title: The role of audience characteristics and external factors in continuing medical education and physician change: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.
abstract: BACKGROUND
  The Agency for Healthcare Research and Quality (AHRQ) Evidence Report identified and assessed audience characteristics (internal factors) and external factors that influence the effectiveness of continuing medical education (CME) in changing physician behavior.
  
  
  METHODS
  Thirteen studies examined a series of CME audience characteristics (internal factors), and six studies looked at external factors to reinforce the effects of CME in changing behavior.
  
  
  RESULTS
  With regard to CME audience characteristics, the 13 studies examined age, gender, practice setting, years in practice, specialty, foreign vs US medical graduate, country of practice, personal motivation, nonmonetary rewards and motivations, learning satisfaction, and knowledge enhancement. With regard to the external characteristics, the six studies looked at the role of regulation, state licensing boards, professional boards, hospital credentialing, external audits, monetary and financial rewards, academic advancement, provision of tools, public demand and expectations, and CME credit. No consistent findings were identified.
  
  
  CONCLUSIONS
  The AHRQ Evidence Report provides no conclusions about the ways that internal or external factors influence CME effectiveness in changing physician behavior. However, given what is known about how individuals approach learning, it is likely that internal factors play an important role in the design of effective CME. Regulatory and professional organizations are providing new structures, mandates, and recommendations for CME activities that influence the way CME providers design and present activities, supporting a role that is not yet clear for external factors. More research is needed to understand the impact of these factors in enhancing the effectiveness of CME.
authors.affiliation: Accreditation Council for Continuing Medical Education, 515 N State St, Ste 1801, Chicago, IL 60654, USA. Mlowe@accme.org
authors.forename: Mary Martin
authors.initials: MM
authors.lastname: Lowe
authors.forename: Nancy
authors.initials: N
authors.lastname: Bennett
authors.forename: Alejandro
authors.initials: A
authors.lastname: Aparicio
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D019317:Evidence-Based Medicine / Q000193:education* / Q000592:standards; D006801:Humans; D010819:Physician's Role / Q000523:psychology*; D017410:Practice Guidelines as Topic / Q000592:standards*; D014481:United States