Dossier n. 169/2008 [Abstract] Health professionals’ opinions on continuing education

With the Agreement of August 1st, 2007, the Italian Ministry of Health and Regions committed in developing a new program for continuing medical education (CME). A national Commission is entrusted with its governance. A national Observatory on the quality of continuing medical education, connected in a network with regional Observatories, will also be established.

The implementation of a system to assess and promote the quality of continuing education through a network of independent observers based on shared criteria and methods has been proposed since some years. In particular in 2004 a pilot project was launched to outline the proposal for a national Observatory, its tools, a guideline for observations and a training path model for observers.

The pilot project was realized in 2005-2007 with the financing by the Ministry of Health and the participation of Emilia-Romagna Region (project and experimentation coordinator), Lazio, Lombardy, Marche, Puglia, Tuscany, Trentino, Valle d’Aosta and Veneto. The final results of the project were presented during a meeting in Bologna, May 21-22, 2007 (see Dossier n. 170).

The observation system is based on six elements:

• analysis of the documentation;
• observational visits;
• standardized observational criteria, tools and methods;
• independent observers;
• qualitative and quantitative opinion surveys;
• common methods to elaborate observation results.

To test other evaluation tools on quality, two national surveys were realized at the end of 2006 to study health professionals’ opinions on the continuing education they have received since the beginning of the CME program and its future. The two surveys are presented in this volume, both for their results that can be useful for the new CME system and for their methodology, that can be of interest for the planning of the new Observatories.

The first was a qualitative survey based on focus groups with professionals from Training Offices, Nursing Services and care structures of public Health Trusts of various Regions.

The second study was a quantitative survey conducted by Project Units and by participants of the Course for observers of CME quality using two different methodologies:

• a sample study in 14 Health Trusts (Local Health, Hospital and University Hospital Trusts) in 11 Regions, with nearly 3,300 professionals responding;
• a voluntary survey available on line on the websites of Regional Health Departments and Health Trusts; about 10,800 people from many Regions responded, in particular from Tuscany, Emilia-Romagna, Marche, Lombardy, Friuli, Veneto and Puglia.

To understand the relevance of this survey in representing the opinions of people involved in CME at national level, it is important to underline that:

• the survey was launched at the end of the first 5 year experimentation period of the CME program, and therefore it summarises opinions elaborated over a long time;
• it involved a high number of people from many areas of the country, with different roles (among them, 28% were physicians and 62% other health professionals) and working in all kinds of public structures (Local Health, Hospital and University Hospital Trusts);
• there are no similar surveys as for dimension and geographical distribution;
• the survey is internally coherent, as it can be demonstrated by the large correspondence of responses from the sample study and the voluntary survey.

The first relevant information from a preliminary data analysis is the overall positive opinion on training chances since the implementation of the CME system: nearly 50% respondents declare that they had more chances than before; about 75% considers this training of good quality. The majority also believes that the received training contributed in satisfying their education needs and in improving their professional competence, and recognises that Health Trusts well understood these needs.

Some questions dealt with different didactic methodologies. A large majority of respondents (75%) declares that all techniques (residential and field training) are useful, including also reading scientific articles (that is not yet an accredited method). On the contrary, the opinion on e-learning usefulness is not so positive (less than 50%), probably because this methodology was not yet often available.

Participants’ interest on the training role of health professionals is surprising. Nearly 20% of the respondents declares that they usually do teaching or tutoring activities, 30% do it sometimes; 3 out of 4 respondents believe very useful for a health professional to be involved in these activities. They represent therefore a large resource for training (also for the University), that is however not yet adequately valorised.

Also the question on the presence of sponsorships in educational events shows interesting results. In both surveys, more than 50% of the respondents declare that there was “little” or “very little” presence of sponsorships, about 30% believe it was “much” or “very much”. Perhaps the phenomenon is less evident than imagined.

The judgements on training usefulness for improvement processes in health organizations in these years are much more controversial. Respondents are divided in two nearly equal groups, one expressing positive and the other negative opinions. It will be interesting to analyse the distribution of answers according to geographical area, job and working structure. However, more than 80% of survey participants believe that Health Trusts should be more involved in the organization of training initiatives.