Continuing education meetings and workshops: effects on professional practice and health care outcomes.
BACKGROUND
Educational meetings are widely used for continuing medical education. Previous reviews found that interactive workshops resulted in moderately large improvements in professional practice, whereas didactic sessions did not.


OBJECTIVE
To assess the effects of educational meetings on professional practice and healthcare outcomes.


METHODS
We updated previous searches by searching the Cochrane Effective Practice and Organisation of Care Group Trials Register and pending file, from 1999 to March 2006.


METHODS
Randomised controlled trials of educational meetings that reported an objective measure of professional practice or healthcare outcomes.


METHODS
Two authors independently extracted data and assessed study quality. Studies with a low or moderate risk of bias and that reported baseline data were included in the primary analysis. They were weighted according to the number of health professionals participating. For each comparison, we calculated the risk difference (RD) for dichotomous outcomes, adjusted for baseline compliance; and for continuous outcomes the percentage change relative to the control group average after the intervention, adjusted for baseline performance. Professional and patient outcomes were analysed separately. We considered 10 factors to explain heterogeneity of effect estimates using weighted meta-regression supplemented by visual analysis of bubble and box plots.


RESULTS
In updating the review, 49 new studies were identified for inclusion. A total of 81 trials involving more than 11,000 health professionals are now included in the review. Based on 30 trials (36 comparisons), the median adjusted RD in compliance with desired practice was 6% (interquartile range 1.8 to 15.9) when any intervention in which educational meetings were a component was compared to no intervention. Educational meetings alone had similar effects (median adjusted RD 6%, interquartile range 2.9 to 15.3; based on 21 comparisons in 19 trials). For continuous outcomes the median adjusted percentage change relative to control was 10% (interquartile range 8 to 32%; 5 trials). For patient outcomes the median adjusted RD in achievement of treatment goals was 3.0 (interquartile range 0.1 to 4.0; 5 trials). Based on univariate meta-regression analyses of the 36 comparisons with dichotomous outcomes for professional practice, higher attendance at the educational meetings was associated with larger adjusted RDs (P < 0.01); mixed interactive and didactic education meetings (median adjusted RD 13.6) were more effective than either didactic meetings (RD 6.9) or interactive meetings (RD 3.0). Educational meetings did not appear to be effective for complex behaviours (adjusted RD -0.3) compared to less complex behaviours; they appeared to be less effective for less serious outcomes (RD 2.9) than for more serious outcomes.


CONCLUSIONS
Educational meetings alone or combined with other interventions, can improve professional practice and healthcare outcomes for the patients. The effect is most likely to be small and similar to other types of continuing medical education, such as audit and feedback, and educational outreach visits. Strategies to increase attendance at educational meetings, using mixed interactive and didactic formats, and focusing on outcomes that are likely to be perceived as serious may increase the effectiveness of educational meetings. Educational meetings alone are not likely to be effective for changing complex behaviours.
Norwegian Knowledge Centre for the Health Services, PO Box 7004, St Olavs plass, Oslo, Norway, 0130. louise.forsetlund@kunnskapssenteret.no
Louise
L
Forsetlund
Arild
A
Bjørndal
Arash
A
Rashidian
Gro
G
Jamtvedt
Mary Ann
MA
O'Brien
Fredric
F
Wolf
Dave
D
Davis
Jan
J
Odgaard-Jensen
Andrew D
AD
Oxman
D003226:Congresses as Topic; D004496:Education, Continuing / Q000379:methods / Q000592:standards; D006801:Humans; D017064:Process Assessment, Health Care; D011364:Professional Practice / Q000592:standards*; D016032:Randomized Controlled Trials as Topic