Intended for healthcare professionals

Education And Debate

Continuing medical education: Learning and change: implications for continuing medical education

BMJ 1998; 316 doi: (Published 07 February 1998) Cite this as: BMJ 1998;316:466
  1. Robert D Fox, professor (,
  2. Nancy L Bennettb
  1. a Research Center for Continuing Professional and Higher Education, University of Oklahoma, Norman, OK 73037-0003, USA
  2. b Department of Continuing Education, Harvard Medical School, PO Box 825, Boston, MA 02115, USA
  1. Correspondence to: Professor Fox


    Medical education, particularly continuing medical education (CME), has been greatly influenced by studies of adult learning. The observation that it is not teaching but learning that leads doctors to change their practice has resulted in a shift in perspective: rather than education being regarded as instruction, it is regarded as facilitation of learning. This paradigm shift has been based on research into how and why doctors change their practice and into the role of learning in that process.

    The direction of continuing medical education in North America and elsewhere has changed in response to the new perspective that has emerged from contemporary studies of learning and change. The nature of this new perspective is evident from a comparison of the common elements of CME in the 1980s with the approach that is now being used. Traditionally a CME programme was an educational event that applied appropriate resources and methods to fulfill set instructional objectives. Such programmes were often considered to be good if the information was valuable, the lecturer skilful, and the setting comfortable. Too often, however, there was little or no actual effect on medical practice, even though all three conditions were met.

    The critical difference in the 1990s is that it has increasingly been accepted that CME programmes are based—or should be—on the principle of teaching and education as a means of facilitating learning. This new approach has been adopted in response to studies on how and why doctors change their performance in clinical practice and the role of learning in that process. This article describes some of these models and sets out the key principles that have emerged for continuing medical education in the past decade.

    Understanding change in clinical performance

    Summary points

    The purpose of continuing medical education is to facilitate change in clinical practice

    CME should be based on the natural processes …

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