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 27 (1) Volume 27, Issue 1, Winter 2007 J Contin Educ Health Prof 2007; 27(1):16 ORIGINAL RESEARCH A Systematic Review of Evaluation in Formal Continuing Medical Education Jing Tian Nancy L. Atkinson Barry Portnoy Robert S. Gold A b s t r a c t Introduction: 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. Methods: 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. Results: 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. Discussion: 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 post intervention follow-up period may also be indicated to investigate the sustainability of intervention outcomes. Lessons for Practice A gold standard of CME evaluation would include assessment of all levels of evaluation: participant satisfaction; participant knowledge, attitude, and skills supported by a reliable and validated instrument; change in participant performance in the clinical setting supported by objectively observed data; and patient health status improvements. A valid, reliable, and adaptable CME evaluation questionnaire addressing variables in the second level (physician knowledge and attitudes) is needed to allow comparison of effectiveness across CME interventions. The CME follow-up period should be at least 12 months to detect the intervention effects and to investigate their sustainability. Research identifying recommended ways for randomization is needed in future studies. Key Words: continuing, education, medical, literature review, evaluation studies, randomized controlled trial
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