Based upon a review and analysis of selected literature, the author presents a conceptual model of discrepancy analysis evaluation for planning, implementing and assessing the impact of continuing medical education. The model is described in terms of its value as a means of diagnosing errors in the development and implementation of CME. The role of explanation and prediction within the design and implementation of CME is discussed, and implications for the development of practical theories of CME are examined. Finally, the model is used as a vehicle for articulating areas of responsibility and accountability of continuing medical educators in the patient health status/physician performance/physician competence relationship.

As research has expanded in scope and diversity, application of new ideas to the programs that facilitate learning and change should have grown accordingly. However, the gap between the theories of how and why physicians learn and change their practices and the practical application of these theories appears to be wider. The research component of research and development in continuing professional development appears to be strong, but the development function appears to be weak. This presentation will describe some of the factors that have led to this gap between theory and practice and suggest some actions that may be taken to reduce this gap. Among the factors leading to the gap are the different perspectives of practitioners and scholars as to the purposes of research, the appropriate foci of studies, and the attributes of quality of studies related to continuing professional development. A traditional model of research is discussed and analyzed for its strengths and weaknesses as they relate to writing research that is relevant to practitioners. The role and function of the research problem and the conclusions of studies are described in terms of how these two parts of a research report can assist in the translation of theory and evidence into the practice. In order to illustrate how theory may be translated into practical tools and procedures, the application of the theory of change and learning to the assessment of readiness to change is reviewed briefly. Implications of this experience are described and steps that may be helpful in bridging the gap between theory and practice will be proposed. Finally, a system of research and development that can ensure a tighter link between research and practice is proposed. The next steps to achieve this kind of system are suggested in the conclusions.

To be effective change agents, continuing education (CE) professionals must be able to develop strategies that assess and affect learners' motivation to learn about specific topics and engage in specific learning activities. This article suggests a framework for assessing and influencing learner motivation. Need reduction theory based on discrepancy analysis provides one way to explain and predict health care professionals' motivation to learn. Pathgoal theory describes how learners make decisions to engage in a specific learning activity. The understanding and use of these two perspectives can help CME programmers influence learner needs and target those needs with more effective CME programs that are likely to draw high rates of participation.

Journal of Continuing Education in the Health Professions: Autumn 1999 - Volume 19 - Issue 4 - p 197-198 doi: 10.1002/chp.1340190402

The objective of this study was to determine whether participation in a readers' test of a medical journal improves knowledge recall. A quasiexperimental design was used. The study population consisted of general practitioners who were divided into three groups: group A—subscribers to journal and readers' test, group B—subscribers to journal only, and group C—nonsubscribers. All physicians were interviewed over the telephone in January and June 1994 and subjected to a knowledge test that contained nine true/false questions. Interviewers were blinded to the correct responses; physicians were unaware of the study's objective and of the second interview. In April 1994, the readers'test required its participants to indicate the correctness of statements referring to information published 2 months earlier and containing the true responses to the study's knowledge test. Statistical analysis was done via an “intention to treat” comparison of postintervention scores (minimum: 0, maximum: 9) and comparison of the change in scores from pre- to postintervention, using a twosample t-test and paired t-test, respectively. Of 373 physicians, 24 (54%), 42 (38%), and 26 (11%) in groups A, B, and C agreed to participate. Mean scores were 5.4 ± 0.68, 5.1 ±0.45, and 4.2 ±0.66 at preintervention and 6.8 ±0.77, 4.6 ±0.49, and 5.1 ±0.66 at postintervention for groups A, B, and C. Groups A and C had a statistically significant improvement in scores, with a mean change of 1.38 ±0.76 (p < 0.02) and 0.84 ± 0.67 (p < 0.02). This is the first study examining the effectiveness of readers' tests in the context of continuing medical education. Physicians participating in the readers' test had a significant improvement in knowledge scores compared to nonparticipants.

