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Moorhead RG. The proposed general practice descriptors--will they influence preventive medicine? COMMUNITY HEALTH STUDIES 2010; 13:343-6. [PMID: 2691193 DOI: 10.1111/j.1753-6405.1989.tb00216.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The proposed descriptor bill to change Medicare rebates to general practice patients could have a benefit to general practice preventive medicine. This seems possible through rewarding practitioners who spend more time with their patients and the positive effects of continuing medical education. However, the potential exists for whittling away any rewards for these practitioners by future governments and the audit of general practices could become a method of political control of Australian general practice.
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Vollmar HC, Rieger MA, Butzlaff ME, Ostermann T. General Practitioners' preferences and use of educational media: a German perspective. BMC Health Serv Res 2009; 9:31. [PMID: 19220905 PMCID: PMC2662827 DOI: 10.1186/1472-6963-9-31] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Accepted: 02/16/2009] [Indexed: 12/02/2022] Open
Abstract
Background Several studies suggest that General Practitioners (GPs) prefer "traditional" media such as journals or quality circles when they are seeking out different options to meet their continuing medical education (CME) requirements. A survey was designed in order to gain a better understanding of German General Practitioners' preferences for different forms of educational media that will meet their CME needs. Methods Four hundred and forty nine (N = 449) German physicians were contacted to take part in this study on the occasion of one of their quality circle meetings. The participating physicians received a standardized 26-item-questionnaire that surveyed their preferences for different forms of educational media. A factor analysis was performed in order to determine whether the observed variables can be explained largely or entirely in terms of the underlying patterns. Results Two hundred and sixty-four physicians with an average age of 51.1 years participated (28.5% female, 71.5% male). We found that GPs favor learning environments such as: journals, colleagues, and quality circles. New media like the internet was used less often for their learning activities, even though the usage of the internet in general was quite high. The most important requirements for media in medical education as perceived by the participants were its relevancy for daily practice and dependability. Conclusion Despite a growing use of the Internet it seems that German GPs favor "classical/traditional" settings for their learning activities. These results should be taken into consideration when planning CME or CPD programs or other learning activities. Trial registration Current Controlled Trials ISRCTN36550981.
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Affiliation(s)
- Horst Christian Vollmar
- Institute of General Practice and Family Medicine, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448 Witten, Germany.
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A Continuing Medical Education Needs Assessment of Primary Care Physicians' Knowledge Awareness of Prediabetes Care. Can J Diabetes 2008. [DOI: 10.1016/s1499-2671(08)24007-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Leong CN, Shakespeare TP, Mukherjee RK, Back MF, Lee KM, Lu JJ, Wynne CJ, Lim K, Tang J, Zhang X. Efficacy of an integrated continuing medical education (CME) and quality improvement (QI) program on radiation oncologist (RO) clinical practice. Int J Radiat Oncol Biol Phys 2006; 66:1457-60. [PMID: 16979841 DOI: 10.1016/j.ijrobp.2006.07.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2006] [Accepted: 07/11/2006] [Indexed: 11/25/2022]
Abstract
PURPOSE There has been little radiation oncologist (RO)-specific research in continuing medical education (CME) or quality improvement (QI) program efficacy. Our aim was to evaluate a CME/QI program for changes in RO behavior, performance, and adherence to department protocols/studies over the first 12 months of the program. METHODS AND MATERIALS The CME/QI program combined chart audit with feedback (C-AWF), simulation review AWF (SR-AWF), reminder checklists, and targeted CME tutorials. Between April 2003 and March 2004, management of 75 patients was evaluated by chart audit with feedback (C-AWF) and 178 patients via simulation review audit (SR-AWF) using a validated instrument. Scores were presented, and case management was discussed with individualized educational feedback. RO behavior and performance was compared over the first year of the program. RESULTS Comparing the first and second 6 months, there was a significant improvement in mean behavior (12.7-13.6 of 14, p = 0.0005) and RO performance (7.6-7.9 of 8, p = 0.018) scores. Protocol/study adherence significantly improved from 90.3% to 96.6% (p = 0.005). A total of 50 actions were generated, including the identification of learning needs to direct CME tutorials, the systematic change of suboptimal RO practice, and the alteration of deficient management of 3% of patients audited during the program. CONCLUSION An integrated CME/QI program combining C-AWF, SR-AWF, QI reminders, and targeted CME tutorials effectively improved targeted RO behavior and performance over a 12-month period. There was a corresponding increase in departmental protocol and study adherence.
