title: Can outcome-based continuing medical education improve performance of immigrant physicians?
abstract: BACKGROUND
  Immigrant physicians are a valued resource for physician workforces in many countries. Few studies have explored the education and training needs of immigrant physicians and ways to facilitate their integration into the health care system in which they work. Using an educational program developed for immigrant civilian physicians working in military primary care clinics at the Israel Defence Force, we illustrate how an outcome-based CME program can address practicing physicians' needs for military-specific primary care education and improve patient care.
  
  
  METHODS
  Following an extensive needs assessment, a 3-year curriculum was developed. The curriculum was delivered by a multidisciplinary educational team. Pre/post multiple-choice examinations, objective structured clinical examinations (OSCE), and end-of-program evaluations were administered for curriculum evaluation. To evaluate change in learners' performance, data from the 2003 (before-program) and 2006 (after-program) work-based assessments were retrieved retrospectively. Change in the performance of program participants was compared with that of immigrant physicians who did not participate in the program.
  
  
  RESULTS
  Out of 28 learners, 23 (82%) completed the program. Learners did significantly better in the annual post-tests compared with the pretests (p <.01) and improved their OSCE scores (p <.001). Most program graduates (90%) rated overall satisfaction as very good or excellent. In comparison with nonparticipants, program graduates performed better on work-based assessments (Cohen's d =.63).
  
  
  CONCLUSIONS
  Our intensive, outcome-based, longitudinal CME program has yielded encouraging results. Other medical educators, facing the challenge of integrating immigrant physicians to fit their health care system, may consider adapting our approach.
authors.affiliation: Department of Family Medicine, Clalit Health Services, Ruth & Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Israel. ocastel@zahav.net.il
authors.forename: Orit Cohen
authors.initials: OC
authors.lastname: Castel
authors.forename: Vered
authors.initials: V
authors.lastname: Ezra
authors.forename: Mordechai
authors.initials: M
authors.lastname: Alperin
authors.forename: Rachel
authors.initials: R
authors.lastname: Nave
authors.forename: Tamar
authors.initials: T
authors.lastname: Porat
authors.forename: Avivit Cohen
authors.initials: AC
authors.lastname: Golan
authors.forename: Shlomo
authors.initials: S
authors.lastname: Vinker
authors.forename: Khaled
authors.initials: K
authors.lastname: Karkabi
mesh_terms: D002983:Clinical Competence / Q000706:statistics & numerical data*; D003479:Curriculum; D004502:Education, Medical, Continuing / Q000379:methods*; D054242:Emigrants and Immigrants; D005550:Foreign Medical Graduates / Q000592:standards*; D006801:Humans; D007557:Israel; D008887:Military Medicine / Q000458:organization & administration / Q000592:standards*; D020380:Needs Assessment; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D015397:Program Evaluation; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies