Intended for healthcare professionals

Education And Debate

Does continuing medical education in general practice make a difference?

BMJ 1999; 318 doi: (Published 08 May 1999) Cite this as: BMJ 1999;318:1276
  1. Peter Cantillon (, lecturer,
  2. Roger Jones, Wolfson professor
  1. Department of General Practice and Primary Care, Guy's, King's and St Thomas's School of Medicine, King's College, London SE11 6SP
  1. Correspondence to: Dr Cantillon
  • Accepted 12 April 1999

Continuing medical education (CME) has undergone enormous changes in recent years in terms of its theoretical base, the methodologies used, and the expectations of what it should deliver. It has become an increasingly important concern for governments and patients as well as doctors. As reaccreditation and quality assurance programmes have become more widespread, the effectiveness of continuing medical education in changing clinical behaviour has come under closer scrutiny.

Davis defines continuing medical education as “any and all the ways by which doctors learn after formal completion of their training.”1 Grant and Stanton distinguish between continuing medical education and continuing professional development.2 Continuing medical education is seen as representing a more teacher based, didactic style whereas continuing professional development implies a more learner centred and self directed approach to learning. These terms are used interchangeably in the literature. For the purposes of this article we will refer to all postgraduate educational events as continuing medical education.

In this review we aim to describe some forces for change in continuing medical education, to summarise the findings of systematic reviews of continuing medical education, and to examine the effectiveness of postgraduate continuing medical education in general practice in particular. Do educational interventions based on general practice change doctors' behaviour and improve patient outcomes?

Summary points

  • The primary purpose of continuing medical education is to maintain and improve clinical performance

  • Its effectiveness in changing clinical behaviour has come under closer scrutiny as reaccreditation and quality assurance programmes have increased

  • Continuing medical education for general practitioners should be largely based on the work that they do

  • Needs assessment is an important component of continuing medical education, but relying entirely on individual doctors' self assessments of their learning needs may be problematic

  • Significant event audits, peer review, group based learning, and reminders by computer have all …

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