Turning understanding into clinical practice : an intervention in continuing professional development based on readiness to change

Abstract

BACKGROUND: Current continuing medical education (CME) programmes are often insufficient in changing doctors performance, and there is a need to improve CME and shift toward a more comprehensive continuing professional development (CPD).The aim of this study was to develop and assess the effects of an educational intervention, based on a modified stages-of-change model, on general physicians stages of readiness to change, knowledge, attitudes and performance regarding management of depressive disorders in Iran.

METHOD: A randomized controlled trial with 192 general physicians in primary care (GPs), who were equally distributed to an intervention and control arm, following stratification related to stage of change, sex, age and work experience. The intervention comprised an interactive workshop for a small group at a higher stage of readiness-to-change ( intention ) and an interactive large group meeting for those demonstrating a lower propensity to change ( attitudes ) at the pre-assessment stage.

MEASURES: All the measures were validated in the Iranian context. The GPs stages-of-change were assessed based on the Modified Prochaska Questionnaire (MPQ), their knowledge and attitudes were assessed using written questionnaires and their performance was assessed by standardized patients (SPs), who filled in checklists regarding the encounter, and collected prescriptions if any. Five different scenarios for depression disorders were compiled by an expert group. The validity and reliability of checklists, SPs portrayals and SPs ways of completing checklists were documented. The pre-assessment of GPs performance was done two months before and the post-assessment two months after the intervention.

RESULTS: GPs in the intervention arm significantly shifted to a higher stage with an intervention effect of 47 percentage units. Their overall mean scores on the knowledge test also improved, with an intervention effect of 12 percentage units. Although their attitudes changed in the post-test in comparison with the pre-test, the difference between the intervention and control arms was not significant. The performance of the GPs in the intervention arm also improved for mean scores regarding diagnosis, with an intervention effect of 14 percentage units, and for appropriate management regarding treatment and referral, with an intervention effect of 20 percentage units. The largest changes appeared in the small intervention group with intervention effects of 28 and 38 percentage units, respectively.

CONCLUSIONS: The model was successful in improving both knowledge and practice according to the theoretical assumptions. It can be used in educational interventions within a CPD context.