Evaluation of Continuing Medical Education for General Practitioners in the West of Scotland

Kelly, Moya Helen (1993) Evaluation of Continuing Medical Education for General Practitioners in the West of Scotland. PhD thesis, University of Glasgow.

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The 1990 Contract changes handed the choice of education to the consumer and changed the structure of postgraduate education without addressing quality. The market place ethos has encouraged the proliferation of courses especially from the pharmaceutical industry. The creation of a new financial incentive for continuing medical education (C.M.E.) has certainly encouraged attendance but below the glossy exterior of this learning package lurks many of the long-standing problems of education. General practitioners had strong negative feelings about the imposition of the contract changes. Although many had participated at C.M.E. courses, lecture style meetings remained popular. C.M.E. is now competing for time in a doctor's busy life and not only must the educational activity be worthwhile but the G.P.'s certainly made it clear that the timing of courses was important. Very few doctors had experience in practice based learning or distance learning. This was disappointing as this type of learning would be valuable for the single handed or rural doctors. Planning of future programmes should take these needs and preferences in timing into account. Course providers, as a group, have taken up their role purely as a result of their enthusiasm to do so. They tend to organise meetings on a topic which is of interest to them and at a time suitable to them rather than the consumer. Many of the meetings are in lecture style and use hospital speakers which is not the best combination to enhance learning. Providers need to have their contribution recognised with proper funding, training, protected time and secretarial back up. In its current form, attendance at courses does increase knowledge in the majority of attenders - but it could be better. Knowledge gain is greatest in disease management courses and in small group work. The initial level of an individual's knowledge may determine the potential value of that course to the doctor and therefore some form of pre course assessment may prove valuable. The level of knowledge gained at courses could be even higher if more active participation at meetings was encouraged. Doctors appeared to be more knowledgeable in health promotion and service management than disease management and therefore less value may be accrued from attendance at these types of meetings. Doubt must be cast on the value of dividing education into categories. Learning at courses is a very complex issue but it did appear to stimulate doctors to think about change but the influence was not great. Many of the intentions immediately post course fell by the wayside and never came to fruition. Doctors were most likely to change if the topics were relevant to them and this should be taken into account when planning and accrediting meetings. The changes found such as prescribing, advice to patients and referrals all impinged on patient care and therefore, if delivered properly, C.M.E. does have the potential to alter the quality of patient care. Few barriers to change were found. Many practices had decision making processes in place but despite this practice changes were few and were most likely to occur if linked in some way to practice income. If doctors are to be handed the responsibility to choose their education then they need to receive guidance in identifying their educational needs, assistance in developing a personal programme and direction in finding the most suitable activity which will be a catalyst for change and alter patient care. As it stands, education is haphazard and flawed. The Government has put a great deal of money into the new educational arrangements on the basis that it will ultimately improve patient care but evidence so far would suggest that they are getting a poor return on their investment. It would be more sensible to direct funds into improving the provision of education so that it is a more worthwhile and enjoyable feature of a doctor's personal and professional development. The West of Scotland is a large region with doctors working in a wide variety of circumstances. Many of the findings and the solutions found here would be applicable to other areas in the United Kingdom.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Additional Information: Adviser: T S Murray
Keywords: Medicine, Health education, Health sciences, Continuing education
Date of Award: 1993
Depositing User: Enlighten Team
Unique ID: glathesis:1993-76392
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 19 Nov 2019 14:46
Last Modified: 19 Nov 2019 14:46
URI: https://theses.gla.ac.uk/id/eprint/76392

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