Evaluation of the effectiveness of an international diploma course in tropical medicine.

BACKGROUND: Numerous impediments to conducting continuing education (CE) courses in remote sites, particularly those courses that take place in developing countries, can include challenges associated with planning, infrastructure, and financial risk. This study reports the effectiveness of a course planned in the United States and executed in Peru, the Gorgas Course in clinical tropical medicine. METHODS: A survey was conducted of participants who had completed the Gorgas Course as recently as 6 months and as long as 3 years earlier. The questionnaire sought to determine each participant's reason for participation, whether the course was instrumental in the participant's reaching the personal goal associated with participation, and whether the participant considered the course to be worth the time and money spent to enable participation. RESULTS: Forty-nine participants responded to the questionnaire, all of whom indicated that the Gorgas Course enabled achievement of the personal goal associated with participation. Fully 100% of course participants stated that participation was worth the time and monetary expenditure, most often citing their having access to patients with tropical diseases and the personal enrichment of living overseas as reasons the course was worth its high cost. FINDINGS: It is logistically and financially feasible to conduct CE courses in developing countries, provided that the organization in the planning country has strong, pre-established relationships with the host institution(s). Continued collaboration between planning partners and frequent, rigorous course evaluations are necessary to enable an international CE course to become a stable, continuous academic offering.

Medcast: evaluation of an intelligent pull technology to support the information needs of physicians.

This study reports the initial results of an evaluation of Medcast, a commercial medical information service that uses intelligent pull technology to deliver medical information to practicing physicians. Medical news, CME, and other information are transferred by modem nightly to the physician's computers where this information can be accessed at a convenient time. A survey was faxed to 195 subscribers to the system. A total of 73 (39%) responded. The results indicate that prior to implementation of the Medcast system, almost 40 percent of the respondents did not use their computers for professional activities because of time constraints, costs and computer literacy problems. After implementation of Medcast, almost 70 percent of the respondents used the system two or more hours per week. Ninety percent of the respondents felt that use of the system has enhanced their practice. These findings have important implications for future efforts to implement medical informatics applications to support the information needs of practicing physicians. Experience with intelligent pull technology that is relatively easy to use may be a good way to break down attitudes and barriers to the use of computer systems to support clinical practice and may prepare physicians for a wider use of the Internet to support their future information needs.

An intervention to increase physicians' use of adherence-enhancing strategies in managing hypercholesterolemic patients.

PURPOSE: Patients' lack of adherence to medical regimens frustrates many practicing physicians. This study was conducted to determine the effectiveness of a combined continuing medical education intervention in increasing physicians' adherence-enhancing skills and improving hypercholesterolemic patients' health. METHOD: A prospective, randomized, controlled trial was designed using a nested cohort of 28 community physicians throughout Alabama and 222 of their hypercholesterolemic outpatients. The intervention, carried out in 1998, consisted of three interactive case audio-conferences plus chart reminders. Physicians' learning was measured by unannounced standardized patients, and patients' health by serum cholesterol levels, weight, knowledge of hypercholesterolemia, self-reported dietary habits, and health status. RESULTS: No significant difference was found in the numbers of physician adherence-enhancing strategies, although the number did increase within the treatment group. There were significant differences in the intervention group's patients' knowledge of cholesterol management (p = .008) and significant reductions in their self-reported consumption of dietary fats (p = .002). A significant difference was found in the serum cholesterol level of men in the intervention group nine months after the intervention (p = .02). CONCLUSION: Combining a series of interactive case audio-conferences with chart reminders shows promise in increasing physicians' adherence-enhancing strategies. In chronic disease management, the problem of enhancing adherence remains complex.

The changing paradigm for continuing medical education: impact of information on the teachable moment.

The teachable moment is the time when a learner is ready to accept new information for use conceptually or in practice. Adult educators are always searching for that "moment" and models in which it has been incorporated. This article reviews the changing paradigm for continuing education of the health professional and the impact of information from the context of university-based providers of continuing education and information. Providers of continuing education and information face similar external opportunities and threats. The continuing education provider is a "marginal dweller" in the organization. The information provider (the library), although moving in that direction as technology affects the way information is accessed and managed, is much more a part of the core institutional mission. These parallel conditions provide opportunities for both organizations to work closely together to identify successful models to serve the "teachable moments" of all health care practitioners. A range of new library roles that suggest strong interaction with continuing educators is presented. Workable models are identified as well as characteristics of successful models. Suggestions for survival for continuing educators and librarians in "stalking the teachable moment" are discussed.

Dynamics of the marketplace: key issues, new linkages, and successful organizational models in academic CME.

Following an initial description of the marketplace for CME, the article identifies and explores six key issues for the future of academic CME: evolution of the academic health center; practice changes and reimbursement; impact of technology; regulatory influences; proliferation of CME providers; and medical school leadership. The author then turns to a discussion of new ways to link CME with practitioners--through academic health centers, within various practice environments, through technology, in the regulatory arena, and by developing relationships with competing groups and organizations. Finally, the article suggests several organizational models with potential for expanding these linkages.