Does an outcome-based approach to continuing medical education improve physicians’ competences in rational prescribing?

Figures & data

Table

Practice points

There is a need to improve the rational prescribing behavior of physicians and the CME in this field in Iran. OBE approaches have been successfully used in undergraduate medical education and is starting to find its way into CME. By using an outcome-based approach in an educational intervention about rational prescribing, a significant improvement in the competencies of physicians was achieved. The improvement took place although the teachers were relatively new to the OBE approach. It is important to evaluate how educational interventions work and impact on behavior in the “real world”.

Figure 1. Flowchart of participation in the study.

Table 1.  General characteristics of eligible GPs^a for participation in the educational programs

General characteristics	Non- participants N = 46 ^a	Participants N = 112	p-value	Intervention N = 58	Control N = 54^b	p-value
Male n (%)	37 (80)	77 (71)	0.24	42 (72)	35 (70)	0.78
Age (in years) mean (SD)	42 (9.2)	39.9 (6.5)	0.07	39.2 (6.8)	40.7 (6.1)	0.23
Work experience mean (SD)	11.5 (7.2)	10.7 (4.9)	0.43	10.3 (5.2)	11.1 (4.4)	0.42

Note: ^a One 82 years old GP with 53 years work experience excluded from non-participant group before analysis.

^b Four missing cases for sex.

Table 2.  Total score (maximum = 53) for the knowledge and skills test for GPs in the intervention and control groups

	Pre-test			Post-test			Intervention effect
	Intervention mean (SD) (n = 58)	Control mean (SD) (n = 54)	p-value	Intervention mean (SD) (n = 58)	Control mean (SD) (n = 53)	p-value	Intervention effect (SE)	p-value
Score	22.2 (4.7)	21.8 (4.6)	0.626	37.3 (3.8)	23.1 (3.8)	<0.001	13.8 (1.1)	<0.001
Percentage (%) of total score	42 (8.9)	41 (8.7)	–	70 (7.2)	44 (7.2)	–	–	–
Diff. Pre-post (%)	–	–	–	29	2.5	–	26	–

Table 3.  Total score for the knowledge and skills test for GPs in the intervention (n = 58) and the control (n = 54) groups for the six different curricular topics

	Pre-test			Post-test			Intervention effect
Topic (Maximal score)	Intervention mean (SD)%*	Control mean (SD)%	p-value	Intervention mean (SD)%	Control mean (SD)%	p-value	Intervention effect (SE) percentage	p-value
1. Principles of prescription writing (19)	7.2 (3.1) 33	6.7 (3.0) 35	0.58	14.4 (2.5) 76	7.4 (2.6) 39	<0.001	6.5 (0.8) 34	<0.001
2. Adverse reactions to drugs (9)	4.2 (1.1) 47	4.2 (1.2) 47	0.90	6.3 (1.1) 70	4.3 (1.2) 48	<0.001	2.0 (0.3) 22	<0.001
3. Drug interactions (4)	2.1 (1.1) 53	2.2 (0.9) 55	0.37	2.8 (1.0) 70	2.3 (0.9) 58	0.007	0.6 (0.3) 15	0.022
4. Injections (3)	1.9 (0.7) 63	2.0 (0.4) 67	0.29	2.5 (0.7) 83	2.0 (0.5) 67	<0.001	0.5 (0.2) 17	0.001
5. Antibiotic therapy (11)	4.0 (2.0) 36	4.0 (1.9) 36	0.91	5.9 (1.7) 54	4.1 (1.4) 37	<0.001	1.8 (0.5) 16	<0.001
6. Anti-inflammatory agents therapy (7)	2.7 (1.2) 39	2.5 (1.2) 36	0.37	5.2 (1.0) 74	2.7 (1.1) 39	<0.001	2.4 (0.3) 34	<0.001

Note: *Percentage of maximum score for each topic.

Table 4.  Total observational checklist scores for the intervention and control groups from the two observers covering the six different curricular topics

Item	Intervention group			Control group
	Fully accomplished	To some extent	Not at all	Fully accomplished	To some extent	Not at all
1. Educational goals were clearly explained in the beginning	10	2	–	–	2	10
2. Opportunity for active participation in discussions for all participants	12	–	–	–	4	8
3. Trainers encourage participants to actively participate in all activities	11	1	–	–	1	11
4. Trainers manage time well	7	5	–	2	10	–
5. The class has a friendly atmosphere	12	–	–	1	10	1
6. Educational materials are given to participants	10	2	–	–	–	12
7. Educational references related to the topic are presented	7	3	2	–	–	12

Box. 1 Example of how teaching methods and learning activities were developed related to the outcome “Prescribe the appropriate number of injections”

Outline	Teaching method	Learning activities	Teacher's assessment
State objectives of lesson (5 m.)	Presentation
Consideration of real needs for prescribing injections (15 m.)	Questions/answers Activating presentation	Answers/questions Brain storming	Quality of participation
Mechanism of injections (15 m.)	Activating presentation Questions/answers	Questioning Answer to questions	Answers to teachers’ questions
Indications for injections (15 m.)	Activating presentation Questions/answers	Questioning Answer to questions	Answers to teachers’ questions
Important factors in prescribing injections (20 m.)	Show samples of real prescriptions	Group discussion	Results from individual examples
Prevalence of using injections in the world and in Iran (10 m.)	Activating presentation	Bring up and discuss own knowledge and experience	Quality of participation
Conclusion [review of the topic, answer to questions] (10 m.)	Presentation	Feedback from the group	Quality of participation