Integrating continuing medical education and faculty development into a single course: Effects on participants’ behaviour

Abstract

Background: Integrating continuing medical education (CME) and faculty development (FD) into a single course can save time for physicians with teaching responsibilities. However, little is known about the effectiveness of integrated courses.

Aim: To determine if there are differences in effectiveness between the CME and FD items as they were integrated in one course.

Methods: Using the commitment-to-change model to assess plans for change from all participants and reported implementation of plans three month after courses. This model is suitable for stimulating and assessing effectiveness of CME. Unplanned changes were also recorded.

Results: One hundred and twenty-seven respondents (of 182 participants) referred to 266 planned changes (out of 384), of which 168 (63%) were reported as implemented. Furthermore, 83 non-planned changes were indicated. In total 251 changes were reported and demonstrated that CME as well as FD items were effective.

Conclusions: This study reveals that integrating CME and FD into a single course is highly effective in changing physicians’ medical practice as well as teaching practice. Although all course items were effective, participants choose more FD items than CME, so future research has to focus on which variables determine those choices.

Introduction

To ensure quality of care through lifelong learning, physicians participate in continuing medical education (CME). In addition, physicians with teaching responsibilities have to develop and maintain their skills by attending teacher training, also known as faculty development (FD). In general, CME and FD are organized separately, thereby competing for physicians’ time and interest. Courses that integrate CME and FD in time and place have been developed to minimize this competition for time (Nieman 1999). However, little is known about the effects of medical and teaching training when integrated in one course.

Practitioners are self-directed learners who choose their own learning goals (Knowles 1998). Differences in the physicians’ choices for medical or teaching content can thereby lead to differences in the effectiveness of an integrated course.

The literature on integrated courses is scarce. One course was described as a short three-hour workshop, integrating medical and teaching content on breast cancer for a small group of 26 physicians (Green et al. 2003). Of the 22 respondents, 19 reported at least one change in personal practice due to the workshop. Another integrated course was on teaching and providing end-of-life care, organized as an intensive course of two one-week full-time sessions for 149 multidisciplinary participants including physicians, nurses, social workers, pharmacists, ethicists and other health professionals (Sullivan et al. 2005). As the authors used different measurements for changes in practice, comparison of medical and teaching course content was impossible, and nor were the results specified for the group of physicians. The aim of our study, therefore, was to explore the effectiveness of an integrated course on psychopathology (CME) and one-on-one teaching skills (FD) for general practitioner (GP) trainers to find out whether an integrated course is not only efficient but also effective. We formulated the following research questions:

1. Which medical and/or teaching topics do participants in an integrated course choose to implement in their daily practice?

2. Which of these intended ‘plans for change’ are implemented after three to five months?

Table

Practice points

Integrating medical and teaching content for physicians into a single course can be a promising alternative to conventional separate CME and FD. For physicians with teaching responsibilities, this approach also saves time. In our integrated course on psychopathology (CME) and one-on-one teaching skills (FD) for general practitioner (GP) trainers, participants reported changes in their medical and teaching practices. Participants preferred FD course content for planning changes, but three-month follow-up showed CME as well as FD content to be implemented in practice.

Methods

Participants

The integrated course took place in Beekbergen, the Netherlands. Six groups with each 29–33 GPs, with experience in one-on-one teaching participated, thereby earning CME as well as FD accreditation points.

Course design

The integrated course consisted of two times two days, with a break of six to eight weeks, and comprised topics in psychiatry and one-on-one teaching (Table 1). The course time was equally divided between medical and teaching topics in time and frequency: on each day of the course the sessions on medical and teaching topics alternated. Integration of course topics took place during interactive sessions where participants were invited to use the former content during the next session. For example, when they learned about Leary's rose as a model for communication in one-on-one teaching, in the next session that model was used to learn more about personality disorders in daily GP practice. The course design was based upon educational standards to maximize the educational effect, using different interactive teaching techniques, workshops, peer groups and role-playing (Steinert et al. 2006; Satterlee 2008).

Table 1  Plans to change (statement) of 182 participants

Topics	Numbers of plans (% of total)
Teaching	302 (79%)
Leary's rose	109
Set-up and use of video's	89
Evasive behaviour of the GP trainer	84
Assessment and feedback	20
Medical	82 (21%)
Addiction care	27
Anxiety disorders	26
Personality disorders	16
Common psychopathology	13
Total	384

Outcome measures

Self-reported changes in practice were measured using the “commitment to change” – method (CTC). This method has proved to be useful in both stimulating and assessing the effectiveness of continuing education interventions (Mazmanian & Mazmanian 1999). To answer the first research question, we asked the participants to ‘specify two changes you will make in your practice as a result of the course’. This statement survey was a mandatory part of the last day of the course. To answer the second research question, we mailed participants a follow-up survey three months after the course, together with a copy of their original CTC-statement. For each ‘plan for change’ in their statement they had to indicate whether and, if so, how it had been implemented. Subsequently, we asked whether additional, non-planned changes in daily practice had been made. Open-ended questions were used in both surveys and converted into numerical variables by the first two authors. Only changes that clearly derived from the course content were included in this study. As it was no aim of this study we did not gather any information about the why or how the participants made their choices for their planned changes nor for the implementation.

