemographic characteristics of attendees differed from those of nonattendees and whether the sociodemographic data were predictive of attendance or nonattendance. Four variables were predictive of attendance or nonattendance: certification status with the College of Family Physicians of Canada (CFPC), year of graduation, sex and hospital affiliation. Physicians who had attended four or more courses were more likely to be graduates of Canadian or US schools, to have graduated after 1969, and to be women, certificants of the CFPC and affiliated with a hospital. Universities, hospitals and professional associations planning continuing education must determine if the needs of nonattending physicians are being met through other means or if new strategies are required to ensure that these physicians have opportunities for upgrading their knowledge. Practitioners who frequently attend short courses can help planners ensure that programming is relevant.     

Six medical students in a community hospital

This paper describes part of an education experiment at the University of British Columbia at Vancouver.Six final-year medical students spent approximately 12 weeks in a community. Their time was divided between the hospital and various doctors'' offices. They answered a simple questionnaire to describe their experiences and commented favourably upon the opportunities for direct patient contact, learning basic skills, informal teaching by both family physicians and consultants, and the variety of work available.They had the opportunity to follow up the progress of the patient and learn the natural history of common illnesses. They achieved their basic objectives. We conclude from their reports and informal conversation that the experiment was successful and recommend other institutions to try similar programs.     

Innovations making CME more clinically relevant,attractive

Educators are rising to the challenge of making continuing medical education relevant, valuable and enjoyable for physicians. Lectures are being replaced by small-group, interactive sessions that try to ensure physicians come away with clinically relevant information that will affect daily practice. Community-based programs also allow physicians to fit learning into their busy lifestyles.     

Degrees in laboratory animal science

The unique and challenging nature of work with animals requires special animal care and use training at all levels. Degree programs, certification boards, and continuing education programs ensure that those who work with animals have the knowledge and skills necessary to provide the best care possible.     

Continuing Medical Education—A Survey Among Physicians Practicing in San Diego and Imperial Counties

Patterns of continuing education of 244 physicians practicing in San Diego and Imperial Counties were studied by means of an interview questionnaire. An additional 20 internists and general practitioners were observed for one week in order to check the validity of the questionnaire findings.All physicians reported that they engaged in one or more means of continuing education and about three quarters had attended at least one formal course during the preceding three years. Almost all (99 percent) had attended some hospital-based teaching conference, tumor board or professional society meeting during the year preceding interview and 88 percent had attended at least once each month. Physicians in group practice participated more regularly in continuing education than those in solo practice, but no differences in participation were observed between those practicing in the metropolitan area of San Diego and those practicing in the other areas of the two counties. Different patterns of continuing education by specialty are also reported and the attitudes of physicians toward continuing education are described.     

The Adequacy of Education for General Practice: A Medical Educator's Viewpoint

The effect on medical education of the doubling of medical knowledge every 10 years is discussed. A brilliant student who might successfully master all the present facts and theories by graduation would be seriously out of date 10 years later, and hopelessly so by retirement age unless he continued his education while in practice. Lengthening the undergraduate course is not considered an effective solution, nor is increasing the general practice internship to two years. Emphasis should be placed on self-education by the medical student, on the inculcation of habits of study and motivation to encourage lifelong learning, and on the provision of more adequate programs of continuing education for the practising doctor. Teachers in medical schools require a better understanding of and interest in the learning processes of their students rather than concentrating on the exposition of their own knowledge.     

Continuing medical education: a personal view.

Over many generations doctors have kept up to date in ways which reflect their own learning styles. The current fashion for formalised and policed continuing medical education may prove ineffective unless it is recognised that individual needs must be taken into account. Attendance at formal courses based on lectures and papers may not suit a large proportion of those who attend to acquire the necessary points to satisfy their royal college. The ability to show that health care teams are up to date should come from effective clinical audit, which should also identify local educational needs.     

A Study of the Food Chain

Field trips provide students with a unique opportunity to experience science in an informal and natural setting. While being exposed to engaging learning environments, students can use their prior knowledge and experience. At the same time, they are applying newly acquired skills and knowledge. In this article, the authors outline a field trip action plan that can be used in most natural habitat settings, parks, outdoor recreation parks, and other informal learning environments.     

Preventive attitudes,beliefs, and practices of physicians in fee-for-service and health maintenance organization settings.

