Hanna E, Premi J, Turnbull J
Department of Continuing Education, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Acad Med. 2000 Feb;75(2):174-6. doi: 10.1097/00001888-200002000-00017.
Noticing that moderately to severely incompetent physicians (as measured by a standardized assessment of physician competence) did not improve after traditional remedial continuing medical education (CME), the authors investigated the effects of a polyvalent, intensive, prolonged educational intervention on five physicians' competence.
The five physicians participated in a CME program that lasted three years and consisted of individualized review, ongoing small-group and evidence-based discussions, simulated patients and role playing, formal chart review, and peer review. At the end of the program, the physicians were reassessed.
Only one physician improved; another remained the same, and three deteriorated.
Successful remediation of severely incompetent physicians is uncertain at best, even with prolonged, intensive CME that incorporates modalities thought to be effective in changing physicians' behaviors. Alternative educational techniques may need to be developed for this select population. Conversely, there may be reasons that preclude improvement even with optimal techniques.
注意到中度至重度能力不足的医生（通过对医生能力的标准化评估来衡量）在接受传统的补救性继续医学教育（CME）后并无改善，作者调查了一种多价、强化、长期的教育干预对五位医生能力的影响。
这五位医生参加了一个为期三年的CME项目，该项目包括个性化复习、持续的小组及循证讨论、模拟患者及角色扮演、正式的病历审查和同行评审。在项目结束时，对医生进行了重新评估。
只有一位医生有所改善；另一位维持原状，三位则出现恶化。
即使采用了被认为能有效改变医生行为的长期、强化CME，对重度能力不足的医生进行成功补救充其量也不确定。可能需要为这一特定人群开发替代教育技术。相反，即使采用最佳技术，也可能存在妨碍改善的原因。
