Table 7 Summary of articles focused on outcomes: knowledge, attitudes, types of skills, practice behaviour, clinical practice outcomes
From: Effective in-service training design and delivery: evidence from an integrative literature review
Citation | Study design | Participants | Intervention | Key findings |
|---|---|---|---|---|
Alvarez M and Agra Y 2006 | Systematic review: 18 articles reviewed to determine educational interventions in palliative care and their impact on practice behaviours | Physicians and other allied health professionals | Practice behaviours | Due to a lack of quality studies, there are insufficient data to conclude about the impact of palliative care interventions on primary care physician practice performance. Although improvements in knowledge, some attitudes and provider satisfaction were demonstrated, there were no significant effects reported on practice behaviours. Didactic education alone was found to be ineffective. Interventions involving multiple techniques, reminders and feedback were found to be more effective at changing behaviours. |
Technique: multiple | ||||
Media: live | ||||
Frequency: both single and multiple | ||||
Berkhof M et al. 2010 | Systematic review: 12 systematic reviews reviewed to determine effective educational techniques to teach communication to physicians | Physicians | Communication skills | Sufficient evidence from 12 systematic reviews to recommend training programmes last at least 1 day, are learner-centred and focus on practicing skills. The best training strategies within the programmes included role-play, feedback and small group discussions. Training programmes should include active, practice-oriented strategies. Oral presentations on communication skills, modeling and written information should only be used as supportive strategies. |
Technique: multiple | ||||
Media: multiple | ||||
Frequency: both single and multiple | ||||
Bloom B 2005 | Systematic review: 26 articles (all systemic reviews or meta-analyses) reviewed to examine effectiveness of current CME tools and techniques in changing physician clinical practices and improving patient health outcomes | Physicians | Practice behaviours and clinical practice outcomes | Sufficient evidence to conclude that interactive techniques (audit/feedback, academic detailing/outreach, reminders) are the most effective CME methods impacting practice outcomes and behaviours, while clinical guidelines and opinion leaders are less effective. Didactic presentations and distributing printed information had little to no effect on physician practice. |
Technique: multiple | ||||
Media: multiple | ||||
Frequency: both single and multiple | ||||
Bordage G et al. 2009a | Systematic review: 29 articles reviewed to determine if CME leads to an increase in physician knowledge | Physicians and health professionals | Knowledge | Despite low quality of evidence presented in the literature, there is sufficient evidence to confirm an increase in physician knowledge with the use of multimedia, multiple instructional techniques and multiple exposures in CME. |
Technique: multiple | ||||
Media: multiple | ||||
Frequency: both single and multiple | ||||
Davis D and Galbraith R 2009a | Systematic review: 105 studies reviewed to determine impact of CME on practice behaviours | Health professionals | Practice behaviours | Sufficient evidence to support the use of single, live or multimedia and multiple educational techniques as effective CME methods in changing physician performance. Recommend multiple exposures over single exposures. |
Technique: multiple | ||||
Media: live | ||||
Frequency: both single and multiple | ||||
Forsetlund L et al. 2009 | Systematic review: 81 articles reviewed to determine the effect of educational meetings on practice behaviours and clinical practice outcomes | More than 11,000 health professionals | Practice behaviours and clinical practice outcomes | Sufficient evidence to conclude that educational meetings alone or combined with other interventions can have a small improvement on professional practice and health care outcomes, but no effect on changing complex behaviours. Previous reviews found that interactive workshops resulted in moderate improvements, whereas didactic sessions did not. |
Technique: multiple | ||||
Media: live | ||||
Frequency: single | ||||
Gysels M et al. 2005 | Systematic review: 16 articles reviewed to evaluate effective educational techniques for teaching communication skills | Health professionals | Communication skills | Sufficient evidence to recommend communication training programmes that are learner-centred, carried out over a long period of time, and combine didactic theoretical components with practical rehearsal and constructive feedback. |
Technique: multiple | ||||
Media: multiple | ||||
Frequency: both single and multiple | ||||
Hamilton R 2005 | Systematic review: 24 articles reviewed to determine how to enhance retention of knowledge and skills during and after resuscitation training | Health professionals | Knowledge, skills | Sufficient evidence to recommend in-hospital simulation to teach resuscitation training for nurses in clinical areas in addition to remedial training and the availability of resuscitation equipment for self-study. Video self-instruction has been shown to improve competence in resuscitation. |
Technique: multiple | ||||
Media: multiple | ||||
Frequency: both single and multiple | ||||
Marinopoulos S et al. 2007a | Systematic review: from 68,000 citations, 136 studies and nine systematic reviews were identified and reviewed | Health professionals and allied health professionals | Knowledge, skills, practice behaviours and clinical practice outcomes | Firm conclusions are not possible due to the overall low quality of the literature. Despite this, the literature supported the concept that CME was effective at the acquisition and retention of knowledge, attitudes, skills, behaviours and clinical outcomes. Common themes included that live media was more effective than print, multimedia was more effective than single media interventions, multiple exposures were more effective than a single exposure, and simulation methods are effective in the dissemination of psychomotor and procedural skills. |
