cine, University of Calgary, 3330 Hospital Dr. NW, Calgary,. Alta. T2N 4N1 ... list of nonspecialists were 118 physicians who .... of West Virginia physicians. W Va ...
I Clinical and Community Studies
Family physician registration at locally produced short courses Jocelyn M. Lockyer, MHA Penny Jennett, PhD John T. Parboosingh, MD, FRCSC Gerald M. McDougall, MD, FRCPC Greg L. Bryan
Physicians who do not take advantage of short courses that are offered within their community may miss the opportunity to learn about new services and consultants as well as to validate new information or practices with trusted colleagues. The registration patterns at short courses of all 505 family physicians in Calgary were assessed to determine whether the sociodemographic characteristics of attendees differed from those of nonattendees and whether the sociodemographic data were predictive of attendance or nonattendance. Four variables were predictive of attendance or nonattendance: certification status with the College of Family Physicians of Canada (CFPC), year of graduation, sex and hospital affiliation. Physicians who had attended four or more courses were more likely to be graduates of Canadian or US schools, to have graduated after 1969, and to be women, certificants of the CFPC and affiliated with a hospital. Universities, hospitals and professional associations planning continuing education must determine if the needs of nonattending physicians are being met through other means or if new strategies are required to ensure that these physicians have opportunities for upgrading their knowledge. Practitioners who frequently attend short courses can help planners ensure that programming is relevant. Le mddecin qui ne suit pas les brefs cours de perfectionnement qu'on offre dans son milieu se Ms. Lockyer and Dr. Parboosingh are from the Office of Graduate Clinical and Continuing Medical Education, and Drs. Jennett and McDougall are from the Office of Medical Education, Faculty of Medicine, University of Calgary. Mr. Bryan is a student at the University of Calgary.
Reprint requests to: Ms. Jocelyn M. Lockyer, Office of Graduate Clinical and Continuing Medical Education, Faculty of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary,
Alta. T2N 4N1
prive peut-etre de l'occasion de se mettre au courant de services et de specialistes nouveaux et de discuter des acquisitions recentes avec les confreres en qui il a confiance. On fait ici le compte de l'inscription a ce genre de cours de tous les 505 medecins de famille de Calgary afin de deceler les attributs personnels relies a cette participation. Quatre d'entre ceux-ci ont un pouvoir de prediction sous ce rapport: le certificat du College des medecins de famille du Canada, l'annee du doctorat, le sexe et l'affiliation hospitaliere. Le medecin qui a suivi au moins quatre de ces cours tend I etre dipl6me d'une faculte du Canada ou des Etats-Unis, a avoir passe le doctorat apres 1969, h etre une femme, a detenir le certificat ci-dessus et a etre affilid k un hopital. Les universites, h6pitaux et societes professionnelles qui organisent les enseignements continus doivent chercher a savoir si les medecins qui n'y recourent pas ont d'autres moyens de satisfaire a leurs besoins ou si au contraire il faut trouver des manieres d'assurer qu'ils se tiennent au courant. Le medecin qui assiste souvent a des cours de perfectionnement est h m6me d'en conseiller les organisateurs quant k la pertinence de leur contenu.
Each man in the profession needs a change of environment; he needs some standard of comparison by which he can estimate his own vantage-ground. The teacher with his admiring crowds of students, the specialist, the country practitioners and the village doctor, are all subject to the laws of environment, and reflect the mental and physical world they live in.... The critics may decide that scientific medicine is not much advanced by these meetings, but this is a narrow view.1
S hort courses are second only to reading as the method preferred by physicians to keep up to date.23 Courses of a half day or longer taken in one's community offer educational opportunities that are not available elsewhere. Through CMAJ, VOL. 139, DECEMBER 15, 1988
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presentations by local specialists family physicians learn what consultants are available for referral. Course content will be relevant, having been derived from clinical needs identified in previous courses, medical record audits, informal discussions among colleagues and opinions solicited from experts. Local courses also provide an opportunity for physicians to discuss and verify innovations with trusted colleagues and specialists before they put them into practice. Most studies of attendance at courses have been prospective surveys of large groups of physicians designed to determine continuing medical education preferences2'4'5 or in-depth studies of physicians registered in a course.6-8 The few surveys of nonattenders have tended to focus on barriers to participation rather than on the characteristics of physicians who do not participate.9"10 We examined the registration patterns of all family physicians and general practitioners attending university and hospital short courses in Calgary to determine whether the sociodemographic characteristics of attendees differed from those of nonattendees and whether the sociodemographic data were predictive of attendance or nonattendance. We felt that the information would help us identify physicians with a greater than average interest in short courses who might assist in the planning of future courses. We also believed that determining the characteristics of nonattenders was the first step toward developing alternative programming tailored to meet nonattenders' clinical needs.
