[Does continuing medical education improve the way physicians conduct their practice?].
OBJECTIVE
Physicians practicing in France are required to participate in continuing education programs in accordance with the code of deontology and the official decree on controlling medical expenditures. We reviewed the literature to analyze the efficacy of such training on the way physicians conduct their practice.


METHODS
We examined the following educational methodologies: diffusion of educational documents or guidelines, conferences and presentations, interventions by opinion leaders, direct visits at the physician's office. The analysis was based solely on publications issuing from work considered to be valid in accordance with the Cochrane collaboration: intervention trials, chronological series, before-after studies with control group.


RESULTS
The diffusion of educational material or more formal continuing education programs do not appear to have an effect on the way physicians conduct their practice. Interventions by opinion leaders have a demonstrated impact but are rarely judged clinically significant. Visits to the physician's office by specially trained health care workers have an effect but this mode of education is costly.


CONCLUSIONS
The conventional strategies, such as simple information diffusion and continuing education programs, developed to promote an evolution of clinical practices appear to be the least effective methodologies.
Durieux
P
P
Hôpital Cochin, Service de santé publique et IEPS, UFR Broussais-Hôtel Dieu, Paris. pierre.durieux@cch.ap-hop-paris.fr
Ravaud
P
P
Chaix
C
C
Durand-Zaleski
I
I
D004502:Education, Medical, Continuing; D005602:France; D006801:Humans; D010818:Practice Patterns, Physicians'; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care