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Changing Clinical Practice: Interaction better than lecturing
Lead author's name and fax: M O'Brien, School of Rehabilitation Science, McMaster University, Hamilton, Ontario. e-mail: maryann.o'rien@hrcc.on.ca
Three-part
Clinical Question: Does teaching, didactic (lectures) or interactive, help
introduce changes to practice? Search Terms: In Cochrane Database of Systematic Reviews: change practice.mp (26)
The Review: Study Selection: Studies of participation in post-graduate training. Included planned educational activities: meetings, conferences, lectures workshops, seminars, symposia and courses.
Didactic: lectures or presentations that may or may not have question and answer session. Interactive: some type of interaction in small (<20) groups. Outcomes: objective measures of health professional practice behaviour or patient outcomes.
Data Extraction: Included: RCTs, also non-equivalent group designs (non-random process other than participant choice). Total of 32 studies. The studies were multiple independent reviews of individual reports. They were tested for heterogeneity.
The Evidence: Didactic teaching sessions did not lead to changes in practice: 7 studies (didactic v no intervention) - no difference in effect Interactive teaching sessions more likely to change practice but not consistently: 10 studies (interactive v no intervention) 6 studies moderate to moderately large effect, 4 studies with small effect.
Comments:
1) Do the methods allow accurate testing of the hypothesis? - YES 2) Do the statistical tests correctly test the results to allow differentiation of statistically significant results? - YES - Methodologically sound systematic review. 3) Are conclusions valid in light of the results? - YES 4) Did results get omitted, and why? - NO 5) Did they suggest areas of further research? YES - need to focus on what makes an interactive session work best: style and content of interactive sessions: timing, duration, repeated, or number of sessions. Need an estimate of the cost effectiveness of interactive sessions: more intensive will be more costly - can we decide if it is worth it? 6) Did they make any recommendations based on the results and were they appropriate? - YES - Note the end point was not learning (factual recall), but whether the intervention lead to a change in practice. No evidence of effect from pure didactic (lecture) teaching. Interactive workshops are the mode most likely to lead to changes in practice. 7) Is the study relevant to my clinical practice? YES - Provision of consistently good healthcare that continuously improves is our aim. We need to know what helps make changes to practice. 8) What level of evidence does this study represent? Level 1- 9) What grade of recommendation can I make on this result alone? B 10) What grade of recommendation can I make when this study is considered along with other available evidence? No additional evidence to be added. 11) Should I change my practice because of these results? If you holding a meeting with the aim of changing practice go for small group interactive format. Remember there are other things that at a lecture base meeting: social and motivational functions and networking / professional support. 12) Should I audit my current practice because of these results? No, use this series of systematic reviews to decide what strategies will help you make changes to your practice. Then audit effects: remember to consider how to accurately record baseline activity.
Appraised by: Malcolm Daniel, Department of Anaesthesia, Glasgow Royal Infirmary; 27 August 2003
Email: md23s@udcf.gla.ac.uk
© SICS EBM Group 2004 |