Methods
All 505 family physicians and general practitioners known to be in active practice in Calgary in February 1987 were included in the study. The register for the College of Physicians and Surgeons of Alberta provided the names of 623 physicians in Calgary who were classified as nonspecialists. To ensure that the study population included only physicians known to be in primary care we consulted local data sources. Deleted from the original list of nonspecialists were 118 physicians who were residents, members of university faculty, engaged full time in emergency medicine, occupational health or geriatrics, or retired. We defined a short course as involving a minimum of 5 hours of classroom teaching or demonstration and then obtained lists of attendees for all 30 short courses offered by the University of Calgary and the local hospitals. All of the courses, which were designed primarily for family physicians, were offered between September 1985 and June 1987. They ranged from 1-day courses on a single subject (e.g., "Angina Review") to courses lasting up to 4 days on a large number of clinical disciplines (e.g., "Family Practice Review and Update"). A profile created for each of the 505 physicians listed courses attended, school and year of 1154
CMAJ, VOL. 139, DECEMBER 15, 1988
graduation, sex, certification status with the College of Family Physicians of Canada (CFPC) and afffliation status with each local hospital. Each physician was categorized as being a nonattender of courses, an attender of between one and three courses or an attender of four or more courses during the study period'. We used chi-squared analysis to determine whether the physicians' sociodemographic characteristics differed by attendance category. Wilk's discriminant function analysis was used to determine whether physicians who attended continuing medical education courses could be differentiated from those who did not." Results
Demographic data were available for all 505 physicians in the study. Most (359) of the physicians were graduates of Canadian medical schools. Of the remaining physicians 5 had graduated in the United States, 81 in the United Kingdom, Australia, Ireland, South Africa or New Zealand, and 60 elsewhere. Of the 505 physicians 306 (61%) had graduated after 1969, and nearly half (48%) were certificants of the CFPC. Over twothirds of the physicians had hospital privileges at one or more Calgary hospitals (Table I). The physicians had attended a mean of 2.3 courses: 138 had not attended any courses during the study period, whereas 1 had attended 13 courses. When the characteristics of the physicians who attended no courses, between one and three courses, and four or more courses were compared there was a significant effect of school of graduation, year of graduation, sex and certification with the CFPC (p = 0.0001), as well as hospital affiliation (p = 0.0464) (Table II). Frequent attenders (i.e., physicians who attended four or more courses during the study period) were more likely to be -- Demographic profite of family phv sIC,af rable and general practitioners in Calgarfy SM
...
;..,
Vargiable ')cri-oo ot graduatior Year cotf graduatio.
Before 1 960
7960-69 9 7 C} -7 Q
1980--184 Male Female
C;ertification with College of Famik, 0hysicilans of Canado- ?CFPC) N.
Afitfiatiorn with iocal S hosimtai %.E,P;".
J..}-.
A,
graduates of Canadian or US schools, physicians who had graduated after 1969, women, certificants of the CFPC and affiliated with a local hospital. With the Wilk's discriminant function analysis we found four variables with which we could predict with 74% accuracy whether a physician would be an attender or a nonattender: certification status, year of graduation, sex and hospital affiliation.
