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A Review of 50 Randomized Controlled Trials

David A. Davis, MD; Mary Ann Thomson, BHSc (PT); Andrew D. Oxman, MD; R. Brian Haynes, MD, PhD

JAMA. 1992;268(9):1111-1117.

Abstract
Objective.
—To assess the impact of diverse continuing medical education (CME) interventions on physician performance and health care outcomes.

Data Sources.
—Using continuing medical education and related phrases, we performed regular searches of the indexed literature (MEDLINE, Social Science Index, the National Technical Information Service, and Educational Research Information Clearinghouse) from 1975 through 1991. In addition, for these years, we used manual searches, key informants, and requests to authors to locate other indexed articles and the nonindexed literature of adult and continuing professional education.

Study Selection.
—From the resulting database we selected studies that met the following criteria: randomized controlled trials; educational programs, activities, or other interventions; studies that included 50% or more physicians; follow-up assessments of at least 75% of study subjects; and objective assessments of either physician performance or health care outcomes.

Data Extraction.
—Studies were reviewed for data related to physician specialty and setting. Continuing medical education interventions were classified by their mode(s) of activity as being predisposing, enabling, or facilitating. Using the statistical tests supplied by the original investigators, physician performance outcomes and patient outcomes were classified as positive, negative, or inconclusive.

Data Synthesis.
—We located 777 CME studies, of which 50 met all criteria. Thirty-two of these analyzed physician performance; seven evaluated patient outcomes; 11 examined both measures. The majority of the 43 studies of physician performance showed positive results in some important measures of resource utilization, counseling strategies, and preventive medicine. Of the 18 studies of health care outcomes, eight demonstrated positive changes in patients' health care outcomes.

Conclusion.
—Broadly defined CME interventions using practice-enabling or reinforcing strategies consistently improve physician performance and, in some instances, health care outcomes.

(JAMA 1992;268:1111-1117)

Author Affiliations
From the Departments of Family Medicine (Drs Davis and Oxman), Clinical Epidemiology and Biostatistics (Drs Oxman and Haynes), and Medicine (Dr Haynes); and the School of Occupational Therapy and Physiotherapy (Ms Thomson), Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.

Footnotes
Reprint requests to Continuing Health Sciences Education, Faculty of Health Sciences, 1200 Main St West, Chedoke Campus, Bldg 74, Hamilton, Ontario, Canada L8N 3Z5 (Dr Davis).

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