COMMENTARY
CONTINUING
MEDICAL
EDUCATION
THROUGH
SELF-EVALUATION
Ped
#{237}a!
rics
VOLUME 45 MAY 1970 NUMBER 5
I
N the late spring of 1970 the American Academy of Pediatrics will offer to its Fellows (and to interested nonmembers) a new continuing educational opportunity. Similar programs have been developed by other specialty societies for their members(American College of Physicians, American Psychiatric Association, and American So-ciety of Anesthesiologists). Parenthetically,
it should be explained that the more famil-jar term, postgraduate education, is now generally reserved for house staff-oriented, hospital-based programs, while continuing medical education is the preferred term for
educational offerings directed to the prac-titioner.
Behind a broad resurgence of interest in the continuing education of the practitioner lies a growing body of criticism from pro-fessional and lay groups. We are told that rapid gains in medical science are not being
distributed efficiently to the primary prac-titioner and that there is a progressive widening of the gap between new medical
knowledge and its application in personal and continuous individual care. Much of the blame for this gap has been placed upon unimaginative and archaic models in continuing education of the practitioner.
Current experiments in undergraduate and postgraduate curricula have not been par-alleled by a searching reevaluation of con-tinuing medical education.
The public’s ability to recognize and de-sire quality medical care is clearly and forcefully embodied in the closing state-ment of the President’s National Health
Advisory Council which urged, “we explore periodic relicensure by study of competence or by challenge examination.” Although few of us are ready for implementation of such a sweeping measure, we must look
realistically at the inadequacies of present continuing medical educational systems.
The Academy’s leadership in initiating the development of a self-evaluation and edu-cation program is in keeping with both its basic purposes and its long tradition of sponsoring educational programs.
At this point it is pertinent to indicate
another basis for seeking new mechanisms of education. Attendance at the annual sessions averages approximately 30% of the membership. Regional and local postgrad-uate courses are well subscribed, but a significant part of the society’s membership does not participate. This segment may in-clude physicians in solo or small group practice who find it difficult to leave their
practice, or physicians who feel that
vaca-tioning with their families should have priority. The cost of attendance at distant sessions may be more than the pediatrician feels he can assume on a regular basis. These reasons suggest that postgraduate education for these physicians should be
730 CONTINUING EDUCATION
offered in their homes or offices. Although certain material is available for home use, it often lacks the stimulus of piqueing the
curiosity, of revealing defects, and of encouraging active participation in the learn-ing process. In addition, certain busy phy-sicians may be unaware of new informa-tion; therefore, they fail to recognize their “knowledge gap.” The Self-evaluation and Education Program - (SEEP) approach
seems to offer unique educational
oppor-tunities.
With these thoughts as background, the advice of several education consultants was sought, the activities of the orthopedic and
neurosurgeons were examined, and the re-cent self-assessment program of the
Amer-ican College of Physicians was studied. The success of the latter and the simplicity of its format led us to consider an adaptation for pediatricians. While SEEP is presented in an examination format, it is in fact an individual postgraduate course aimed at
assisting the Fellow to determine his strengths and weaknesses in a constantly increasing and evolving body of knowledge and to determine how well he can deal with the problems considered important by those responsible for assembling the ma-terial. Through such a program it was
an-ticipated that the Fellow would be en-couraged to read, study, review, and discover and correct gaps in his medical
knowledge. The reference material to be provided along with the answer sheets will provide a study guide with inherent moti-vation for the pediatrician to seek new knowledge and to renew his interest in the current medical literature.
In November 1969, a letter announcing
the details and schedule of SEEP was mailed to the membership. Since the pro-gram is self-supporting, its cost, to both
form might be greeted negatively by Fel-lows whose years of training and
prep-aration had contained many examination hurdles. From the beginning, it was em-phasized that the primary purpose is not an external examination but rather self-assess-ment aimed at motivating for self-educa-tion. The second problem concerned the source of material for the program. The
consensus held that the panel appointed to construct the examination should be ap-proximately equally balanced between the pediatrician in full-time teaching and the pediatrician in full-time private practice. Although overlaps occur in the professional lives of most of the panel members, this
balance was reasonably well maintained. Fourteen categories of problems were identified: (1) behavior, social, develop-ment, and learning disorders; (2) cardiol-ogy; (3) dermatology; (4) gastroenterol-ogy; (5) immunity and immunizations; (6) infectious diseases; (7) metabolic and endocrine; (8) newborn; (9) genetics;
(10) respiratory; (11) therapeutics; (12) poisoning; (13) renal, fluid, and electro-lytes; and (14) neurology. Thus,
approxi-mately one half of the categories are con-sidered to be of a general nature and one half of them are organs-system oriented. The panel members were selected by the District Chairmen of the Academy in
con-sultation with the pediatric department chairman in their district; these 27 mem-bers were joined by the 9 members of the Education Committee. Over 1,000 ques-tions were prepared in consultation with the offices of the National Board of Medi-cal Examiners. Approximately one third of
those questions were acceptable to the 36-man panel, and these were screened for accuracy by 34 consultants. These
Asso-COMMENTARY
a modified patient management approach which is designed to evaluate cognitive and effective performance. Initially, it was pro-posed that clinical management of patients might be tested by questions in which the candidate learns the patient’s reactions to a
decision by uncovering a selected portion of the paper, after the decision is made;
however, after considerable debate, it be-came obvious that this costly technique had
few advantages for a self-evaluation pro-gram. Marking of the answer sheets may be by the individual or through the services of an independent, bonded agent and will be confidential. References from conveniently available sources will be provided to the
731
Fellow at the time his answer sheet is re-turned if he submits his answers for mark-ing, or they will be provided at his request if he prefers to correct his own answer
sheet. The reference bibliography will list articles covering all questions in the book-lets and will allow review by each indi-vidual of those areas in which updating is
indicated.
C.\V. DAESCHNER, M.D. Committee on Medical Education
American Academy of Pediatrics
GERALD E. HUGHES, M.D.
Department of Educational Affairs American Academy of Pediatrics
