Does continuing medical education in general practice make a difference?
BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7193.1276 (Published 08 May 1999) Cite this as: BMJ 1999;318:1276All rapid responses
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Dear Sir
Cantillon and Jones' article comes at an important moment in the
development of general practice and gives a helpful description of what
works and what doesn't work educationally for doctors at practice level.1
The article is clear about the principles and methods involved but omits
to consider how any future education will fit the new organisational
arrangements which began on 1st April 1999. 2 Before this time the
educational agenda for doctors was largely driven from above by academic
and educational bodies. This education produced little apparent benefit
for patient care.3
Since the 1st April responsibility has been devolved and broadened so
that PCGs are now tasked with developing their own educational leadership
and promoting the education and training agenda at all levels of their
organisation.4 The issue has now become wider than just the education of
doctors. Progress in this area is a pressing priority for those of us
trying to balance needs and wants emerging from our practice teams and
matching these to resources and expertise.
This switch in responsibility highlights the gap separating PCGs and
those organisations who possess the educational expertise and control
resources. This gap needs to be filled by these organisations aligning
themselves to PCGs by building effective working relationships and being
helpful in releasing funds. Regional medical postgraduate organisations,
educational consortia, Trusts with responsibility for community staff and
health authorities need to relate directly to PCGs via a personnel link
initially and in the future through a pooled education and training
budget.
We feel strongly that practice-based education should develop the
individual and the team. To be truly effective primary health care teams
need to work, learn and plan together. 5 For patients to benefit, the
evidence outlined by Cantillon and Jones needs to be brought to bear on
the emerging plans of PCGs and incorporated into the day to day work and
education of their constituent practice teams. Systems and structures need
to adapt to support this.
Yours sincerely
Bill Cunningham
General practitioner and Clinical Governance Lead
Ann Marie Armstrong
Health Visitor and Executive Nurse
Derek Thompson
General Practitioner and Chairman
Barbara Howe
Executive Officer
West Northumberland PCG
1 Cantillon P, Jones R. Does continuing medical education in general
practice make a difference? BMJ 1999;318:1276-9
2 Secretary of State for Health. The new NHS. London: Stationary
office, 1997.
3 Calman K. A review of continuing professional development in
general practice: a report by the Chief Medical Officer. London:
Department of Health, 1998.
4 NHSE The new NHS Modern and Dependable. Primary Care Groups.
Developing the education and workforce framework. Working paper. NHSE
1999.
5 Cunningham W. Interdisciplinary practice educational meetings -
continuing education for the working primary health care team. Education
for General Practice 1995; 6:41-48.
Competing interests: No competing interests
Targeting Continuing Medical Education (CME) to Achieve Health Outcomes A preview of plans for CME i
In Australia, the traditional or adhoc approach to continuing medical
education in general practice may be giving way to educational strategies
which have been shown to change behaviour. One of the recommendations of
the General Practice Strategy Review in 1998, was that continuing medical
education (CME) activities for general practitioners (GPs) should be based
on adult learning principles, designed to reflect evidence of what works
and involve peer- and self-review processes. There are 123 Divisions of
General Practice in Australia that now operate as an important vehicle
through which GPs participate in the health system, access CME and improve
service delivery. In a pilot program, 21 Divisions were funded by the
Australian government on an outcomes basis commencing three-year contracts
at the beginning of 1998. These Divisions were recently surveyed by e-
mail to determine the type of CME activities and educational strategies
they had planned. The response rate was 100%.
CME activities are scheduled in cardiovascular disease, diabetes,
mental health, aged care, asthma, cancer, immunization, early detection of
disease and risk reduction and quality care in prescribing and test
ordering. 18 of the 21 Divisions reported educational needs assessment
were complete or planned, 14 have a GP CME coordinator, and 5 said they
have a CME program which integrates undergraduate and postgraduate
training with CME. Adult learning strategies including small group
discussions and case based presentations were planned in 20 Divisions and
all plan to conduct skills workshops. Practice based educational
activities include clinical audit (19), academic detailing/outreach visits
(13) and peer review activities (6). 10 Divisions planned to use opinion
leaders to educate GPs. The introduction of information management
systems in 19, recall/reminders in 17, decision support systems (14),
effective GP ordering programs (9) and clinical attachments (13) are
planned to enable and reinforce change in practice. 18 Divisions plan to
promote evidence-based guidelines in at least one program area. In
addition, the Divisions plan to evaluate change in knowledge (20) and
attitude (14) while 17 Divisions plan to evaluate change in practice as a
result of the CME. All plan to offer CME points as incentives while 9 are
offering financial incentives and 3 locum support.
These data suggest that more carefully considered CME programs are being
developed by Divisions as services to their members and as interventions
to achieve improvements in population health. Furthermore they also
demonstrate that as providers of CME, Divisions are incorporating the
lessons of evidence-based CME2. What remains to be seen is whether these
planned changes in CME result in or contribute to improved quality of care
and patient outcomes. Of great interest is the process by which Divisions
will engage or fail to engage the majority of general practitioners in
these non-traditional CME activities.
References
1. Commonwealth Department of Health and Family Services. General
Practice Changing the future through partnerships. Report of the General
Practice Strategy Review Group. Commonwealth of Australia 1998
2. Booth B. Does continuing medical education make a difference? Med J
Aust 1997;167:238-9
Competing interests: No competing interests