Continuous Medical Education with a Combination of Standardized Patients and a Computer-based Training Programme in Musculoskeletal Diseases

Setting. A new approach to continuous medical education CME was introduced in fall 2000. It implicates teaching and knowledge assessing of general practitioners in the field of musculoskeletal diseases. The participants were chosen by external staff of Aventis Pharma (physicians more interested in rheumatology).Context. According to the experiences gained with a new course (called MuSkel) on musculoskeletal diseases at LMU containing a final examination with standardized patients, the concept of this type of training was modified for CME with practicing physicians. Focussing on the acquisition of more practical skills as well as on interactive learning and problem solving considering cost-effectiveness, an innovative type of further training seminar was advised by Aventis Pharma to general physicians. Small groups of 6-9 physicians were the precondition of this type of training which took place in a hotel located in the town the doctors are practising in.

Interventions. The 3 elements of the CME-seminar were an interactive tutorial with a CBT-programme, the assessment and discussion of problem solving strategies including 3 standardized patients with different frequent musculoskeletal diseases and finally a lecture on innovative therapeutic possibilities in rheumatology. Outcome. The new form of CME was welcomed by nearly all of the 21 physicians (with the exception of 1 physician), their opinion about this kind of training was very positive. Individual deficits in problem solving were obvious to each of the physicians so that immediate improvement was possible. The 3 educational elements of the CME were judged almost equally with a slight advantage for the part with the standardized patients. The CBT programme was considered an integral and important part of the rheumatology seminar.

Measures. An evaluation of the physician'sopinions with questionnaires about all course elements was performed at the end of the CME-seminar.Questions about important decisions handling a standardised patient problem were also asked (revealed facts concerning the medical history,clinical examination, differential diagnoses and further planned xaminations).

Conclusion. Focussing on the assessment of practical skills and nteractive learning with a CBT programme is a positively judged form of CME. There has been only 1 rejection. It might be impossible to measure he effectiveness of this type of CME, though it seems that it is much higher than the effect of a traditional lecture.