Continuing education as an instrument of medical quality management

A rheumatologic educational program for general practitioners (GPs), based on andragogic principles, has been developed by the study group for Continuing Education and Quality Control of the Association of Cooperative Centers of Rheumatology in the DGRh. The educational program has been tested and evaluated by a study group supported by the German Ministry of Health (FB 2-43346-8/63) as an possible tool for quality assurance in rheumatology. Evaluation was carried out in 2 audit circles each of the KV Hessen and KV Lower Saxony. In the 4 audit circles 39 GPs and 3 trained rheumatologists, acting as "experts", participated. Using didactic materials provided by the study group, the topic "shoulder-neck pain" was discussed in all 4 audit circles. Questionnaires and case records according to the topic were used as evaluation tools. The evaluation was supported scientifically by the Scientific Institute of the German Medical Association (WIAD). Of patients with shoulder-neck pain (1193 pre- and 958 post-education) 2151 records were documented by the participating GPs for the evaluation of outcome in respect of changes of diagnostic and therapeutic attitude. Additionally pre- and postintervention, 10 MC questions related to the topic were used to measure changes in specific knowledge, and at the end of the audit circles participants were asked by questionnaire for acceptance of the educational program. An index of acceptance of 9.6 points (best: 7.0 points, worst: 31.0 points) indicating an excellent acceptance of the educational program by the participating GPs was recorded. The increase in specific knowledge amounted to about 30% in all 4 audit circles. Changes in diagnostic and therapeutic attitudes showed a better specification within the spectrum of diagnoses, a reduction of expensive and not indicated diagnostic procedures (e.g., CT), as well as a reduction in the use of non-adequate therapeutic modalities (e.g., massage, fango, unguenta, and gels) in favor of physiotherapy and mobilisation or local and systemic use of corticosteroids. The results of the evaluation project demonstrate that interactive learning in small groups (audit circles) based on andragogic principles can contribute to a better quality of care of patients with rheumatic diseases. The innovative concept seems to be a well-accepted alternative to formal lectures in postgraduate medical education.