Tian Jing, Atkinson Nancy L, Portnoy Barry, Gold Robert S
Department of Public and Community Health, University of Maryland, College Park, MD 20742-2611, USA.
J Contin Educ Health Prof. 2007 Winter;27(1):16-27. doi: 10.1002/chp.89.
Physicians spend a considerable amount of time in Continuing Medical Education (CME) to maintain their medical licenses. CME evaluation studies vary greatly in evaluation methods, levels of evaluation, and length of follow-up. Standards for CME evaluation are needed to enable comparison among different studies and to detect factors influencing CME evaluation.
A review of the CME evaluation literature was conducted on primary research studies published from January 2000 to January 2006. Studies assessing only satisfaction with CME were excluded, as were studies where fewer than 50% of the participants were practicing physicians. Thirty-two studies were included in the analyses. Determinations were made about evaluation methods, outcome measures, and follow-up assessment.
Only 2 of 32 reviewed studies addressed all evaluation levels: physician changes in knowledge and attitudes (level 2), practices (level 3), and improved patient health status (level 4). None of the studies using self-developed instruments (n = 10) provided reliability and validity information. Only 6 studies used validated scales. Twenty studies had a follow-up period of 6 months or less, and 11 had a follow-up period between 1 and 2 years.
A gold standard for evaluating the effectiveness of CME would include assessment of all 4 levels of evaluation. A valid, reliable, and adaptable CME evaluation questionnaire addressing variables in the second level is needed to allow comparison of effectiveness across CME interventions. A minimum 1-year postintervention follow-up period may also be indicated to investigate the sustainability of intervention outcomes.
医生花费大量时间参加继续医学教育(CME)以维持其行医执照。CME评估研究在评估方法、评估水平和随访时长方面差异很大。需要CME评估标准,以便在不同研究之间进行比较,并检测影响CME评估的因素。
对2000年1月至2006年1月发表的主要研究进行了CME评估文献综述。仅评估对CME满意度的研究被排除,参与者中执业医生少于50%的研究也被排除。32项研究纳入分析。对评估方法、结果指标和随访评估进行了判定。
32项综述研究中只有2项涉及所有评估水平:医生知识和态度的改变(2级)、实践(3级)以及患者健康状况的改善(4级)。使用自行开发工具的研究(n = 10)均未提供信度和效度信息。只有6项研究使用了经过验证的量表。20项研究的随访期为6个月或更短,11项研究的随访期在1至2年之间。
评估CME有效性的金标准应包括对所有4个评估水平的评估。需要一份有效且可靠、适用于评估第二级变量的CME评估问卷,以便比较不同CME干预措施的有效性。还可能需要至少1年的干预后随访期来调查干预效果的可持续性。