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but does it work?
- Christopher M. Buttery (16 June 2006)
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The price of independence - no more Drugs and Therapeutics Bulletin for NHS staff
- Francis H Sansbury (20 June 2006)
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Christopher M. Buttery, Professor of Public Health Virginia. 23289
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There seems to be some inborn belief among editors and educators that CME works. What is the evidence? The few attempts to measure effectiveness have been less than satisfactory. Recall may be fine immediately after a lecture, but how is it 3-6 months later. How do we measure changes in practice? What causes those changes? How much CME is based on studies of individual pratices? CME is not based on practice epidemiology. How much CME and practice content is based on an assessemnts of the problems in a specific practice populations? One of my first published papers was written in 1958 on my experience of placing my patient data on Royal McBee punch cards and evaluating the content of my practice (diagnoses, procedures, prescriptions) every 6 months. One CME size does not fit all any more than one design fits all. People learn in different ways. Some do well searching for ideas on the internet. Some find journal articles worth while. Some find repetition of subjects boring. The desire to ensure the best quality practice is laudable. With proper training in medical school most phsyicians subscribe to life long learning, yet we still see such simple activities as lack of immunization among patients in a practice. Many patients do not have their blood pressure measured regularly. We often measure the wrong things. We provide the wrong type of continuing education. We pay for services based on quantity rather than quality. We do not pay for consultations but for surgery, shots and prescriptions. Those truly interested in improving physician performance need to dump CME as it presently exists and develop a new model to improve practice quality, once we have decided what quality is. It is not usually what professors and educators believe it is! The worry about pharmaceutical support is a distraction from focussing on practice quality. Competing interests: None declared |
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Francis H Sansbury, Foundation Year 1 doctor (PRHO) Royal Devon & Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW
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Editor - The 17 June 2006 BMJ contains an editorial calling for strategic funding of online learning for doctors,1 an article on commercial bias in medical journals,2 and a “First person” article on the price of independence.3 This combination is topical in an additional way you do not mention. For many years in the United Kingdom the Drug and Therapeutics Bulletin (DTB) has been the only widely available independent review of medicines available to National Health Service staff. In March the Department of Health ended the national contract for DTB on the grounds that it was appropriate given the current move towards local commissioning.4 The Department of Health is surely being disingenuous if it expects local National Health Service organisations, in their current financial straits, to pick up the funding for access to DTB. It is also bizarre given that the National Electronic Library for Health,5 the online gateway for DTB for NHS staff, was set up as a nationwide resource. Local funding is likely to be much more expensive per person that benefits than national funding. The alternative is funding by individually subscribing doctors, but as the 17 June Editor’s choice comments,6 the editorial calling for strategic funding of online learning is “perhaps based on long experience that doctors won’t pay for information.” The likely result is that far fewer doctors will read DTB, whether in paper or online, and for many this will mean the loss of their only medicines review that is completely devoid of pharmaceutical advertising or sponsorship. Sadly, both online learning and evidence based practice will lose out. It is odd that the Department of Health is calling a strategic online learning fund while getting rid of a useful resource that is already available. Perhaps one immediate use of such a fund could be to reinstate national access to DTB? 1. Johnson J, Dutton S, Briffa E, Black DC. Broadband learning for doctors. BMJ. 2006;332:1403-4. 2. Commercial influence and the content of medical journals. Lexchin J, Light DW. BMJ. 2006;332:1444-7. 3. Collier J. The price of independence. BMJ. 2006;332:1447-9. 4. Letter from Drugs and Therapeutics Bulletin to current recipients, May 2006. 5. www.nelh.nhs.uk, now in the process of migrating to the National Library for Health (www.library.nhs.uk) 6. Godlee F. What price integrity? BMJ. 2006;332(7555). Competing interests: FHS finds DTB a useful source of evidence based medicine |
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