What do Northern Ontario physicians think about CME?

"Continuing medical education (CME) is an important component of physician education which enables practitioners to keep up-to-date on current knowledge and practices. There are a variety of potential formats for delivery of CME including self-directed learning (e.g., journal reading, audio/video tapes, and computer simulated programs), short courses (e.g., seminars, lectures, journal clubs, and visiting speakers), and long courses (e.g., refresher courses and updates). Whether these formats are traditional lectures in large groups or innovative, problem-based, small group learning sessions employing the evidence-based medical education paradigm, there is considerable evidence that they are effective in a number of ways (Beaudry, 1989; Haynes et al., 1984 and 1989; Heale et al., 1988)....

"Physicians in northern, remote or rural areas face special problems in accessing CME. Distance from course sites may be great, availability of local expertise/venues may be limited and back-up coverage may be non-existent. Moreover, the costs of travel, a lack of time and lost practice revenues may be additional barriers to obtaining CME. Consequently, there has been great interest in alternative provision of CME to health care providers in northern areas....

"In this paper, we describe the results from a survey that was undertaken to determine attitudes toward CME, barriers to access and CME preferences of physicians practising in Northeastern Ontario (NEO)....

"A mail survey was used to collect information from physicians in Northeastern Ontario (NEO) and Southern Ontario (SO). Both primary care physicians and specialist were surveyed....

"Names and addresses of all physicians practising in NEO were collected, using the 1992 Canadian Medical Directory.... A sample of physicians practising in Southern Ontario was used as a control group....

"A total of 503 questionnaires were sent to NEO physicians and, following three mail-outs, a response rate of 64 percent was obtained. The control group from SO had a lower response rate (48 percent) following similar survey procedures....

"NEO physicians rated colleague consultations and formal CME sessions (e.g., out-of-town lectures and conferences) as most enjoyable (Table 4). Passive CME delivery such as audiotapes and teleconferences were rated enjoyable less often (21% and 7%, respectively). Also, more innovative, self-directed approaches such as interactive computer programs, and literature searching were less popular.

"However, when the two groups were compared, there were few differences in what physicians enjoyed most. In fact, the only significant differences were lectures (both local and out-of-town) and academic hospital rounds....

"NEO physicians cited lack of time (68 percent), cost of travel (57 percent) and availability of CME (40 percent) as the leading barriers to obtaining CME. Lack of interest (7 percent) and lack of back-up (25 percent) were mentioned less frequently. When compared to their SO counterparts, NEO physicians were more likely to cite availability of CME, cost of travel and lost practice revenues as barriers....

"When success in gaining access to CME was examined, differences emerged between the two groups (Tables 7A and 7B). For example, compared to SO physicians, fewer NEO physicians were 'completely successful' and more were 'not very successful' or 'not at all successful' in obtaining the kind of CME they would like. Similar differences were found when physicians in communities of less than 25,000 and those in communities of 25,000 or more were compared with respect to CME access....

"Physicians in NEO are less likely to be successful in obtaining the amount of CME they require (Table 7A) and more frequently not at all successful in obtaining the CME they feel they require. While both groups feel CME should form part of practice assessment, there is ambivalence regarding its use for relicensure....

"The results of this study suggest that efforts to improve CME delivery in the north should be multifaceted. From other research, it is clear that they should address the needs/problems that are relevant to northern physicians (Heale et al., 1988). In addition, consideration should be made to offer CME programs in needed locations, rather than sending physicians to southern venues.

"An example of this approach is currently being funded by the Regional Trauma Network through the Ontario Ministry of Health. Advanced Trauma Life Support (ATLS) is being provided in selected locations in Northern Ontario (Sault Ste. Marie, Sudbury, Timmins, North Bay, etc.) to physicians and other learners (paramedics, nurses, etc.). This educational initiative is relevant since trauma care is an important component of emergency care and has been shown to be deficient in some rural areas. In addition, this program is provided without costs to the learners, thus reducing their expenses. Finally, the convenience of the location minimizes the learners' revenue loss by eliminating or reducing travel time.

"Innovative technology such as audio/video conferencing may also be a possible solution to this problem. Alternatively, with the proliferation of personal computers and office automation, advances in CME delivery may be possible. However, these alternatives do not take into consideration the importance of the social interaction element in CME activities. Finally, the use of evidence-based, problem-based, small group educational venues may also provide for more enjoyable and enthusiastic learning."

From: B.R. Rowe, J.V. Mulloy, D.T. Ryan, and R.W. Pong (1995). Continuing medical education: A comparison of Northeastern and Southern Ontario physicians. In B. Minore and C. Hartvikson, eds., Redressing the Imbalance: Health Human Resources in Rural and Northern Communities. Thunder Bay, Ontario: Northern Health Human Resources Research Unit, Lakehead University.