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Affiliation(s)
- Cheng Nang Leong
- Department of Radiation Oncology, The Cancer Institute, National University Hospital, Singapore.
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Shakespeare TP, Mukherjee RK, Lu JJ, Lee KM, Back MF. Evaluation of an audit with feedback continuing medical education program for radiation oncologists. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2005; 20:216-21. [PMID: 16497133 DOI: 10.1207/s15430154jce2004_9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Meta-analyses demonstrate audit with feedback (AWF) is effective continuing medical education (CME). However, efficacy varies between specialties, with little published radiation oncologist (RO)-specific evidence. We evaluated an AWF CME intervention for ROs determining efficacy, cost-effectiveness, and participant satisfaction. METHODS CME program: The CME incorporated fortnightly random patient chart audit, scoring management adequacy via a checklist. Scores were presented at a same-day institutional meeting, and case management discussed. Senior peers provided individualized, educational feedback. EVALUATION Changes in behavior and performance were evaluated by chart review of new patients seen by ROs in the 2 months before commencement of AWF (T0), and at months 13-14 of the program (T1). Behavior and performance were evaluated with a validated, reproducible, 19-item instrument. Criteria for each case audited included 10 targeted and 3 nontargeted behavior items and 6 performance items; each scored 1 point if deemed adequate (maximum score 19). Cost-effectiveness was reported as cost to the institution per item point gained. The mean score (out of 5) of a 14-item questionnaire evaluated program perception. RESULTS A total of 113 and 118 charts were evaluated at T0 and T1, respectively. Mean score of targeted behavior improved between T0 and T1 (from 8.7 to 9.2 out of 10, P = .0001), with no significant improvement of nontargeted behavior/performance items. Annual costs and cost-per-point gained were US 7,897 dollars and 15 dollars. Participant satisfaction was positive, increasing after efficacy result distribution (P = .0001). CONCLUSION Audit with comparative, individualized, educational feedback is cost-effective and positively perceived CME, significantly improving targeted RO behavior. Oncologists' CME design and evaluation require further research.
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Curran V, Christopher J, Lemire F, Collins A, Barrett B. Application of a responsive evaluation approach in medical education. MEDICAL EDUCATION 2003; 37:256-266. [PMID: 12603765 DOI: 10.1046/j.1365-2923.2003.01442.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
INTRODUCTION This paper reports on the usefulness of a responsive evaluation model in evaluating the clinical skills assessment and training (CSAT) programme at the Faculty of Medicine, Memorial University of Newfoundland, Canada. The purpose of this paper is to introduce the responsive evaluation approach, ascertain its utility, feasibility, propriety and accuracy in a medical education context, and discuss its applicability as a model for medical education programme evaluation. METHODS Robert Stake's original 12-step responsive evaluation model was modified and reduced to five steps, including: (1) stakeholder audience identification, consultation and issues exploration; (2) stakeholder concerns and issues analysis; (3) identification of evaluative standards and criteria; (4) design and implementation of evaluation methodology; and (5) data analysis and reporting. This modified responsive evaluation process was applied to the CSAT programme and a meta-evaluation was conducted to evaluate the effectiveness of the approach. RESULTS The responsive evaluation approach was useful in identifying the concerns and issues of programme stakeholders, solidifying the standards and criteria for measuring the success of the CSAT programme, and gathering rich and descriptive evaluative information about educational processes. The evaluation was perceived to be human resource dependent in nature, yet was deemed to have been practical, efficient and effective in uncovering meaningful and useful information for stakeholder decision-making. CONCLUSIONS Responsive evaluation is derived from the naturalistic paradigm and concentrates on examining the educational process rather than predefined outcomes of the process. Responsive evaluation results are perceived as having more relevance to stakeholder concerns and issues, and therefore more likely to be acted upon. Conducting an evaluation that is responsive to the needs of these groups will ensure that evaluative information is meaningful and more likely to be used for programme enhancement and improvement.
