What Works to Change Practice

What can we do to help physicians improve their practice? There is research that can help guide decisions and priorities. In a 1998 “review of reviews,” looks at methods that have improved practice. The educational message is pretty clear – didactic methods will not work, we need to include education that that helps physicians think about, and practice their new knowledge.




Consistently Effective Interventions

Reminders (manual or computerized)

Multifaceted interventions

Interactive educational meetings that include at least include discussion or practice



Interventions of Variable Effectiveness

Audit and feedback

Local opinion leaders

Local consensus processes

Patient mediated interventions



Interventions with little or no effect

Educational materials, including clinical practice guidelines, recommendations for clinical care, audiovisual materials, and electronic publications

Didactic educational meetings





Bero, L.A., Grilli,R., Grimshaw,J.R., Harvey, E., Oxman, A.D., and M Thomson (1998) Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. BMJ; 317 : 465.

CME in Second Life

There was a big surge in interest in virtual reality as a training tool about five years ago when Second Life, and several other virtual reality tools became widely available.  Much of that initial excitement has died down.  I suspect that there are a number of reasons that it has faded but one reason may be that many people did not use the technology very well.  I went to a number of presentations in Second Life, but most were merely lectures, which can get boring, no matter what the technology. 

Lectures aren't the only things that you can do in Second Life though.  I think that one very promising use of the technology might be for training that involves role playing. Virtual reality offers some potential advantages over face-to-face role playing - including alleviating a little of the embarrassment that people can feel when they're the center-of-attention. 

Two recent blog posts (first, second) by Robin Heyden describe the experience of delivering continuing medical education on motivational interviewing to family physicians.  The training included a 40 minute presentation on motivational interviewing, followed by practice sessions. 

There are lots of caveats, including the usual problems that new user often have accessing all of the media in Second Life, but overall, it's a very interesting step and one that I'll be paying attention on the future. 

Here is the presentation portion of the training:

CME can alleviate misconceptions about back pain

A recent paper in Spine (2009, 34(11), 1218-1226) looked at general practitioner knowledge about back pain treatments. 

Doctors who had recently participated in CMEs about lower back pain had significantly better pain management beliefs, supporting the importance of CME for updating people’s knowledge. 

One surprising result was that physicians who self-identified as having a special interest in lower back pain were actually less likely to understand the most appropriate treatments, which include continued activity, rather than bed-rest.   That’s right, physicians in this survey, with an interest in lower back pain, actually knew less about how to treat it.  This may be a statistical hiccup, but it might also fit with the idea that people are actually very poor at self-evaluating their own knowledge and skills (see, for instance Advances in Health Sciences Education, 2004, 9(3):211-24).