To identify the self-reported differences in preventive practices, attitudes, and beliefs of physicians practicing in fee-for-service (FFS) and health maintenance organization (HMO) settings, we surveyed a 100% sample of primary care physicians practicing in a large, urban, closed-panel HMO and a random sample of physicians, in the same county, who were in an FFS practice. The FFS physicians were more likely to consider behavioral risk factors important than were HMO physicians, and they were more likely to ask their patients about behavioral risk factors. Fee-for-service physicians were more likely than HMO physicians to use continuing medical education courses to upgrade their skills in modifying behavioral risk factors. There was little difference in the self-reported proportion of patients with specific behavioral risks in the FFS and HMO practices. Also, both groups were comparable in their perception of their ability to do behavioral counseling and their perceived success in such counseling. We conclude that FFS physicians are more likely to have positive preventive beliefs, attitudes, and practices than are HMO physicians.     

New Mexico's First Case of Plague

In 1981 a decision was made by the University of New Mexico School of Medicine to create a new Office of Community Professional Education whose primary function was to create continuing medical education programs tailored to its constituency. To accomplish this, a needs assessment survey was distributed to a stratified random sample of members of the New Mexico Medical Society practicing throughout the state to determine preferred learning styles, locations of programs and times of year, as well as other determinants for attending such programs. The survey was received by 647 physicians and 469 returned them—a response rate of 72.4 percent.Conclusions reached as a result of the needs assessment will serve as a basis of policy formation for the delivery of continuing medical education at the University of New Mexico School of Medicine.     

Education for sustainability in higher education: a multiple-case study of three courses

Education for sustainability (EfS) in higher education is an emerging specialisation within the general field of EfS. EfS encompasses cognitive, affective and behavioural aspects, and aims at enhancing a variety of learning outcomes in these domains and reaching students from all programmes. One of the main challenges for higher education educators is to design courses in a way that will effectively promote the various learning outcomes of EfS. A central question is how sustainability should be integrated into the curriculum; which topics should be taught and which pedagogies ought to be applied to improve students’ knowledge, skills and motivation to promote sustainable living. The present study aimed to contribute to the knowledge about students’ learning outcomes yielded by different designs of EfS courses. This multiple-case study of three courses used a mixed-methods design. For each course, we identified its characteristics and analysed students’ self-reported learning outcomes. We found that: (1) a course with a higher degree of participatory learning, employing a system approach, promoted the highest and most varied learning outcomes; (2) the lecture-based course yielded the fewest learning outcomes; and (3) field trips promoted learning outcomes only when accompanied by more advanced pedagogies.     

Continuing Medical Education Tuition: A Survey of Charges

A survey was carried out on the tuition charged for continuing medical education (CME) programs offered by a variety of providers. These included schools of medicine throughout the United States, national organizations and societies, state-wide organizations and societies located in California, and a small group of hospitals in or near Sacramento, California.The fees charged for continuing medical education (expressed in this article as the amount in dollars that a physician must pay for one hour of approved Category I credit) may vary from nothing to more than $20 an hour. The average charge per hour for CME courses sponsored by medical colleges in the United States ranged from none to $11.19 during 1976 and 1977. Recent data indicate that most schools have increased tuition for CME courses because of inflation. Many schools of medicine provide CME through grand rounds, conferences and special lectures at no cost to participants. Similarly, in a small sample of hospitals in California, CME was found to be available at a minimal charge to physicians.Some CME programs are more costly because fees may include the expenses of honored visiting faculty, and costs of food or social activities. There may be further expense if travel is required, although these additional costs may be offset by the benefits of study in a relaxed atmosphere away from practice and office pressures.     

Medical students as medical educators: opportunities for skill development in the absence of formal training programs

All physicians, at some point in their career, are responsible for the education of their peers and junior colleagues. Although medical students are expected to develop clinical and research skills in preparation for residency, it is becoming clear that a student should also be expected to develop abilities as a teacher. A handful of institutions have student-as-teacher programs to train medical students in education, but most students graduate from medical school without formal training in this area. When such a program does not exist, medical students can gain experience in education through participation in peer teaching, course design, educational committees, and medical education scholarship. In doing so, they attain important skills in the development, implementation, and evaluation of educational programs. These skills will serve them in their capacity as medical educators as they advance in their careers and gain increasing teaching responsibility as residents, fellows, and attending physicians.     