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Affiliation(s)
- Vernon Curran
- Faculty of Medicine, Memorial University of Newfoundland, Canada Faculty of Education, Memorial University of Newfoundland, Canada.
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Thompson RS, Rivara FP, Thompson DC, Barlow WE, Sugg NK, Maiuro RD, Rubanowice DM. Identification and management of domestic violence: a randomized trial. Am J Prev Med 2000; 19:253-63. [PMID: 11064229 DOI: 10.1016/s0749-3797(00)00231-2] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Diagnosis of domestic violence (DV) in primary care is low compared to its prevalence. Care for patients is deficient. Over a 1-year period, we tested the effectiveness of an intensive intervention to improve asking about DV, case finding, and management in primary care. The intervention included skill training for providers, environmental orchestration (posters in clinical areas, DV questions on health questionnaires), and measurement and feedback. METHODS We conducted a group-randomized controlled trial in five primary care clinics of a large health maintenance organization (HMO). Outcomes were assessed at baseline and follow-up by survey, medical record review, and qualitative means. RESULTS Improved provider self-efficacy, decreased fear of offense and safety concerns, and increased perceived asking about DV were documented at 9 months, and also at 21 months (except for perceived asking) after intervention initiation. Documented asking about DV was increased by 14.3% with a 3.9-fold relative increase at 9 months in intervention clinics compared to controls. Case finding increased 1.3-fold (95%, confidence interval 0.67-2.7). CONCLUSIONS The intervention improved documented asking about DV in practice up to 9 months later. This was mainly because of the routine use of health questionnaires containing DV questions at physical examination visits and the placement of DV posters in clinical areas. A small increase in case finding also resulted. System changes appear to be a cost-effective method to increase DV asking and identification.
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Affiliation(s)
- R S Thompson
- Department of Preventive Care and the Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington, 98101-1448, USA.
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Abstract
The development of a continuing education scheme for cytotechonologists in Australia is described. The process involved the establishment of a working party with Terms of Reference to review current practice in Australia and existing schemes in other parts of the world. The scheme developed takes the form of a continuing education diary that provides guidelines on the various forms of continuing education activity and corresponding credit points. The diary also provides for a record of activity to be kept. The scheme requires bi-annual submission of personal activity which is logged into a national database. A peer profile is provided and successful achievement is marked by the issue of a certificate of participation. The programme has achieved a 57% compliance in its first year of operation.
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Affiliation(s)
- M W Stevens
- Cytology Laboratory, Division of Tissue Pathology, Institute of Science, South Australia, Australia
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Evans KD, Sachs L. Effectiveness of a Sonography Distance-Learning Event for Continuing Medical Education Credit. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2000. [DOI: 10.1177/875647930001600402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Continuing education for sonographers is a requiremeint for them to maintain their national registry. Satellite teleconferences are an example of a distance-learning activity that provides access ad information to sonographers regardliess of the location of the participant. The difficulty with this type of continuing medical education activity is that it is unmeasured for satisfaction, relevance, and knowledge gain for sonographers. Using previous research into effective physician continuing medical education, a study was designed as an investigation of the effectiveness of a commercially sponsored distance-learning event.The results of this study suggest that a more structurd: study is necessary to validate satisfaction and relevance scores for this type of continuing medical education activity for all job titles. It is also important to begin to describe the efetiveness of continuing education distance-learning events for sonographers and other allied medical professionals.
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Affiliation(s)
- Kevin D. Evans
- Ohio State University, Columbus, Ohio; 278 Amfield Court, Gahanna, OH 43230
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Affiliation(s)
- H Pardell
- Centro de Estudios Colegiales del Colegio Oficial de Médicos de Barcelona.
