Continuing education for general practice and the role of the pharmaceutical industry.

A survey of the involvement in and attitudes towards continuing medical education of 101 general practitioners achieved a 95% response rate. Ninety per cent of the 96 doctors worked in practices which held meetings the content of which was organized by representatives of pharmaceutical companies but only 46% worked in practices which organized their own educational meetings. Seventy six per cent attended meetings away from their practice which were organized by drug companies and 75% had attended at some time continuing medical education activities organized by a local postgraduate centre. The promotional aspects of the drug company organized meetings were disliked by a majority of respondents (58%); more of the trainers (62%) and more of those who had entered general practice within the last seven years (71%) disliked this aspect. Nonetheless the educational content of both meetings held in the practice and those held elsewhere was the aspect most liked by over half of the respondents (59% and 53% respectively). Only 16% of all respondents thought that visits by representatives from pharmaceutical companies were educationally valuable and 37% thought that educational events organized by these companies were of value. Surprisingly 60% of those who worked in practices which held meetings organized by drug company representatives thought them to be of little or no educational value. There is clearly a need for practice based continuing medical education but the current level of dependence on drug companies for organizing these meetings must be questioned. Alternative strategies for the provision of independent non-sponsored educational activities should be sought.

Why general practitioners and consultants change their clinical practice: a critical incident study.

OBJECTIVE: To describe the complete range of factors which doctors recognise as changing their clinical practice and provide a measure of how often education is involved in change. DESIGN: Interviews using the critical incident technique. SETTING: Primary and secondary care. SUBJECTS: Random sample of 50 general practitioners and 50 consultants. MAIN OUTCOME MEASURES: Categories of reasons for change in clinical practice. RESULTS: Doctors described 361 changes in clinical practice, with an average of 3.0 reasons per change. The three most frequently mentioned reasons were organisational factors, education, and contact with professionals, together accounting for 47.9% of the total number of reasons for change. Education accounted for one sixth (16.9%) of the reasons for change and was involved in one third (37.1%) of the changes. Education was seldom mentioned as a reason for change in referral practice but was more often mentioned in management and prescribing changes. Consultants were influenced by medical journals and scientific conferences, while general practitioners were more influenced by medical newspapers and postgraduate meetings. CONCLUSIONS: Education is involved in about a third of changes in clinical practice. The wide range of other factors affecting changes in practice need to be taken into account in providing and evaluating education. The role of education in the numerous changes in clinical practice that currently have no educational component should also be considered.

General practitioners' continuing medical education within and outside their practice.

To study continuing medical education 96 out of 101 general practitioners chosen at random from the list held by a family practitioner committee were interviewed. The results provided little evidence of regular attendance at local postgraduate centre meetings, though practice based educational meetings were common. Thirty one of the general practitioners worked in practices that held one or more practice based educational meetings each month at which the doctors provided the main educational content. Performance review was undertaken in the practices of 51 of the general practitioners, and 80 of the doctors recognised its value. The general practitioners considered that the most valuable educational activities occurred within the practice, the most valued being contact with partners. They asked for increased contact with hospital doctors. The development of general practitioners' continuing medical education should be based on the content of the individual general practitioner's day to day work and entail contact with his or her professional colleagues.

Comparison of teachers at a 'traditional' and an 'innovative' medical school.

A 50% random sample (n = 186) of teaching staff at a 'traditional' medical school and all staff (n = 205) at an 'innovative' school were surveyed on their attitudes to teaching and teacher training. Response rates were 80% and 93% respectively. Staff at both institutions were predominantly men, highly experienced and active as teachers. Though only a minority had undergone recent teacher training, some 95% rated their teaching as 'average' or 'above average'. High levels of enthusiasm for teaching were detected in both schools. Staff at the 'innovative' school were more positive about the rewards for teaching. There was a common perception that formal training would improve the quality of teaching, though a third would not wish to participate. When developing strategies to enhance the quality of medical teaching, it is important to appreciate the existing attitudes of teachers. This survey indicates that inflated views of their own teaching ability, a perceived lack of reward for teaching, and ambivalence towards formal teacher training are three problem areas which need to be considered.

Attitudes to teaching among teachers at a British medical school.

A random sample of clinical teachers at a British medical school was surveyed by postal questionnaire to assess their attitudes to teaching and to teacher training. The response rate among the 186 teachers sampled was 80%. A high degree of enthusiasm for teaching was detected despite a perception that teaching received neither sufficient priority within the medical school nor due recognition within its reward structure. Feelings were mixed concerning the quality of training which graduates received. However, only 5% of teachers believed their own teaching ability to be below average. This survey revealed considerable support for the concept of training courses for medical teachers, though feelings were mixed as to whether such courses should be compulsory. These findings are discussed and related to recent initiatives to improve both the status of teaching within medical schools and the quality of medical education.

Teachers at a British medical school.

Clinical teachers' attributes, beliefs and attitudes to teaching were measured by mailing a questionnaire to a 50% sample of staff at a British medical school. This paper describes the attributes of the 80% who responded. The majority (83%) were male and females were particularly under-represented in the upper echelons of academia. Most (57%) taught at least once weekly, though 20% taught less often than once a month. The 41% who were primarily NHS employees were as active in teaching as those employed by the University. Small group teaching was most frequently undertaken by 73%, though 17% (who were more likely to be University employees) most often lectured. Only 19% of teachers had attended a course in medical education in the previous 5 years--these were more likely to have qualified relatively recently and to be University employees. Few (9%) teachers claimed membership of a medical education society. It is hoped that these findings will stimulate debate on how medical school teachers are selected, how they can be helped to improve their teaching performance and how their enthusiasm for teaching can be fostered.

Training for medical teachers: a UK survey, 1993.

Opportunities and resources for training of medical teachers have been criticized in recent UK reports. A survey of undergraduate and postgraduate medical deans showed that training courses were available at most institutions, though only a few were specifically designed for medical teachers. Many new and specific courses are being planned and many new appointments are being made in medical education at both medical school and postgraduate levels. While the outcome of greater resources for training of medical education cannot yet be determined, we conclude that criticisms are being speedily addressed.