Discussion Our study was helpful in identifying physicians who had attended a greater than average number of courses. Of the 505 physicians 139 had registered for four or more courses, which demonstrates their reliance on the short course as a means of keeping up to date. As such, some members of this subset should be approached to join other physicians in planning short courses. The characteristics we identified for nonattenders suggest that these physicians may be isolated from organized medicine and at greater risk of reduced medical competence. Older physicians have two problems in that they have to reject old practices as well as learn new ones. Noncertificants of the CFPC may not hear about or may feel uncomfortable participating in the many excellent educational programs offered by the college. Physicians without hospital privileges miss both formal and informal opportunities to meet with and learn from colleagues. Members of hospital, university and professional associations who are developing educational programs need to determine whether the learning
needs of physicians who have not attended any courses are being met. The reasons for nonattendance and whether other methods may be more helpful could be determined by face-to-face or telephone interviews. Clinical traineeships may be of interest to physicians who prefer to learn in a supervised setting. Short local newsletters could provide information about new services and consultants. Personal overtures to nonattending physicians to try a course might help these physicians establish new sources of information and collegial networks. Year of graduation and certification status were strongly associated: 75% of the physicians who graduated after 1970, compared with fewer than 25% of those who graduated before 1970, were certificants. Thus, if sex, hospital affiliation and either year of graduation or certification status are known one can predict physician attendance at short courses. Course planners can provide faculty with more specific information about the mix and background of family physicians likely to register for a course, and continuing education programs can be marketed more efficiently. Although our study was limited to practitioners in Calgary it identified those who attended several courses as well as those who did not attend any. Further analysis should be conducted in other communities to determine the replicability of our results for physicians living in other cities with or without medical schools. We thank Son Nguyen, a computer programmer, for his help.
References Table II - Attendance at short courses according to demographic characteristics No. of courses; no.
(and %) of physicians One to
Variable School of graduation* Canadian or American Other Year of graduation* Before 1960 1960-69 1970-79 1980-84 Sex* Male Female Certification with CFPC* No Yes Affiliation with local
None
three
Four or more
81 (59) 164 (72) 57 (41) 64 (28)
119 (86) 20 (14)
54 (24)
39 (17) 78 (34) 57 (25)
11 (8) 15 (11) 55 (40) 58 (42)
120 (87) 162 (71) 18 (13) 66 (29)
66 (48) 73 (52)
108 (78) 115 (50) 30(22) 113 (50)
1 (30) 98 (70)
50 (36) 63 (28) 88 (64) 165 (72)
32 (23) 107 (77)
48 (35) 32 (23) 40 (29) 18 (13)
Yes
-=0.000)1 t= 0.0464.
course for physicians. J Kans Med Soc 1977; 78: 129-130
9. Dohner CW, Hamberg RL: The CME short course. North-
west Med 1970; 69: 327-330
hospitalt No
1. JAMA, Nov 27, 1897. Cited in Richards RK, Cohen RM: The Value and Limitations of Physician Participation in Traditional Forms of Continuing Medical Education, Upjohn, Kalamazoo, Mich, 1981: 5 2. Curry L, Putnam RW: Continuing medical education in Maritime Canada: the methods physicians use, would prefer and find most effective. Can Med Assoc J 1981; 124: 563-566 3. Manning PR, Denson TA: How internists learned about cimetidine. Ann Intem Med 1980; 92: 690-692 4. Kristofco RE, Hall SA, Chick E: CME preferences, practices of West Virginia physicians. W Va MedJ 1987; 83: 223-225 5. Buchanan K, Laxdal OE: Continuing education habits of Saskatchewan general practitioners. Can Med AssocJ 1971; 105: 1328-1329, 1331-1333 6. Snelbecker GE, Ball MJ, Roszkowski MJ: Evaluation of continuing medical education by resort-based participants. Mobius 1982; 2 (4): 20-27 7. Duff WM, Cheung MC: CME program evaluation: longterm retention. Contin Med Educ Newsl 1979; 8 (13): 7-9 8. Rising JD, Neth RL: An evaluation of the Kansas circuit
10. Ferguson KJ, Caplan RM: Physicians' preferred learning
methods and sources of information. Mobius 1987; 7 (1): 1-
9 11. Nie NH, Hull CH, Jenkins JG et al: SPSS: Statistical Package for the Social Sciences, 2nd ed, McGraw, New
York, 1975: 434-467 CMAJ, VOL. 139, DECEMBER 15, 1988
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