河北省医院卫生技术人员继续医学教育费用负担研究

目的 分析河北省二甲、三甲医院卫生技术人员参加继续医学教育项目学习的状况和经费负担特点。方法 采用分层抽样方法对45所二甲、三甲医院6 013名卫生技术人员问卷调查和描述性研究方法分析。结果 三甲医院人员各类项目参加率均高于二甲医院。两级医院人员参加率高的项目有收益率低,参加率与有收益率背离。教育费用负担有单位全部负担、单位和个人共同负担和个人全部负担3种形式。二甲医院3种负担的课程次数构成比分别为22.23%、16.03%、61.74%,单位全部负担和个人全部负担是主要的负担形式;三甲医院为19.50%、29.56%、50.94%,单位和个人共同负担是主要的负担形式。结论 投入不足和制度落实不到位是二甲医院滞后的主要原因,单位和个人共同负担是较为合理的负担形式。     

Reconstructive breast surgery: referring physician knowledge and learning needs

Despite the positive impact that reconstructive breast surgery can have on a woman's quality of life, the percentage of eligible candidates that have this procedure remains surprisingly low. The authors hypothesized that this may be attributable to inadequate knowledge, inadequate information, and/or misinformation available to physicians caring for these patients. A needs assessment of primary care physicians, general surgeons, oncologists, and plastic surgeons was conducted to determine referring physicians' current level of knowledge of reconstructive breast surgery and to discover potential learning needs. This comprised a survey, focus groups, and individual interviews. Referring physicians rated their own knowledge of reconstructive breast surgery as low. Plastic surgeons rated their referring physicians' knowledge as even lower. Specific learning needs were identified, as large discrepancies between referring physicians' self-reported knowledge of individual breast reconstruction topics and their own opinion of their relevance were revealed. In addition, despite evidence to the contrary, more than one-third of referring physicians indicated a belief that a breast reconstruction delayed the detection of local cancer recurrence and adversely interfered with adjuvant oncologic therapy. This lack of knowledge and misinformation may be negatively affecting patient referrals to plastic surgeons, as more than one-third of referring physicians and 90 percent of plastic surgeons believed that eligible candidates were not being offered referrals because of inadequate referring physician knowledge of this topic. Furthermore, patients older than 49 years were not being referred despite the fact that plastic surgeons would consider these patients as potential surgical candidates. Referring physician gender affected both referral patterns and perceived importance of reconstructive breast surgery. Finally, personal beliefs and past experiences played a role both in physicians' decisions to refer patients and in patients' decisions to have breast reconstructions. These deficiencies in information, knowledge, and learning needs should be addressed by educational interventions during residency training and through continuing education endeavors.     

Impact of problem-based learning in a large classroom setting: student perception and problem-solving skills

Problem-based learning (PBL) can be described as a learning environment where the problem drives the learning. This technique usually involves learning in small groups, which are supervised by tutors. It is becoming evident that PBL in a small-group setting has a robust positive effect on student learning and skills, including better problem-solving skills and an increase in overall motivation. However, very little research has been done on the educational benefits of PBL in a large classroom setting. Here, we describe a PBL approach (using tutorless groups) that was introduced as a supplement to standard didactic lectures in University of British Columbia Okanagan undergraduate biochemistry classes consisting of 45-85 students. PBL was chosen as an effective method to assist students in learning biochemical and physiological processes. By monitoring student attendance and using informal and formal surveys, we demonstrated that PBL has a significant positive impact on student motivation to attend and participate in the course work. Student responses indicated that PBL is superior to traditional lecture format with regard to the understanding of course content and retention of information. We also demonstrated that student problem-solving skills are significantly improved, but additional controlled studies are needed to determine how much PBL exercises contribute to this improvement. These preliminary data indicated several positive outcomes of using PBL in a large classroom setting, although further studies aimed at assessing student learning are needed to further justify implementation of this technique in courses delivered to large undergraduate classes.     

The interface between spoken and written language: developmental disorders

We review current knowledge about reading development and the origins of difficulties in learning to read. We distinguish between the processes involved in learning to decode print, and the processes involved in reading for meaning (reading comprehension). At a cognitive level, difficulties in learning to read appear to be predominantly caused by deficits in underlying oral language skills. The development of decoding skills appears to depend critically upon phonological language skills, and variations in phoneme awareness, letter–sound knowledge and rapid automatized naming each appear to be causally related to problems in learning to read. Reading comprehension difficulties in contrast appear to be critically dependent on a range of oral language comprehension skills (including vocabulary knowledge and grammatical, morphological and pragmatic skills).