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GENERAL PRACTICE: Guy R K Fender, Andrew Prentice, Tess Gorst, Richard M Nixon, Stephen W Duffy, Nicholas E Day, and Stephen K Smith Randomised controlled trial of educational package on management of menorrhagia in primary care: the Anglia menorrhagia education study BMJ 1999; 318: 1246-1250 [Abstract] [Full text]

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Randomised controlled trial of educational package on menorrhagia

Paul Sackin   (12 May 1999)

Nothing new

Michael Dawson   (3 June 1999)

Randomised controlled trial of educational package on menorrhagia 12 May 1999
Paul Sackin Send response to journal: Re: Randomised controlled trial of educational package on menorrhagia	The authors of this article(1) demonstrate that a careful educational intervention for doctors can lead to improved care for patients. Yet their study left me with disquiet: 1) A costly educational intervention was only shown to improve management in one small area of general practice. 2) I'm concerned that the boundary between education and indoctrination may be blurred. Yes, there is evidence that tranexamic acid is a good treatment for menorrhagia but might the participants have learnt more if they had derived the evidence for themselves? 3) The learning described in the paper could be called training - learning specific skills for known situations. This can be very important in general practice (e.g. learning and maintaining skills in resuscitation) but it is quite different from education in the true sense. 4) An "educated" general practitioner is one who can deal with unforeseen - and often unforeseeable - situations. The learning needed for this is the opposite of the sort described in this paper. It needs to enhance creativity and discovery and eschew any hint of merely absorbing received wisdom. 5) It is much easier to measure outcomes of "training" than of "education". Is well evaluated training better than inadequately evaluated education? In the current climate of accountability many might think so. But isn't that dealing with prices rather than values? Paul Sackin General practitioner, Chestnut Grove, Great Stukeley, Huntingdon, Cambs PE17 5AD Possible competing interest: I am assistant editor of the Journal Education for General Practice. 1 Fender GRK, Prentice A, Gorst T, Nixon RM, Duffy SW, Day NE, Smith SK. Randomised controlled trial of educational package on management of menorrhagia in primary care: the Anglia menorrhagia evaluation study. BMJ 1999; 318:1246-1250
Nothing new 3 June 1999
Michael Dawson Send response to journal: Re: Nothing new	Editor In the paper by Fender et al, is it not striking that the principles of academic detailing summarised in the box on p.1247 are exactly what pharmaceutical company representatives are striving for in promoting their particular products to practitioners? The conclusion, that "this study used techniques that significantly influence behaviour..." is therefore nothing new to drug reps. They aim to sustain the changes by reinforcing any messages with repeat visiting, offering free pens and sponsoring meetings. We may all claim to be uninfluenced by these visits but here by inference is more evidence to the contrary. Is this study a recommendation for gamekeepers to turn to poaching? Michael Dawson GP Tutor Stirchley Medical Practice Sandino Road Stirchley Telford TF3 1FB