Impact of postgraduate education on physician practice for community-acquired pneumonia


  • Dr Ikai is now with the Department of Healthcare Economics and Quality Management, Kyoto University School of Public Health, Kyoto, Japan. Morimoto is now with the Center for Medical Education, Kyoto University, Kyoto, Japan. Dr Shimbo is now with the Department of Clinical Research and Informatics, Research Institute, International Medical Center of Japan, Tokyo, Japan.

  • Grant Support: This study was supported in part by a grant-in-aid (health technology assessment) from the Ministry of Health, Labor, and Welfare, Japan.

Dr Hiroshi Ikai, Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan, E-mail:


Background  Clinical practice guidelines on community-acquired pneumonia (CAP) are widely recognized by hospitals in Japan; however, little is known about the effect of postgraduate education on physicians' adherence to the guidelines or on patient outcomes.

Method  We conducted a chart review of inpatient CAP cases at a single teaching hospital in Japan from 2003 to 2005, during which the educational programme for residents was gradually reinforced by the introduction of multifaceted education and training in the management of infectious diseases. To assess the effects of this educational programme, we measured process indicators such as usage of diagnostic tests, choice of antibiotics, and clinical outcomes, including length of antibiotic treatment, length of stay, and mortality.

Results  Several improvements were observed after educational intervention: (1) more frequent blood, sputum cultures, and Gram stain tests; (2) less frequent use of broad-spectrum antibiotics as the initial empiric therapy (from 50% to 12%) and on hospital day 5 (from 66.7% to 10%); and (3) median length of stay was shorter after intervention (16.5 days to 13 days).

Conclusions  Our findings suggest that multifaceted educational intervention for residents focused on diagnostic efforts, including Gram stain and cultures, choice of antibiotics with the appropriate spectrum, and de-escalation of antibiotics, can increase adherence to CAP guidelines as well as improve clinical outcomes.