CAT: Education, didactic: Clinical performance

About the Book <I>How to Practice and Teach EBM</i>

DIDACTIC EDUCATIONAL SESSIONS DON'T IMPROVE CLINICIANS' PERFORMANCE.

Clinical Bottom Line:
The available Level I evidence indicates that didactic sessions (lectures, even with handouts) do not improve clinicians' performance.

Appraised by: Sackett, Medicine, Oxford

Educational Scenario: You have your educational objectives and a half-day with your trainees. How much time should you allot to a didactic lecture?

Three-part Question: When I want to improve my trainees' clinical performance, does a didactic lecture (maybe with a hand-out) result in clinically significant improvements in how they look after patients?

Search Terms: none; DLS was asked to review the draft of Thomson MA et al: A systematic review of educational meetings, workshops, and traineeships to improve professional practice and health care outcomes.

The Systematic Review:
Examined MEDLINE (1966-1996) and EMBASE (1994-1996) and studied all 4 randomised trials of lectures to practicing health professionals that included objective measures of subsequent clinical performance (there were 24 trials of other educational manoeuvres in this systematic review).

Ref Learners Taught by: Clinical Outcomes Comments

1 385 French GPs A day of lectures and handouts Better use of mammography and cervical cytology No clinically important effects

2 197 US Physicians A 3 hour lecture Better use of cholesterol testing No clinically important effects

3 35 Nurses who care for diabetics 7 20-minute lectures (q 2 wks) Better care of diabetic patients No clinically important effects

4 83 post-graduate trainees and consultants in ITU 6 lectures over 6 months Better concurrent care of patients with "do not resuscitate" orders. No clinically important effects

Ref	Learners	Taught by:	Clinical Outcomes	Comments
1	385 French GPs	A day of lectures and handouts	Better use of mammography and cervical cytology	No clinically important effects
2	197 US Physicians	A 3 hour lecture	Better use of cholesterol testing	No clinically important effects
3	35 Nurses who care for diabetics	7 20-minute lectures (q 2 wks)	Better care of diabetic patients	No clinically important effects
4	83 post-graduate trainees and consultants in ITU	6 lectures over 6 months	Better concurrent care of patients with "do not resuscitate" orders.	No clinically important effects

Comments:

Study #4 had other arms that added case-conferences and rounds, and these did improve clinical performance.
This same review documented statistically significant and clinically important improvements in clinical performance when the teaching consisted of workshops that included practicing the target clinical behaviours, and in trials of face-to-face traineeships.
Note that NONE of the trials were conducted in the UK.

Expiry date: June 1998

References:

Boissel JP et al: Education program for general practitioners on breast and cervical cancer screening: a randomized trial. Rev Epidem et Sante Publ 1995;43:541-7.
Browner WS et al: Physician management of hypercholesterolemia: a randomized trial of continuing medical education. West Med J 1994;161:572-8.
Parker MT et a;: The impact of an educational program on improving diabetes knowledge and changing behaviors of nurses in long term care facilities. The Diabetes Educator 1995;21:541-5.
Sulmasy DP et al: The quality of mercy: caring for patients with "do not resuscitate" orders. JAMA 1992;267:682-6.

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