Results

Statement-survey

All 182 participants completed the statement survey on the last day of the course; most participants chose two course topics, seven participants chose one, 25 participants chose three and one participant chose four topics as ‘plans for change’.

Plans for change

The 182 participants specified a total of 384 medical and teaching topics in their ‘plans for change’. The most mentioned topic was ‘Leary's rose’, the least mentioned was ‘common psychopathology’ (Table 1).

Follow-up survey

Within three to five months after the course 127 respondents (70% of 182 participants) sent back the follow-up survey.

Implementation of ‘plans for change’

The respondents referred to a total of 266 topics from their earlier statements and reported 168 of the planned changes (63% of 266) as implemented (Table 2).

Table 2  Responded and implemented changes (follow-up) of 127 respondents

Topics	Responded	Implemented (% of responded)
Teaching	214	140 (65%)
Leary's rose	79	62(79%)
Set-up and use of video's	68	38 (56%)
Evasive behaviour of the GP trainer	52	32 (62%)
Assessment and feedback	15	8 (53%)
Medical	52	28 (54%)
Anxiety disorders	17	7 (41%)
Addiction care	16	9 (56%)
Personality disorders	11	9 (82%)
Common psychopathology	8	3 (38%)
Total	266	168 (63%)

Almost every topic showed an implementation of more than 50%, indicating that more than half of the respondents, who planned to change that topic, reported that change as implemented in practice.

There were also 82 respondents (65% of 127) who reported that they had implemented changes related to topics other than those intended. A total of 83 non-planned changes were implemented (Table 3).

Table 3  Other implemented changes (follow-up)

Topics	Numbers (% of total)
Teaching	38 (46%)
Leary's rose	28
Assessment and feedback	5
Set-up and use of video's	3
Evasive behaviour of the GP trainer	2
Medical	45 (54%)
Personality disorders	26
Common psychopathology	14
Anxiety disorders	3
Addiction care	2
Total	83

Respondents

Spotlighting the respondents, a total of 113 (89% of 127) reported that they had implemented at least one of their ‘plans for change’. Of the remaining 14 respondents, seven reported that they had implemented change in other topics than the intended ones. And seven respondents reported no change. Consequently, 120 respondents (94% of 127 respondents and 66% of 182 participants) reported an implemented change for at least one topic from the integrated course. Twenty-nine (48%) out of 61 respondents who did not implement change in one of their planned teaching topics implemented change in a medical topic instead.

Discussion

This study shows that on completion of this integrated CME/FD course, GP trainers choose teaching topics as well as medical topics when planning to change their daily practice. Almost two-thirds of the intended changes were made and two-thirds of the participants described at least one change in daily practice. This indicates that the integrated course impacted on medical and on teaching practice.

Participants and respondents showed a clear preference for teaching topics with ‘Leary's rose’ being the most frequently chosen topic. This could be because of the general applicability of this topic, as ‘Leary's rose’ is a communication-model put forward in 1957 by the psychologist T. Leary (Leary 1957). This model was taught in our course for use in one-on-one teaching with GP-trainees, but it was also used in the item about dealing with personality disorders. The open questions from the follow-up survey revealed that ‘Leary's rose’ was also used in various settings with trainees, patients, colleagues or even families. However, in addition to its general applicability, using this model in CME and FD course content also meant that slightly more time was spent on the topic, which could be another reason for choosing it as a plan for change. A third reason could be that this item is seldom taught in CME and not in FD courses alone. The item least chosen was ‘common psychopathology’, perhaps because it was too universal for concrete implementation in general practice.

As clinical practice as well as teaching practice is influenced by many factors, changing physicians’ performance is complex. We can confirm the findings of a few smaller studies that used a ‘commitment to change’ model to measure the effectiveness of CME, reporting implementation of 50–67% of planned changes (Wakefield 2004; Domino et al. 2011). Previous studies showed that goal commitment predicts actual behaviour in general, and in particular, within CME (Wakefield et al. 2003; Perkins et al. 2007). In addition, a review of the effectiveness of FD indicates that our integrated course is comparable to teaching courses that are taught separately (Steinert et al. 2006). Further research should investigate whether our findings are applicable to other integrated courses with different CME and FD topics.

The strengths of our study are the large number of participants and respondents, the measurement of long-term effects up to five months after the course, the well-designed course based on educational evidence of effectiveness, and the detailed outcome measure of change in practice. A possible limitation of our study is the use of self-reported changes without actual measurement of changes in behaviour. Other possible limitations of our study might be respondent-bias and the lack of a control group, as we did not compare our integrated course with separate CME or FD courses.

Conclusion

This study revealed that integrating CME and FD into a single course of two two-day sessions can lead to changes in the participating physicians’ medical and teaching practice.

Glossary of terms

Faculty development: Faculty development programs exist to enable teachers to acquire necessary professional knowledge, skills, attitudes and tools. It is an essential component for obtaining high reliability and validity of applied assessment on a day-to-day basis.

Continuing medical education: A continuous process of acquiring new knowledge and skills throughout one's professional life.

Reference: http://www.mededworld.org/Glossary.aspx

Acknowledgements

We want to thank all the participants of the Beekbergen course. We also thank J. Bouwkamp-Timmer for critical and constructive comments on the manuscript.

Declaration of interest: The authors report no declarations or conflicts of interest.