Continuing education meetings and workshops

The primary question the review sought to answer was: Are educational meetings and workshops effective in improving professional practice? In order to answer this question, the review analysed 32 studies (both randomized trials and studies with quasi-experimental designs involving 2995 health professionals) that investigated the outcomes of educational meetings versus outcomes in a non-intervention control group. All studies were judged by the authors, according to criteria described in the review, to be of moderate or high quality in terms of protection against bias. In the main, the review compared:

Educational meetings versus no intervention

Overall, 24 of the 32 studies included had reported a significant improvement in professional practice (for at least one major outcome); and 3 out of 8 studies that had studied impact on patient outcomes had reported statistically significant benefits in favour of the intervention-i.e. educational meeting.

This comparison constitutes the primary focus of the review, although it was not the primary question. Only one of the 32 studies made such a direct comparison, and found no difference between the two approaches. However, when the authors compared the two approaches across the studies, in 6 out of 10 comparisons, they found "moderate or moderately large" statistically significant positive effects in favour of interactive workshops; in the remaining 4 they found a "small" positive effect, with only one being statistically significant. In another set of 19 comparisons of meetings or workshops that combined interactive and didactic approaches with those that included only lectures, 12 were found to have "moderate or moderately large" positive effects (11 being statistically significant) and 7 a "small" positive effect. Meetings with only a didactic component were found to have no statistically significant effect on professional practice.

In discussing the above results, the authors concede that the findings are not clear-cut and need to be interpreted with caution. They cite poor reporting of study methods, insufficient information on follow-up of health professionals and inadequate blinding of the outcome measure as primary weaknesses in the studies included in the review. They also suggest that publication bias (i.e. bias in favour of publishing studies that show positive, rather than negative, results) and overestimation of positive effects of continuing education could have influenced these findings. While underplaying the value of the overall positive effect of meetings and workshops on improving professional practice, the authors believe that the issue of didactic versus interactive workshops is of far greater importance in the context of continuing medical education. This belief explains why the review, which set out to answer simply whether educational meetings improve practice, is overshadowed by a lengthy, and sometimes incomprehensible, discussion of interactive versus didactic workshops. In the end, the authors argue in favour interactive training (based on pedagogical theories and qualitative analyses), even though in this review the evidence for this is rather weak: note that the only study that made such a comparison did not find any positive effect, although between-study comparisons showed a "moderate" or "moderately large" effect in many cases.

The methods used to search the literature to identify the studies conform to Cochrane standards and appear to be comprehensive. The authors carefully applied the inclusion criteria and assessed the quality of studies based on each study's design, blinded outcome assessment and completeness of follow-up and then rated the eligible studies in terms of degree of protection against bias (high, moderate, low). The data were extracted from the studies independently by two reviewers.

The methods section of the review is detailed, complex and generally difficult to follow. The authors performed many analyses to assess the variations in results in the studies and the quality of the studies. For example, they subjectively rated the different practice behaviours used to measure outcomes in the studies according to degree of complexity. However, it is not clear from the review how this rating was used in terms of the results.

The full RHL commentary also includes sections on: