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Educational interventions to improve the effectiveness in clinical competence of general practitioners: problem-based versus critical reading-based learning.

Gongora-Ortega J, Segovia-Bernal Y, Valdivia-Martinez Jde J, Galaviz-DeAnda JM, Prado-Aguilar CA - BMC Med Educ (2012)

Bottom Line: The participants exhibited no significant differences in clinical competence measures at baseline, or in socio-demographic or job characteristics (p > 0.05).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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Unidad de Investigación en Salud, Instituto de Salud del Estado de Aguascalientes, Aguascalientes, Ags, Mexico.

ABSTRACT

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.

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Educational process and the role of the participants in the Problem-Based intervention.
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Figure 2: Educational process and the role of the participants in the Problem-Based intervention.

Mentions: 2. Tutorial. The strategy ran for 4 days, 8 hours per day. The aim of this intervention was to learn to identify problems, pose questions and debate the best solutions to the clinical problems at hand, a debate that was chaired by the tutor. Each session was divided into two meetings, as described previously [22]. A session for each of the health program lasted approximately 3 hours and a half; 1 hour and a half for the discussion meeting 1 hour for individual study, and 1 hour for the concluding meeting. The strategy was carried out under the direction of the tutor with help from a program expert (Chair). At the discussion meeting, the first 5 steps proposed by Schmidt were completed [23] and the physicians analyzed the problems posed in each clinical case study. After this meeting and prior to the following meeting, the physicians had time for individual study (step 6). In the concluding meeting (step 7), a physician from the group drafted a report on the intervention, describing the participants´ experience of the presentation and dynamics of the workshop, and the resolution of the tasks involved. Figure 2 presents each of the steps in the educational process and the role played by each participant.


Educational interventions to improve the effectiveness in clinical competence of general practitioners: problem-based versus critical reading-based learning.

Gongora-Ortega J, Segovia-Bernal Y, Valdivia-Martinez Jde J, Galaviz-DeAnda JM, Prado-Aguilar CA - BMC Med Educ (2012)

Educational process and the role of the participants in the Problem-Based intervention.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3814588&req=5

Figure 2: Educational process and the role of the participants in the Problem-Based intervention.
Mentions: 2. Tutorial. The strategy ran for 4 days, 8 hours per day. The aim of this intervention was to learn to identify problems, pose questions and debate the best solutions to the clinical problems at hand, a debate that was chaired by the tutor. Each session was divided into two meetings, as described previously [22]. A session for each of the health program lasted approximately 3 hours and a half; 1 hour and a half for the discussion meeting 1 hour for individual study, and 1 hour for the concluding meeting. The strategy was carried out under the direction of the tutor with help from a program expert (Chair). At the discussion meeting, the first 5 steps proposed by Schmidt were completed [23] and the physicians analyzed the problems posed in each clinical case study. After this meeting and prior to the following meeting, the physicians had time for individual study (step 6). In the concluding meeting (step 7), a physician from the group drafted a report on the intervention, describing the participants´ experience of the presentation and dynamics of the workshop, and the resolution of the tasks involved. Figure 2 presents each of the steps in the educational process and the role played by each participant.

Bottom Line: The participants exhibited no significant differences in clinical competence measures at baseline, or in socio-demographic or job characteristics (p > 0.05).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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Unidad de Investigación en Salud, Instituto de Salud del Estado de Aguascalientes, Aguascalientes, Ags, Mexico.

ABSTRACT

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.

Show MeSH
Related in: MedlinePlus