A method of self-directed learning in continuing medical education with implications for recertification.

A method of self-directed learning for physicians that can be used to satisfy a portion of specialty board recertification requirements integrates contract learning (self-formulated learning plans), information brokering (linking physicians with consultants and community resources), and collegial networking (discussion groups). The method encourages physicians to focus on educational objectives, supplies learning resources, and promotes interactions with colleagues in study groups. Fifty-nine (53%) of the 102 learning goals update physicians' knowledge. Print sources and discussions with experts were the commonest resources used. Forty-five (49%) of 91 participants completed their learning plans. Forty-nine (74%) completed projects were judged successful in achieving their goals. Twenty-five (45%) of 56 physicians responding to a questionnaire stated that the method was superior to traditional continuing medical education. Fifty-two percent of the participants found the method as effective as traditional continuing medical education. Proof of accomplishment allows the method to be used as part of a specialty board recertification process.

Epidemiologic aspects of a St. Louis encephalitis outbreak in Mesa County, Colorado.

An epidemic of St. Louis encephalitis in 1985 in Mesa County, Colorado, led to 17 cases, including one fatality. Risk was associated with advanced age and residence in Grand Junction, the county's principal city. A trend was observed toward higher risk in females. However, increased risk in females was not associated with higher infection rates (increased exposure). Capture enzyme immunoassays detected specific immunoglobulin M (IgM) and immunoglobulin A after infection. A serosurvey of Grand Junction residents disclosed an infection rate of 4.0%, indicating that 1,123 epidemic St. Louis encephalitis infections may have occurred in the city. Evidence of previous St. Louis encephalitis virus infection was found in 11.2% of survey respondents who had neutralizing antibody to the virus without specific IgM. The prevalence of St. Louis encephalitis virus antibody was similar to rates observed in serosurveys undertaken 30 years earlier, indicating that the level of endemic St. Louis encephalitis transmission in the city had not changed appreciably in that interval.

Changing prescribing practices through individual continuing education.

In a study involving 94 practicing physicians, committees of clinical pharmacologists analyzed copies of prescriptions (and additional relevant clinical data) to identify problems in prescribing ("educational needs"). Only the ten most commonly prescribed drugs were studied in the samples of 200 prescriptions from each physician; 1061 problems were identified in the prescriptions of the 94 participants. One physician group (n = 41) received feedback (instructional packets) addressing specific problems in prescribing; a second sample consisting of 200 prescriptions was then collected and analyzed. The physicians in this group changed their prescribing practices 30% of the time in accordance with recommendations, whereas those in the group that received no educational feedback changed in only 3% of the cases. When a physician stated an intention to change, an actual change resulted 50% of the time. Individualized teaching in response to real events in practice is a practical and effective method of improving physician performance.

Access to data and the information explosion: oral contraceptives and risk of cancer.

This report describes a technically feasible method to deal with the enormous volume of literature published regarding oral contraceptives. This subject was discussed in 3735 publications during the period from November 1977 through October 1980. Our findings showed that those papers reporting original, numeric relationships involving risk of cancer and use of oral contraceptives were one percent of the total 3735 publications. However, only seven of the 27 articles involved were authored by individuals from departments of obstetrics and gynecology. Further, only four of the 27 were published in journals devoted to obstetrics and gynecology. The analyses suggest a form of censorship taking place, in that the obstetrics/gynecology specialists do not have ready access to the primary data.

PIP: Effective decision making necessitates access to pertinent data. Because of information explosion, however, the mechanisms used in the literature review process can overwhelm a researcher or a practitioner. This paper describes a technically feasible method for dealing with a current large volume situation using the subjects oral contraceptives and risk of cancer as examples. The National Library of Medicine's MEDLARS system identified 3735 citations covering the period November 1977 through October 1980 at the time of the survey. It was found that papers reporting original numeric relationships involving risk of cancer and use of oral contraceptives were 1% of the 3735 publications and only 7 of 27 articles involved were authored by individuals from depts. of obstetrics and gynecology. Only 4 of the 27 were published in the obstetric/gynecology journals, suggesting that obstetricians/gynecologists are not having ready access to primary data. The authors therefore recommended an information processing technique which separates the analysis into 2 parts: 1) the mechanical, performed by the technician; and 2) the cognitive, performed by the professional. The technician examines the cited article and classifies it relative to the presence of numeric displays, originality of work reported, and inclusion of data of interest to the professional. The cognitive functions are left to the professionals. This process provides relevant articles and identifies verifiable reasons for excluding others. It is also effective in terms of cost and time. In this survey, the retrieval; analysis; and photocopying took 14 days or 112 hours. In contrast, the professional time traditionally spent in reviewing citations before the retrieval process begins is about 7 hours (given 741 citations containing 250,000 words and reading time of 600 words per/minute. Also, the accuracy of selections using the title; abstract; and indexing terms is questionable given the variable nature of matching author's and user's purposes and the presence of specific indexing terms and the relationships of interest to the user. The literature search and analysis described in this paper is particularly effective in isolating articles with relevant data directed to different medical groups.

Determining educational needs in the physician's office.

Techniques to identify educational needs from real events in office practice are usually unwieldy, intrusive, and expensive. We are developing an approach based on review and analysis of individual physicians' prescriptions. This technique imposes little additional effort on the participating physician, yet effectively identifies problems in drug prescribing that can lead to specific educational remedies. Experience with 44 physicians using the system shows wide variation in prescribing practices as well as in the needs identified. The problems can be grouped into seven major categories: inappropriate indications; excessively frequent prescriptions for certain drugs; prescription of drugs with abuse potential; inadequate instructions; excessive dosage, especially in elderly patients; prescription of ineffective drugs; and potential drug interactions. The method offers promise as a component of an individualized guidance system linking continuing medical education with actual medical practice.

Continuing education and library services for physicians in office practice.

A program is described which incorporates library services into continuing medical education for physicians. The educational service is based on the actual needs of the physician rather than on his perceived needs. The needs assessment is accomplished by reviewing drug-prescribing habits. Current medical literature is then selected for the physician to coincide with his unique educational needs. The program is further designed to evaluate the change in the physician's drug-prescribing habits as a result of his study of the literature received.