Technique: multiple | ||||
Media: live | ||||
Frequency: both single and multiple | ||||
Mansouri M and Lockyer J 2007 | Meta-analysis: 31 studies reviewed to determine the impact of CME on knowledge, skills and clinical practice outcomes | Mostly physicians | Knowledge, skills, practice behaviours and clinical practice outcomes | Sufficient information to conclude that the impact of CME on physician performance and patient outcome is small, but has a medium effect on knowledge and a larger effect when the interventions are interactive, use multiple methods and are designed for a small group of physicians from a single discipline. |
Technique: multiple | ||||
Media: live | ||||
Frequency: both single and multiple | ||||
Mazmanian P et al. 2009a | Systematic review: 37 articles reviewed to determine the impact of CME on clinical practice outcomes | Physicians, nurse-practitioners, nurses, allied health professionals | Clinical practice outcomes | Due to low quality of evidence, there is no firm conclusion on the impact of CME on clinical practice outcomes; however, multimedia, multiple techniques of instruction and multiple exposures to content are suggested to meet instructional objectives intended to improve clinical outcomes. |
Technique: multiple | ||||
Media: multiple | ||||
Frequency: both single and multiple | ||||
Moores L et al. 2009a | Systematic review: 136 articles and nine systematic reviews were reviewed to evaluate what makes CME effective | Health professionals | General | Significant evidence to support the use of CME interventions that use multimedia in instruction, multiple instruction techniques and frequency of exposure, to have a positive effect on knowledge, psychomotor skills, practice performance and clinical outcomes. The use of print media alone is not recommended. |
Technique: multiple | ||||
Media: multiple | ||||
Frequency: both single and multiple | ||||
Nestel et al. 2011 | Systematic review: 81 articles retrieved to summarize the best evidence related to use of simulation for learning | Health professionals | Psychomotor skills | Sufficient evidence is available to conclude that use of simulation leads to improved knowledge and skill. Studies with low-quality evidence suggest a transfer of skills to the clinical setting. Instructional design and educational theory, contextualization, transferability, accessibility and scalability must all be considered in simulation-based education programmes. |
Technique: multiple | ||||
Media: multiple | ||||
Frequency: both single and multiple | ||||
O’Neil K et al. 2009a | Systematic review: from the 136 studies identified in the systematic review, 15 articles, 12 addressing physician application of knowledge and three addressing psychomotor skills, were identified and reviewed | Health professionals and allied health professionals | Knowledge, psychomotor skills | Sufficient evidence to support CME as effective in improving physician application of knowledge. Multiple exposures and longer durations of CME are recommended to optimize educational outcomes. Quality of evidence does not address to psychomotor skill development. |
Technique: multiple | ||||
Media: multiple | ||||
Frequency: both single and multiple | ||||
Rampatige R et al. 2009 | Systematic review: 476 articles selected for inclusion. Section A relates to CPE in general (sections B and C are not relevant); nine studies were reviewed to determine effect of CME on practice behaviours and clinical practice outcomes | Health professionals | Practice behaviours and clinical practice outcomes | Interactive and practice enabling strategies are more useful than print-based and educational meetings. Multiple education efforts combined with good feedback/interaction between educators and learners are most effective. Opinion leaders and outreach visits shown to be effective. |
Technique: multiple | ||||
Media: multiple | ||||
Frequency: both single and multiple | ||||
Raza A et al. 2009 (follow-up study to Coomarasamy A and Khan KS 2004) | Systematic review: Cochrane review of 36 studies reviewed to determine evidence to support effective CME | Health professionals | General | Evidence from 16 randomized trials support interactive and clinically integrated learning sessions and interactive classroom teaching as second choice for an effective form of CME. Review demonstrated that interactive workshops improved knowledge and practice behaviours. |
Technique: multiple | ||||
Media: multiple | ||||
Frequency: both single and multiple | ||||
Satterlee W et al. 2008 | Systematic review: nine articles reviewed to determine impact of CME on clinical practice outcomes | Health professionals | Clinical practice outcomes | Combined didactic presentations and interactive workshops and combined didactic presentations were more effective than traditional didactic presentations alone. The use of multiple interventions over an extended period increased effectiveness. Targeted education should focus on changing a behaviour that is simple, since effect size is inversely proportional to the complexity of the behaviour. |
Technique: multiple | ||||
Media: multiple | ||||
Frequency: both single and multiple | ||||
Thomson O’Brien MA et al. 2001 | Systematic review: 32 articles reviewed to determine the effect of educational meetings on practice behaviours and clinical practice outcomes | Health professionals | Practice behaviours and clinical practice outcomes | Moderate data quality suggests interactive workshops can result in moderately large changes in professional practice. Didactic sessions alone are unlikely to change professional practice. |
n = 2,995 | Technique: multiple | |||
Media: live | ||||
Frequency: single | ||||
Williams J et al. 2008 | Systematic review: nine studies reviewed to evaluate if disaster training improves knowledge and skills | Health professionals and allied health professionals | Knowledge, skills | Insufficient data quality exists to report on the impact of disaster response training interventions on knowledge and skills. Data suggest that both computer-based and live instruction may increase knowledge. |
Technique: multiple | ||||
Media: multiple | ||||
Frequency: both single and multiple |