Continuing education meetings and workshops: effects on professional practice and health care outcomes

 

Abstract

Background

Educational meetings are widely used for continuing medical education. Previous reviews found that interactive workshops resulted in moderately large improvements in professional practice, whereas didactic sessions did not.

Objectives

To assess the effects of educational meetings on professional practice and healthcare outcomes.

Search methods

We updated previous searches by searching the Cochrane Effective Practice and Organisation of Care Group Trials Register and pending file, from 1999 to March 2006.

Selection criteria

Randomised controlled trials of educational meetings that reported an objective measure of professional practice or healthcare outcomes.

Data collection and analysis

Two authors independently extracted data and assessed study quality. Studies with a low or moderate risk of bias and that reported baseline data were included in the primary analysis. They were weighted according to the number of health professionals participating. For each comparison, we calculated the risk difference (RD) for dichotomous outcomes, adjusted for baseline compliance; and for continuous outcomes the percentage change relative to the control group average after the intervention, adjusted for baseline performance. Professional and patient outcomes were analysed separately. We considered 10 factors to explain heterogeneity of effect estimates using weighted meta-regression supplemented by visual analysis of bubble and box plots.

Main results

In updating the review, 49 new studies were identified for inclusion. A total of 81 trials involving more than 11,000 health professionals are now included in the review. Based on 30 trials (36 comparisons), the median adjusted RD in compliance with desired practice was 6% (interquartile range 1.8 to 15.9) when any intervention in which educational meetings were a component was compared to no intervention. Educational meetings alone had similar effects (median adjusted RD 6%, interquartile range 2.9 to 15.3; based on 21 comparisons in 19 trials). For continuous outcomes the median adjusted percentage change relative to control was 10% (interquartile range 8 to 32%; 5 trials). For patient outcomes the median adjusted RD in achievement of treatment goals was 3.0 (interquartile range 0.1 to 4.0; 5 trials). Based on univariate meta-regression analyses of the 36 comparisons with dichotomous outcomes for professional practice, higher attendance at the educational meetings was associated with larger adjusted RDs (P < 0.01); mixed interactive and didactic education meetings (median adjusted RD 13.6) were more effective than either didactic meetings (RD 6.9) or interactive meetings (RD 3.0). Educational meetings did not appear to be effective for complex behaviours (adjusted RD -0.3) compared to less complex behaviours; they appeared to be less effective for less serious outcomes (RD 2.9) than for more serious outcomes.

Authors' conclusions

Educational meetings alone or combined with other interventions, can improve professional practice and healthcare outcomes for the patients. The effect is most likely to be small and similar to other types of continuing medical education, such as audit and feedback, and educational outreach visits. Strategies to increase attendance at educational meetings, using mixed interactive and didactic formats, and focusing on outcomes that are likely to be perceived as serious may increase the effectiveness of educational meetings. Educational meetings alone are not likely to be effective for changing complex behaviours.

 

Plain language summary

Continuing education meetings and workshops for health professionals

Educational meetings are commonly used for continuing medical education with the aim of improving professional practice and, thereby, patient outcomes. Educational meetings include courses, conferences, lectures, workshops, seminars, and symposia.

Eighty-one trials that evaluated the effects of educational meetings were included in this review. Based on these studies, we concluded that educational meetings alone or combined with other interventions can improve professional practice and the achievement of treatment goals by patients. The effect on professional practice tended to be small but varied between studies, and the effect on patient outcomes was generally less. It is not possible to explain the observed differences in effect with confidence but it appeared that higher attendance at the meetings was associated with greater effects, that mixed interactive and didactic education was more effective than either alone, and that the effects were less for more complex behaviours and less serious outcomes.

 

摘要

背景

持續教育會議及工作坊：對於專家作法及健康照護結果的影響

教育會議被廣泛地用於持續醫學教育。以前的回顧發現互動式的工作坊可造成適度地大量改善專家的做法，然而教育講習課程則不會。

目標

評估教育會議對於專家作法及健康照護結果的影響。

搜尋策略

我們檢索1999至2006年3月the Cochrane Effective Practice and Organisation of Care Group Trials Register及待辦檔案以更新以前的檢索結果。

選擇標準

客觀測量教育會議對於專家做法或健康照護結果的隨機對照試驗。

資料收集與分析

兩名作者分別摘錄資料並評估研究品質。初步分析納入低或中度偏差風險並有報告基本資料的研究。依據健康專家參與的人數進行加權。對每一種比較組，我們在調整基礎的遵從性後計算類別變項的風險差(risk difference (RD))；調整基礎的行為後計算連續變項在介入後相較於對照組之平均改變的百分比。分別分析專家及病患結果。我們考量10個因素以解釋效果的異質性，效果的估計是採用加權的統合迴歸並輔以氣泡圖與箱型圖的視覺分析。

主要結論

這次更新回顧納入了49篇新的研究。總共有81項試驗，包含超過11,000名健康專家被納入回顧中。根據30項試驗(36種比較組)，當介入措施中包含教育會議作為其中之一的要素時相較於無介入措施，遵從性與期望行為之中位數的調整後RD為6%(interquartile range為1.8至15.9)。單一的教育會議具有相似的效果(中位數之調整後RD為6%，interquartile range為2.9至15.3；根據19項試驗中的21個比較組)。相較於對照組，連續變項中位數之調整後改變的百分比為10%(interquartile range為8至32%；5項試驗)。病患結果達成治療目標之中位數的調整後RD為3.0(interquartile range為0.1至4.0；5項試驗)。關於專家做法，根據36種比較組之類別變項的單變項統合迴歸分析，愈高的教育會議出席率與愈大的調整後RDs有關(P < 0.01)；互動與訓練混合的教育會議(中位數之調整後RD為13.6)比訓練會議(RD為6.9)或互動式會議(RD為3.0)兩者更為有效。相較於較不複雜的行為，教育會議對於複雜的行為似乎不具有效果(調整後RD為−0.3)；比起較嚴重的結果，它們對於較不嚴重的結果似乎較不有效(RD為2.9)。

作者結論

單一的教育會議或合併其他的介入措施可以改善專家的做法及病患的健康照護結果。這種效果可能不大且與其他類型的持續醫學教育效果相似，如稽核與回饋，教育推廣訪查。用來增加教育會議出席率的策略，採用互動與訓練混合的形式，並針對認為可能是嚴重的結果也許會增加教育會議的效果。單一的教育會議對於複雜行為可能沒有效果。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

教育會議通常被使用於持續醫學教育中，目標為改善專家做法與病患結果。教育會議包括課程，會議，講座，工作坊，研討會與專題討論會。 這篇回顧納入了81篇評估教育會議影響的試驗。根據這些研究，我們推論單一的教育會議或合併其他的介入措施可以改善專家做法並達成病患的治療目標。對於專家做法的影響不大，但各個研究間的結果各不相同，且對於病患結果的影響通常不大。無法有信心的解釋觀察到的效果差異，但似乎愈高的會議出席率與較大的影響有關，互動與訓練混合的教育比兩者單獨來的更為有效，且對於較複雜行為與較不嚴重結果的影響較少。