Continuing medical education has been widely criticized as ineffective; most such criticism is directed at the assumption that the mere transmission of information on new research findings is sufficient to change physician performance Eight studies published during the 1970s report changes in physician behaviour (and, in one, improved patient outcomes) as a result of CME organized on sound educational principles, including systematic effort to evaluate program effectiveness and learner achievement It is also suggested that additional information on CME effectiveness is likely to be obscured by the form in which much medical literature is presented

The effectiveness of continuing medical education: eight research reports.

Objectives Despite the broad range of continuing medical education (CME) offerings aimed at educating practicing physicians through the provision of up-to-date clinical information, physicians commonly overuse, under-use, and misuse therapeutic and diagnostic interventions. It has been suggested that the ineffective nature of CME either accounts for the discrepancy between evidence and practice or at a minimum contributes to this gap. Understanding what CME tools and techniques are most effective in disseminating and retaining medical knowledge is critical to improving CME and thus diminishing the gap between evidence and practice. The purpose of this review was to comprehensively and systematically synthesize evidence regarding the effectiveness of CME and differing instructional designs in terms of knowledge, attitudes, skills, practice behavior, and clinical practice outcomes. Review methods We formulated specific questions with input from external experts and representatives of the Agency for Healthcare Research and Quality (AHRQ) and the American College of Chest Physicians (ACCP) which nominated this topic. We systematically searched the literature using specific eligibility criteria, hand searching of selected journals, and electronic databases including: MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, The Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Abstracts of Reviews of Effects (DARE), PsycINFO, and the Educational Resource Information Center (ERIC). Two independent reviewers conducted title scans, abstract reviews, and then full article reviews to identify eligible articles. Each eligible article underwent double review for data abstraction and assessment of study quality. Results Of the 68,000 citations identified by literature searching, 136 articles and 9 systematic reviews ultimately met our eligibility criteria. The overall quality of the literature was low and consequently firm conclusions were not possible. Despite this, the literature overall supported the concept that CME was effective, at least to some degree, in achieving and maintaining the objectives studied, including knowledge (22 of 28 studies), attitudes (22 of 26), skills (12 of 15), practice behavior (61 of 105), and clinical practice outcomes (14 of 33). Common themes included that live media was more effective than print, multimedia was more effective than single media interventions, and multiple exposures were more effective than a single exposure. The number of articles that addressed internal and/or external characteristics of CME activities was too small and the studies too heterogeneous to determine if any of these are crucial for CME success. Evidence was limited on the reliability and validity of the tools that have been used to assess CME effectiveness. Based on previous reviews, the evidence indicates that simulation methods in medical education are effective in the dissemination of psychomotor and procedural skills. Conclusions Despite the low quality of the evidence, CME appears to be effective at the acquisition and retention of knowledge, attitudes, skills, behaviors and clinical outcomes. More research is needed to determine with any degree of certainty which types of media, techniques, and exposure volumes as well as what internal and external audience characteristics are associated with improvements in outcomes.

Effectiveness of continuing medical education.

Medical education can be divided into three segments: undergraduate, graduate, and continuing. Of these, continuing medical education (CME) clearly takes place for the longest time--if the practicing physician is to employ recent scientific developments that translate into optimal practice. Our assignment was to examine the past, present, and future of CME. We evaluated what forms it has taken and what forms it may take. We also include a review of the evidence of its impact.

Continuing medical education: past, present, future.

To assess the opinions of healthcare workers (HCWs) about a satellite videoconference as a means of earning continuing education credit, a telephone survey was conducted in September 1998, 1 month after a live interactive satellite video-conference on antimicrobial use and resistance. There were 180 registered sites in 45 states surveyed, representing 1,589 viewers: 764 nurses (48.1%), 201 physicians (12.6%), and 624 other HCWs (39.3%). Continuing education credit was requested by 51% of nurses, 31% of physicians, and 27% of all other HCWs. Although preferred learning formats varied, 70% of respondents said it was important to offer continuing education credit. Furthermore, 31% of the respondents stated that the video-conference influenced institutional strategies. We concluded that satellite videoconferences are a method to reach audiences around the world efficiently and effectively, provide the latest information, facilitate interaction, and meet some of the demand for continuing education credit for HCWs.

Satellite Videoconferencing for Healthcare Workers: Audience Characteristics and the Importance of Continuing Education Credits

OBJECTIVES 
To investigate the clinical findings and to identify the microorganisms in the pathogenesis of otitis externa.
 METHODS 
The symptoms and signs, as well as the bacterial flora, from the auditory canals of 70 Jordanian patients (94 ears) suffering from otitis externa were studied during the period from February 1999 to February 2000.
 RESULTS 
Pain was the most common symptom (82%). The most common sign was erythema (65%), while oedema was the least common (42%). Pseudomonas aeruginosa was found in 39%, Aspergillus in 27%, Candida albicans in 18%, Staphylococcus aureus in 18% and no growth in 8.5%. Ninety three percent of healthy ears revealed normal skin flora.
 CONCLUSIONS 
Gram-negative microorganisms (Pseudomonas aeruginosa) were the most frequently isolated pathogenic microorganisms.

Otitis externa in a localized area at the South of Jordan.

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Techniques for distance learning.

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The chronically discharging ear.