Continuing medical education.

While continuing medical education (CME) is receiving increasing attention from medical educators and health administrators worldwide, many efforts need to be made to improve its performance and overall effectiveness. Traditionally, CME has depended primarily on periodic courses and conferences. These remain of unproven cost-effectiveness and often the choice of their content is not tailored to meet best the needs of the learners. It is proposed that CME activities be reshaped to depend more on supervised small-group tutorials in which the learner is an active participant in preparation and presentation. Moreover, instead of having CME activities take place once or twice a year in a distant location, a more practical format would be to plan additional activities more frequently, but less condensed, on an ongoing basis and preferably at the place of work all year round. Factors that may increase learner motivation would be to depend not only on attendance at CME activities but also on the introduction of assessment mechanisms that will measure objectively the actual desired advancement of the learners. Incentives for good learners and teachers need to be introduced. The cost of CME is heavy and can be a burden on health authorities and medical institutions. Contributions from the medical/pharmaceutical industry are acceptable provided quality control is assured and conflict of interest is avoided. Increasing use of computer-assisted teaching and modern telecommunication should, in the near future, help to reduce costs and improve effectiveness of most CME programmes.