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Simpson L, Kamerow D, Fraser I. Pediatric guidelines and managed care: who is using what and what difference does it make? Pediatr Ann 1998; 27:234-40. [PMID: 9589503 DOI: 10.3928/0090-4481-19980401-12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- L Simpson
- US Department of Health and Human Services, Agency for Health Care Policy and Research, Rockville, MD, USA
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Affiliation(s)
- F Davidoff
- American College of Physicians, Philadelphia, PA, USA
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Umble KE, Cervero RM. Impact studies in continuing education for health professionals. A critique of the research syntheses. Eval Health Prof 1996; 19:148-74. [PMID: 10186908 DOI: 10.1177/016327879601900202] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Documenting impact has been a continual pursuit in continuing education (CE) for health professionals. Hundreds of primary impact studies have been published, along with 16 impact study syntheses that have sought to generalize about the effectiveness of CE and sometimes how and why the effects occur. This article describes and critiques the methodology of the 16 syntheses and summarizes their findings. A first wave of syntheses established a general causal connection between CE and impacts, but explained impact variability only in the dependent variable-knowledge, competence, performance, or outcome. A second wave added a search for causal explanation through analysis of variables that moderate impact. This wave has begun to identify the most appropriate types of programs for promoting performance changes. The article concludes by suggesting questions and methods for future primary studies and meta-analyses, including improved experimental and meta-analytical methods, along with case and naturalistic studies and action research.
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Affiliation(s)
- K E Umble
- Department of Adult Education, University of Georgia, Athens 30602, USA
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Harris JK, Yates B, Crosby WM. A perinatal continuing education program: its effects on the knowledge and practices of health professionals. J Obstet Gynecol Neonatal Nurs 1995; 24:829-35. [PMID: 8583273 DOI: 10.1111/j.1552-6909.1995.tb02567.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES To determine whether there was an increase in knowledge when an interdisciplinary group of health care providers participated in the same comprehensive perinatal continuing education program and to determine whether care practices followed before the program differed from those followed 1 year after its completion. DESIGN Administration of a 100-item comprehensive pretest and a similar posttest measuring knowledge before the continuing education program and 1 year after taking it, as well as an ex post facto audit of medical records of newborns who were sick and at risk. SETTING Hospitals throughout the state of Oklahoma that provide perinatal care. Test data were derived from health care providers in 24 hospitals; data on care practices were obtained from 12 hospitals. INTERVENTION A comprehensive program of perinatal continuing education. PARTICIPANTS Physicians, nurses, and other providers of perinatal health care. MAIN OUTCOME MEASURES Scores on a 100-item test measuring knowledge of perinatal care and newborn care practices taught in the educational program. RESULTS Pretest and posttest scores demonstrated an increase in scores at the p < 0.001 level for each group of providers studied. There was a statistically significant increase in use of two care practices and a definite trend toward an increase in the use of three others. CONCLUSION A continuing education program delivered to a multidisciplinary group of health care providers can increase knowledge and improve perinatal care to newborns who are sick and at risk.
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Affiliation(s)
- J K Harris
- Office of Perinatal Continuing Education, University of Oklahoma Health Sciences Center, Oklahoma City, USA
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Glazier R, Buchbinder R, Bell M. Critical appraisal of continuing medical education in the rheumatic diseases for primary care physicians. ARTHRITIS AND RHEUMATISM 1995; 38:533-8. [PMID: 7718007 DOI: 10.1002/art.1780380412] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To critically appraise evidence of the effectiveness of continuing medical education (CME) in rheumatic diseases for primary care physicians. METHODS Three physicians independently applied preset criteria to evaluated CME interventions published between January 1966 and August 1993. RESULT Eight of 166 articles identified were critically appraised, 7 of which had positive results. Marked heterogeneity in educational interventions, evaluative methods, and outcomes was noted. CONCLUSION Despite generally positive results, weak methodology precludes drawing firm conclusions about the effectiveness of CME in rheumatic diseases.