Journal of Continuing Education in the Health Professions 18(4):p 253, Fall 1998. | DOI: 10.1002/chp.1340180410

Journal of Continuing Education in the Health Professions: Winter 1998 - Volume 18 - Issue 1 - p 5 doi: 10.1002/chp.1340180102

Although learning and change have been connected in theoretical models of innovation diffusion and change theory, evidence has been limited to qualitative data. Moreover, guidance to practitioners as to how these concepts relate to practice has been limited. In order to evaluate its applications to understanding how learning is related to innovations in radiological practices, a survey based on theories of learning and change was distributed to Canadian radiologists. The study evaluated the relationships described in models presented as explanations of how and why changes are made in medical practices. It focused on the nature of the relationship among types of innovations, images of change as described by learners, and use of learning resources in self-directed curricula. Of the 1005 members of the Canadian Association of Radiology who received the survey, 352 responses were described. Responses indicated that a variety of resources for learning were used in order to learn about innovations into practice. Type of change was significantly associated with specific types of resources for learning and attributes of the image of change. Continuing education for health professionals should be based on a variety of strategies to facilitate learning rather than a single approach. Continuing medical education (CME) providers should support the self-directed learning needs of physicians as well as provide courses, workshops, and other traditional forms of CME.

This essay responds to the need for closer intellectual ties between continuing medical education (CME) and the undergraduate experience. Medical educators in each of these two phases of lifelong learning are often unfamiliar with the implications of research in each phase for the other. In order to redress this, this essay describes one of the major explanations for change and learning in clinical practice and draws implications of this model for the education of undergraduate medical students. The model includes the role of forces for change, image of change, assessment of needs for learning, and the use of learning resources in a self-directed curriculum. Specific implications for each of the phases of the change process are offered. General implications of the model and a set of new assumptions for the development of formal curriculum in undergraduate medicine are also described.

A pocket-size diary was offered to 4005 volunteers, physicians, and surgeons practicing across Canada in 10 specialties. Volunteers were requested to keep records of their self-directed continuing medical education (SD CME) activities for a period of 10 months in 1993. At the end of this period, they were surveyed to determine use of the diary, their opinion about keeping records of SD CME activities, and their acceptance of the MOCOMP* program's philosophy. A second survey was undertaken of volunteers who had not used the diary. A total of 2188 volunteers responded to the survey. Of those, 56.6% reported using the diary. Respondents concurred with four statements in the survey, which correlated with their reported use of the diary. A significant positive association was found with statements concerning their understanding of what to record, identifying which keywords to enter into the diary, and whether recording SD CME activities helped them to think about the care of patients. No correlation was found between recording activities and the ability of physicians to identify a potential impact that the SD CME activity may have on their practice. The number one reason given by those who did not complete their diaries was an abhorrence to filling in forms. Overall, the degree of compliance in using the diary was encouraging. Additionally, over two thirds of the volunteers who used the diary reported that they would personally recommend the MOCOMP program to their colleagues. The next steps for the program include developing a software tool to enhance the educational value of a personal diary for SD CME activities.

Journal of Continuing Education in the Health Professions: Winter 1995 - Volume 15 - Issue 1 - p 1-7 doi: 10.1002/chp.4750150102

The purpose of this study of health care professionals was to find answers to the following research questions: (1) What changes related to geriatrics/gerontology occurred in the last year? (2) If changes occurred, what factors caused or led to those changes? (3) Did learning play a part in the changes? Twenty randomly chosen participants in the First Summer Geriatric Institute were questioned using a semi-structured interview format. Data analysis was performed using the constant comparative methods. Changes were categorized by types (i.e., accommodations, incremental changes, and structural changes). Each change was then analyzed according to the model's framework (i.e., forces for change, clarity of image of the future change, self-assessment of learning needs, and learning activities). One half of the changes were found to be incremental changes, consisting of adjustments in some element of life or practice. The other half were structural changes involving complex additions, subtractions, or reorganization of major elements. Participant responses indicated that multiple forces were involved in each change; change was a long process involving a series of interrelated experiences. Analysis of the forces initiating change revealed that professional forces were the strongest initial forces for change, followed closely by professional/social forces. Although learning accompanied every change, the change process varied according to the type of change (e.g., workshops or classes were chosen by those making incremental changes, while colleagues and experience were chosen by those making structural changes).