Problem-based learning in continuing medical education: review of randomized controlled trials.

OBJECTIVE: To investigate the effects of problem-based learning (PBL) in continuing medical education. DATA SOURCES: PubMed, MEDLINE, EMBASE, CINAHL, and ERIC databases were searched for randomized controlled trials published in English from January 2001 to May 2011 using key words problem-based learning, practice-based, self-directed, learner-centered, and active learning, combined with continuing medical education, continuing professional development, post professional, postgraduate, and adult learning. STUDY SELECTION: Randomized controlled trials that described the effects of PBL on knowledge enhancement, performance improvement, participants' satisfaction, or patients' health outcomes were selected for analysis. SYNTHESIS: Fifteen studies were included in this review: 4 involved postgraduate trainee doctors, 10 involved practising physicians, and 1 had both groups. Online learning was used in 7 studies. Among postgraduate trainees PBL showed no significant differences in knowledge gain compared with lectures or non-case-based learning. In continuing education, PBL showed no significant difference in knowledge gain when compared with other methods. Several studies did not provide an educational intervention for the control group. Physician performance improvement showed an upward trend in groups participating in PBL, but no significant differences were noted in health outcomes. CONCLUSION: Online PBL is a useful method of delivering continuing medical education. There is limited evidence that PBL in continuing education would enhance physicians' performance or improve health outcomes.

Factors Affecting the Quality of Diabetic Care in Primary Care Settings in Oman: A qualitative study on patients' perspectives.

OBJECTIVES: The quality of services delivered to type 2 diabetic patients in primary health care has an important impact on long-term outcomes. The aim of this study is to explore diabetic patients' views of factors affecting quality of diabetic services delivered in primary care in Oman, a developing country with a high burden of diabetes. METHODS: Semi-structured face to face interviews were conducted with 19 type 2 diabetic patients recruited from four selected primary healthcare centres (PHCs) in Muscat region, the capital city of Oman. A framework approach was used to analyse the qualitative data. RESULTS: PARTICIPANTS IDENTIFIED SEVERAL FACTORS WHICH COULD AFFECT THE QUALITY OF DIABETIC SERVICES PROVIDED IN PHCS: delays in the follow-up process; lack of continuity of care; diabetes educational materials unavailable in waiting areas; shortage of Omani nurses able to speak the patients' language; inadequate explanations from the attending primary care physician (PCP); under involvement of dieticians in patient management; delays in provision of laboratory results; inadequate supplies of diabetic medication between appointments, and long waits to see ophthalmologists. CONCLUSION: Several factors were identified by diabetic patients that may influence the quality of diabetic services provided in the PHC setting in Oman. Health care professionals and decision makers in the Ministry of Health (MOH) and other health care sectors in Oman should consider patients' views and concerns in order to improve the quality of diabetic care services in primary health care.