Are there differences in learning preferences among doctors in various specialties? That's the question that researchers from the University of Toronto set out to discover in a study whose results were discussed at the CME Congress 2004, held May 15 to 18 at the Fairmont Royal York in Toronto, Ontario. As Darlyne Rath, assistant professor, Department of Health Policy, Management and Evaluation,of Medicine, University of Toronto, said, “We conducted the study because we wanted to find out if there are differences in the ways different specialties learn, because [CME] conferences are all designed the same way.”
Viva la Differences
The researchers distributed questionnaires at annual CME conferences for cardiologists, psychiatrists, pediatricians, and general surgeons to gather data on each specialty's learning preferences and behavior-change results from the meetings. They analyzed the 409 completed questionnaires, along with data gleaned from interviews during coffee and lunch breaks on the final days and follow-up interviews conducted three months after the meeting with those who said they planned to change practice behaviors. The 18-month study, which was to conclude in the spring of last year, was postponed a year when one of the participating conferences was canceled because of the SARS scare in Toronto last spring.
Among the questions they asked were: If new learning occurred, what were the circumstances? Attendees were given the choices of lecture, discussion, or workshop. The first choice across the specialties on this question was “lecture,” with cardiologists and surgeons leading the pack at around 90 percent. Approximately 80 percent of the psychiatrists said they prefer lectures. While pediatricians also picked lectures first, their numbers were much lower — approximately 60 percent. Almost a third of the pediatricians said they acquired new learning in workshops, something none of the surgeons and very few of the cardiologists said. Very few of any of the specialists reported discussion, the third choice, as the prime circumstance under which new learning occurred.
However, in a seeming contradiction, when asked “How do you learn best?” and given the choices of lecture, interaction (including Q&A and workshops), hands-on, and expert advice, lecture fell out of first place. The majority (more than 40 percent) of the cardiologists chose “interaction,” as did roughly a third of the psychiatrists and almost half of the pediatricians.
Since many lectures include Q&A, maybe the difference in responses is not as contradictory as it seems. Perhaps most of the respondents learn new material best during the Q&A section of a lecture, and since Q&A was not an option in the first question, they selected lecture.
Surgeons stayed the course they set in the first question, with the majority choosing lecture as their first choice. Hands-on activities did come in a close second, with interaction coming in third. For their second choice, they joined the other specialties, with roughly 40 percent naming interaction as their No. 2 choice. When asked in face-to-face interviews, several of the surveyed surgeons said that they learn best through video and watching surgery via the Internet.
Do Demographics Affect Behavior Change?
Another question the researchers asked was if participants were likely to make changes in their practices after attending a conference. They then broke down the results by age, the size of population the doctor served, and whether the doc had an academic appointment. Cardiologists who had been in practice longest were most likely to change behavior; psychiatrists followed a bell curve, hitting their change stride in their midcareer years. Surgeons were less likely than the other specialties to make changes across the board, while 100 percent of the youngest pediatricians reported that they would make changes to their practices, with around three-quarters maintaining that attitude throughout their careers.
When the data was studied in the aggregate, those who come from areas with a population of fewer than 50,000 were the most likely to make behavior changes. The same held true when the information was broken down by specialty; interestingly, however, none of the psychiatrists participating in the study came from the smallest population base — the smallest population they reported serving was 50,000 to 100,000. Still, the percentage of those willing to change was highest in this population base, which was the smallest for that specialty.
While academic affiliation did not affect cardiologists' attitudes toward making changes, the change rate was higher for psychiatrists and surgeons with an affiliation, and highest yet for pediatricians.
When it came to gender, the researchers found two statistically significant differences: Women preferred a workshop format, and men preferred Q&A.
But Did They Really Change?
The 29 qualitative interviews conducted three months after the CME activity with those who said they would make a change found that nine participants among those interviewed actually did, although none were cardiologists. Only two of the 29 said they were unable to make the change because of problems outside their control, including a surgeon who had not yet being able to procure the new equipment needed to make the change. Five said the didactic lecture alone was enough to spur them to make changes, especially less complex changes and changes resulting from evidence given by an expert.
While the study was limited to self-reported data and change was not confirmed through chart reviews or other means, it did indicate that there are differences among specialties in how their member physicians learn best and in what types of delivery mechanisms they believe will cause them to make changes in practice based on what they learn. Rath characterized the study as a pilot project, and said more study in this area would be a welcome idea for CME providers.
For more on physician format preferences and behavior change, see our cover story on page 26.