만약 공식적 CME가 효과가 없다면, 왜 의사들은 여전히 참석하나?

만약 공식적 CME가 효과가 없다면, 왜 의사들은 여전히 참석하나?

If formal CME is ineffective, why do physicians still participate?

P.J. MCLEOD & A.H. MCLEOD

McGill University Centre for Medical Education, Montreal, Quebec, Canada

공식적, 전통적 CME는 주로 전문직협회, 대학, 병원 등에서 sponsored되는 학습경험이다. 일반적으로 강의, 소그룹, 등등으로 구성된 짧은 과정으로 구성된다.

Formal or traditional continuing medical education (CME)usually entails learning experiences sponsored by a profes-sional association, a university or a hospital department. It ordinarily consists of short courses featuring lectures and small groups; content experts usually do the majority of the lecturing and group facilitation. 

교수자-중심적 접근에 대해서 비판이 있어왔는데, 교수자와 학습자 간 협력이 최소화된 episodic한 방식은 non-reinforcing하고, 학습자의 요구에 제대로 반응하지 못하기 때문이다. 더 나아가 공식적 CME가 의사의 행동, 퍼포먼스, 환자성과를 변화시킨다는 근거가 부족하다. 우연하게도, 비공식적 CME는 점차 지지를 받고 있는데, 성인학습의 원칙이나 특성을 잘 보여주기 때문이다. 여기에는 자기주도학습, problem driven literature search, 실습세팅에서의 학습 등이 있다. 

Criticism is often leveled at this teacher-centered approach to enhancing learning because it is episodic, involves minimal collaboration between instructors and learners, is non-reinforcing and lacks responsiveness to learners’ needs (Moore, 1995; Grant & Stanton, 1999). Furthermore, there is limited evidence to indicate that formal CME changes physician behavior, physician performance or patient outcomes (Davis et al., 1995, 1999; Gifford et al., 1999). Coincidentally, informal CME is gaining adherents because it exemplifies the principles and features of adult learning. Prominent among these are self-directed learning, problem-driven literature searches and learning in the practice setting (Knowles, 1980; Bandura, 1986; Candy, 1991).

공식적 CME의 영향에 대한 연구는 영향력의 지표로 협소한 행동 변화만을 강조한다. 예컨대 test ordering이나 prescribing 등인데, 그러한 성과는 educational events의 효과성 지표로 삼기에는 너무 제한적이다.

Studies of the impact of formal CME tend to emphasize narrow behavior changes as indicators of impact. Test-order-ing behavior in a single clinical condition, or prescribing of a particular drug or drugs, are examples of changes which are often studied. Such outcomes are too limited to rely on as indicators of effectiveness of educational events (Grant,1999). 

A. Competence and patient care 높음

• Maintain my professional competence 1 

• Learn new knowledge and skills 2 

• Improve my understanding of concepts 3 

• Eliminate my clinical deficiencies 4 

• Reassure me that I am doing ‘it’ right 5 

• Evaluate or validate my knowledge and skills 7 

• Better meet the needs of specific patients 9 

B. Professional relationships 낮음

C. Desire for personal well-being 높음

D. Rules, regulations, economic and institutional issues 낮음

• Acquire CME credits 6 

• Maintenance of certification 8

 

B영역과 D영역의 순위가 A영역이나 C영역의 순위보다 유의하게 낮은 것을 볼 수 있다.

Perusal of the rest of Table 1 reveals that motivators in categories B and D, ‘professional relation- ships’ and ‘rules, regulations, economic and institutional issues’, are ranked significantly lower than those in categories A and C, ‘competence and patient care’ and ‘desire for personal well-being’ respectively.

설문 결과는 우리의 bias를 확인해주었다. 의사들은 공식적 CME에 여전히 열심히 참여하는데 그렇게 하는 이유나 동기는 명확하다. 우리는 공식 CME가 실제 의사의 요구를 만족시킨다거나 역량을 유지/발전시킨다고 단언할 수 없으며, 비공식적 CME에 대해서도 마찬가지이다. 두 유형의 CME 모두에 대해서 일반화가능한 hard outcome은 별로 없다. 한 저자는 공식적 CME보다 비공식적 CME를 선호하는 경향에 대해서 '트렌디한 교육법'이 그것의 효과성이 증명되지 않았음에도 이미 시도되고 검증된 방법을 대체한다고 지적했다.

The survey results confirm our biases. Practitioners are still participating actively in formal CME courses and the reasons or motivators for doing so are clear. We cannot aver that formal CME events meet actual physician needs or that they maintain or improve competence, nor can we find strong evidence that informal CME does so. There are few generalizable ‘hard’ outcomes for either type of CME. One author, commenting on the trend to favor informal over formal CME, said that ‘trendy teaching methods’ are supplanting tried and tested methods even though their benefits have not been well evaluated (Davies, 1999).

우리의 관점에서 교육자들, 특히 공식적 CME에 관여하는 교육자들은 언제나 social marketing 전략을 활용해야 한다. 그리고 이 전략은 의사들의 perceived needs를 타게팅해야한다.

In our personal view, educators, and particularly those engaged in formal CME, should always employ a liberal dose of social marketing strategies when designing CME courses (Kotler & Zaltman, 1971). These strategies can assure accurate targeting of physicians’ perceived needs.

의사들이 공식적 CME의 효과가 없음에도 참석하는 이유는 sense of security and well-being, 그리고 competent professional이 되기 위함이다.

At the outset we posed the question of why physicians attend formal CME courses if this learning format is ineffective.  They do so because they are looking for a sense of security and well-being and because they want to be competent professionals

 

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Med Teach. 2004 Mar;26(2):184-6.

If formal CME is ineffective, why do physicians still participate?

McLeod PJ1, McLeod AH.

Author information

• 1McGill University Centre for Medical Education, Montreal, Quebec, Canada. peter.mcleod@muhc.mcgill.ca

Abstract

Formal or traditional CME can be criticized because organizers often ignore adult learning principles when designing courses. Critics also suggest that formal CME courses have limited impact on attendees' behaviors and practices. The authors agree that attention must be paid to pedagogic principles to assure success of educational courses, but feel that the extant negative evidence related to the impact of formal CME is narrow in scope and of inadequate strength to seriously damn formal approaches. Survey responses were received from 853 practicing physicians who say they still regularly attend formal CME courses. They are motivated to attend to satisfy specific professional needs and for personal reasons. Formal CME is still popular despite what its critics say. The authors are convinced that attention to physicians' perceived needs, effective use of social marketing strategies, and adherence to adult learning principles can assure successful delivery of CME and that formal CME is a useful complement to physician-driven informal CME.

PMID:

 

15203529

 

DOI:

 

10.1080/01421590310001643136

[PubMed - indexed for MEDLINE]