Journal of Continuing Education in the Health Professions



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CURRENT ISSUE BACK ISSUES SUBSCRIBE ADVERTISE ABOUT JCEHP FOR AUTHORS JCEHP AWARD SEARCH (Members only) FULL-TEXT		Volume 22 (4) Volume 22, Issue 4, Fall 2002 J Contin Educ Health Prof 2002; 22(4):244-251 INNOVATIONS IN CONTINUING EDUCATION Changing physicians' competence and performance: finding the balance between the individual and the organization Grol R A b s t r a c t There are serious problems associated with the underuse, overuse, and misuse of health care. Part of the solution involves changing practicing physicians' competence and performance, but this proves to be a difficult task. People differ widely in their views of how the behavior of physicians can be effectively changed. Some approaches focus on improving the knowledge, skills, or attitudes of professionals, whereas others believe in changing the social interaction and collaboration within teams or changing the organizational or political context. Some believe in self-motivation and regulation by those who need to change, whereas others emphasize external stimuli, pressure, or control. However, systematic reviews show that no current approach is superior for all purposes and target groups and that we may need them all, well integrated, to achieve effective improvements in patient care. Educational activities for professionals are not sufficient and should be combined with activities and measures at other levels. Those wishing to improve the competence and performance of physicians must be aware of the limitations of educational approaches and know how to integrate these with approaches that focus on teams, organizations, or the political or economic context. Teachers of physicians need to develop their knowledge and skills in these areas to be successful. Lessons for Practice Reflections as presented in this article lead to some personal lessons for those wanting to improve clinical competence and performance: The main aim of CME is improving patient care through the complex process of improving professionals' knowledge, skills, and attitudes. Those wishing to improve competence and performance must learn about the strengths and limitations of available educational approaches. They must also understand the assumptions underpinning these approaches. Educational approaches must be integrated with other approaches to address the differing needs of learners, who are themselves at different stages of change. Strategies for improving performance must be adapted to the needs of the learners, the barriers to change, and the settings in which the learners work. Strategies focusing on individual professionals should be integrated with strategies addressing teams, organizations, and the wider environment (patients, policy makers, etc.). At the practitioner level, educational activities should be integrated with other approaches such as evidence-based medicine, guideline development, performance assessment and accountability, and total quality management. Teachers of practicing clinicians should develop their skills and knowledge in a wider field of quality improvement and change management so that they evolve from educators (providing information and skills to physicians) into real "change agents" (changing patient care). This requires an understanding of the complexity of changing practice and the skills necessary to change it. MeSH Terms: Clinical Competence; Diffusion of Innovation; Education, Medical, Continuing; Evidence-Based Medicine; Health Services Misuse; Learning; Patient Care Team; Physician's Practice Patterns; Quality Assurance, Health Care; Support, Non-U.S. Gov't
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