Carney P A, Dietrich A J, Freeman D H, Mott L A
Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH 03756.
Acad Med. 1995 Jan;70(1):52-8. doi: 10.1097/00001888-199501000-00014.
Although continuing medical education (CME) has long been used to inform physicians and teach specific skills, its efficacy in many areas is not well established. This randomized controlled trial assessed the effects of differing educational techniques on the cancer-control skills of 57 physicians.
The CME program was part of the Cancer Prevention in Community Practice Project in Hanover, New Hampshire, and was implemented in 1988. The program used several methods in its presentation, including interactive small-group discussion, role playing, videotaped clinical encounters, lecture presentations, and trigger tapes. Measurements included cross-sectional observations made by unannounced standardized patients (SPs) who, one year after the CME program, assessed 25 physicians who had participated in the program and 32 physicians who had not. To measure consistency in the SPs' performances and accuracy in assessing the physicians' performances, most interactions were audiotaped using a hidden microphone. Pearson chi-square, Fisher exact two-tailed test, and kappa coefficients were used for analysis.
Significantly higher ratings were found for the CME physicians in two areas: breast cancer risk-factor determination (determined maternal history: 80% versus 52%, p = .03; determined age at first period: 16% versus 0%, p = .02), and smoking cessation counseling (providing written material: 32% versus 9%, p = .03). The CME physicians were rated higher on all 19 study variables in the target areas of early detection of breast cancer and smoking cessation. The results show that the physicians' performance were better in those areas where the CME program had used performance-based learning, such as role playing or viewing and discussing a videotaped role-play encounter.
The educational techniques that rehearsed or portrayed clinical applications seem to have increased the physicians' performances of cancer-control clinical activities. The standardized-patient instrument seems to be particularly useful in evaluating interventions that address specific skills training.
尽管继续医学教育（CME）长期以来一直用于指导医生并教授特定技能，但其在许多领域的效果尚未得到充分证实。这项随机对照试验评估了不同教育技术对57名医生癌症控制技能的影响。
该继续医学教育项目是新罕布什尔州汉诺威社区实践中的癌症预防项目的一部分，于1988年实施。该项目在授课过程中采用了多种方法，包括小组互动讨论、角色扮演、临床录像观摩、讲座以及触发式录像带。测量方法包括由未事先通知的标准化病人（SP）进行横断面观察，这些标准化病人在继续医学教育项目开展一年后，对25名参与该项目的医生和32名未参与该项目的医生进行评估。为了衡量标准化病人表现的一致性以及评估医生表现的准确性，大多数互动过程都使用隐藏式麦克风进行录音。采用Pearson卡方检验、Fisher精确双侧检验和kappa系数进行分析。
继续医学教育组的医生在两个方面获得了显著更高的评分：乳腺癌风险因素判定（确定母亲病史：80% 对52%，p = 0.03；确定初潮年龄：16% 对0%，p = 0.02），以及戒烟咨询（提供书面材料：32% 对9%，p = 0.03）。在乳腺癌早期检测和戒烟的目标领域的所有19项研究变量上，继续医学教育组的医生得分更高。结果表明，在继续医学教育项目采用基于表现的学习方法的领域，如角色扮演或观看并讨论录像中的角色扮演场景，医生的表现更好。
演练或描述临床应用的教育技术似乎提高了医生在癌症控制临床活动中的表现。标准化病人工具在评估针对特定技能培训的干预措施方面似乎特别有用。
