Ockene J K, Zapka J G
Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, North Worcester, MA 01655, USA.
Chest. 2000 Aug;118(2 Suppl):33S-39S. doi: 10.1378/chest.118.2_suppl.33s.
Although the interest in and promulgation of clinical practice guidelines have significantly increased in the past 2 decades, concern exists about their actual implementation. This article focuses on one strategy to encourage guideline implementation at the clinician level: clinician education. The objectives of the article are to review educational strategies, to consider them within the context of complementary strategies carried out at the organizational and clinic setting levels, and to outline challenges and recommendations for clinicians' continuing education.
Experience and data from relevant randomized clinical trials within an educational framework are reviewed.
Implementation of clinical practice guidelines requires a variety of skills, including assessment, appropriate delineation of a treatment and monitoring plan, patient tracking, and patient counseling and education skills. Continuing education strategies must reflect the content and teaching methods that best match the learning objectives. The pressures of current-day practices place limits on the resources, particularly clinician time, that are available for continuing education. Organizational resources must be committed to build the complementary supportive systems necessary for improved clinician practice. In addition to physicians, education must be directed at nonphysician clinicians, office staff, and administrators who also are responsible for guideline implementation.
To meet the challenges of developing clinician motivation, balancing competing demands, and treating patients with complex medical conditions, all within time constraints, clinical leaders need to design education activities that have leadership support, reflect compelling evidence, use multiple strategies and teaching techniques, and engage learners in skill building and problem solving.
尽管在过去20年里，对临床实践指南的关注和推广显著增加，但人们对其实际实施情况仍存在担忧。本文聚焦于一种在临床医生层面鼓励指南实施的策略：临床医生教育。本文的目的是回顾教育策略，在组织和诊所层面实施的补充策略背景下对其进行考量，并概述临床医生继续教育的挑战和建议。
回顾教育框架内相关随机临床试验的经验和数据。
临床实践指南的实施需要多种技能，包括评估、合理制定治疗和监测计划、患者跟踪以及患者咨询和教育技能。继续教育策略必须反映最符合学习目标的内容和教学方法。当前临床实践的压力限制了可用于继续教育的资源，尤其是临床医生的时间。组织资源必须用于建立改善临床医生实践所需的补充支持系统。除了医生，教育还必须针对同样负责指南实施的非医生临床医生、办公室工作人员和管理人员。
为了应对在时间限制内培养临床医生积极性、平衡相互竞争的需求以及治疗患有复杂疾病患者的挑战，临床领导者需要设计出得到领导支持、反映有力证据、使用多种策略和教学技巧并让学习者参与技能培养和问题解决的教育活动。
