Educational interventions to improve the effectiveness in clinical competence of general practitioners: problem-based versus critical reading-based learning.
BACKGROUND
Evidence suggests that continuing medical education improves the clinical competence of general practitioners and the quality of health care services. Thus, we evaluated the relative impact of two educational strategies, critical reading (CR) and problem based learning (PBL), on the clinical competence of general practitioners in a healthcare system characterized by excessive workload and fragmentation into small primary healthcare centers.


METHODS
Clinical competence was evaluated in general practitioners assigned to three groups based on the educational interventions used: 1) critical reading intervention; 2) problem based learning intervention; and 3) no intervention (control group, which continued clinical practice as normal). The effect on the clinical competence of general practitioners was evaluated in three dimensions: the cognitive dimension, via a self-administered questionnaire; the habitual behavioral dimension, via information from patient's medical records; and the affective dimension, through interviews with patients. A paired Student´s t-test was used to evaluate the changes in the mean clinical competence scores before and after the intervention, and a 3 x 2 ANOVA was used to analyze groups, times and their interaction.


RESULTS
Nine general practitioners participated in the critical reading workshop, nine in the problem-based learning workshop, and ten were assigned to the control group. The participants exhibited no significant differences in clinical competence measures at baseline, or in socio-demographic or job characteristics (p > 0.05). Significant improvements in all three dimensions (cognitive, 45.67 vs 54.89; habitual behavioral, 53.78 vs 82.33; affective, 4.16 vs 4.76) were only observed in the problem-based learning group after the intervention (p > 0.017).


CONCLUSIONS
While no differences in post-intervention scores were observed between groups, we conclude that problem-based learning can be effective, particularly in a small-group context. Indeed, problem-based learning was the only strategy to induce a significant difference between pre- and post- intervention scores for all three CC dimensions.
Unidad de Investigación en Salud, Instituto de Salud del Estado de Aguascalientes, Aguascalientes, Ags, Mexico.
Javier
J
Gongora-Ortega
Yolanda
Y
Segovia-Bernal
J de Jesus
Jde J
Valdivia-Martinez
J Martin
JM
Galaviz-DeAnda
Carlos A
CA
Prado-Aguilar
D002983:Clinical Competence; D003479:Curriculum; D003695:Delivery of Health Care; D003906:Developing Countries; D004502:Education, Medical, Continuing / Q000379:methods*; D058006:General Practice / Q000193:education*; D006801:Humans; D008800:Mexico; D017145:Models, Educational; D011320:Primary Health Care; D018794:Problem-Based Learning / Q000379:methods*; D058996:Quality Improvement; D011932:Reading; D016526:Workload