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Affiliation(s)
- R Glazier
- University of Toronto, Wellesley Hospital Research Institute, Ontario, Canada
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Brown LF, Keily PA, Spencer AJ. Evaluation of a continuing education intervention "Periodontics in General Practice". Community Dent Oral Epidemiol 1994; 22:441-7. [PMID: 7882660 DOI: 10.1111/j.1600-0528.1994.tb00794.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Evidence exists that some dentists may be failing to perform adequate periodontal diagnostic and preventive care for their patients. Continuing education (CE) is an avenue that is frequently employed as a strategy to alter the style of practice. This paper presents an evaluation of a year-long continuing education intervention "Periodontics in General Practice", conducted among randomly selected private general dental practices in Adelaide, South Australia. The CE intervention featured a 1-day seminar, bi-monthly newsletters, individualised 3-monthly comparative feedback, and technical assistance. The study employed a longitudinal quasi-experimental design, which allowed for evaluation of the effectiveness of the intervention among practices employing hygienists (n = 12) and not employing dental hygienists (n = 12), taking into account the covariates of baseline level of provision of periodontal services, the practice's level of participation in the intervention and attendance at other CE courses in periodontics over the year. A comparison group of practice (n = 12) did not participate in the intervention over the year. Patient record audits, conducted at baseline and at 12 months, provided data for the evaluation of the effect of the intervention on the recording of periodontal diagnostic, preventive and treatment items. Practices participating in the intervention showed increases in the percentage of records containing at least one periodontal diagnostic notation, and those practices employing hygienists showed an increase in the percentage of records with at least one preventive notation and one treatment item.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- L F Brown
- School of Dental Science, University of Melbourne, Parkville, Victoria, Australia
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Abstract
OBJECTIVE To review current knowledge of the effectiveness of medical audit programmes as a whole and of specific interventions within these programmes, as a means of changing clinical behaviour. CRITERIA FOR INCLUSION AND EXCLUSION OF PUBLISHED REPORTS: Articles listed on Medline from 1985-92 with key words "quality assurance" or "medical audit", and "evaluation" and relevant references from these articles, and from recently published reviews and reports on medical audit, were included. Excluded were simple descriptions of audit activity, replications of previous work, and publication in a language other than English. RESULTS Evaluation of entire programmes of medical audit is unusual. Most reports concern specific interventions and focus particularly on the scientific and technical aspects of quality. These interventions may be classified by the means through which they attempt to achieve desired changes: patient characteristics; physician characteristics; administrative and organisational structures; and financial incentives. CONCLUSIONS Knowledge about effective methods of bringing about specific changes in clinical behaviour is rudimentary. Impact is highly dependent on local factors, so generalisation of results to other settings is difficult. More qualitative research is needed to define the local factors which influence results.
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Affiliation(s)
- M B Robinson
- Division of Public Health, Nuffield Institute for Health, Leeds
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Abstract
The Royal Australian College of General Practitioners has been a leader in quality assurance in Australia, requiring members to participate in its Quality Assurance Programme since 1987. This paper presents the underlying philosophy and requirements of the programme, the results of the first 1987-89 triennium, and the likely future development based on an evaluation of the problems and successes of the first triennium.
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Affiliation(s)
- R B Hays
- Department of Community Medicine, University of Sydney, New South Wales, Australia
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VanAmringe M, Shannon TE. Awareness, assimilation, and adoption: the challenge of effective dissemination and the first AHCPR-sponsored guidelines. QRB. QUALITY REVIEW BULLETIN 1992; 18:397-404. [PMID: 1287520 DOI: 10.1016/s0097-5990(16)30564-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- M VanAmringe
- Center for Research Dissemination and Liaison (CRDL), Agency for Health Care Policy and Research, Rockville, MD 20852
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Affiliation(s)
- R Gabb
- Royal Australian College of Obstetricians and Gynaecologists
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Abstract
The increasing importance of continuing medical education (CME) in psychiatry is discussed. The need to take account of the principles of adult education (AE) and also of the diversity of current psychiatric practice and individual differences when developing CME programmes is emphasised. The relevance of mandatory CME to the assessment of practitioner performance is also discussed.
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Battista RN. Innovation and diffusion of health-related technologies. A conceptual framework. Int J Technol Assess Health Care 1988; 5:227-48. [PMID: 10303488 DOI: 10.1017/s0266462300006450] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The development and diffusion of health-related technologies constitute an extremely complex process. This article examines the phenomenon of technological innovation; discusses the factors determining the diffusion of high, medium, and low technologies; and suggests strategies for controlling the diffusion of these technologies. A research program is also proposed that should improve our understanding of the process of development and diffusion of health-related technologies.
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Affiliation(s)
- G W Stevenson
- Department of Radiology, Chedoke McMaster Hospitals, Hamilton, Ontario
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Affiliation(s)
- Jeanette Ward
- NSW Faculty of The Royal Australian College of General Practitioners 48 Albany Street St Leonards NSW 2065
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