Introduction:

Continuing Medical Education (CME) as set of activities to maintain and improve the knowledge, skills and professional performance of physicians seem to be essential (1).Education is an important part of medical systems which it`s executive processes has been investigated in some countries (2, 3). According to the changing of health care needs, many experts in healthcare fields believe that education of GPs like other health professionals is necessary to be continued by education system after their graduation.

Based on mentioned information, the CME system is established, programmed and implemented in many countries (4). CME has been enacted in Iran according to the other countries since 1990 to improve and update graduated people`s knowledge, skills and attitudes (5). As investigations indicate, an important reason to apply these kinds of plans and training programs is the lack of self-assurance among physicians who are working in outlying centers (4). On the other side, out of dated medicinal graduated personnel could be harmful to health system and human society (6). Due to the growing CME around the world, including Iran, an issue that is now considered is CME quality and effectiveness on increasing knowledge and improving attitudes and practices of GPs attending. Also, the main question is whether the application of time and energy, professors, participants, and administrative systems is efficient or not? Some experiences have raised doubts in this issue especially about suitability of educational planning, which has important role in manpower training in the medical community.

In addition, educational planning, as outline of training activity, determines course content and defines teaching method, expectations or demands of pupils, facilitating learning process methods, ways of students’ assessment, program evaluation, and finally the schedule of course. Therefore, educational planning of the training process is so important (7).

Although, it is crystal clear which educational programs and trainings in health sciences should not be confined to students. In the other words, physician re-training schemes should also be considered. Therefore, new methods of educational programs should be applied to both of students and physicians. So, personnel training and comprehensive educational program according with the requirements of the health system is the main part of any medical education plan and it is important that education plan be in parallel with the updated society needs.

In this regard, personnel training and comprehensive educational program, which could respond to the needs of changing health society, is an important and crucial part of educational system (8).

Although, CME is applied in health system all the time, but there is not enough evidences about its benefits. Therefore, this investigation applied to study the effects of CME on GP`s knowledge in the field of psychiatry in Dezful University of medical sciences (DUMS) as a underserved medical center with limited scientific resources.

Methods

This study was Quasi-experimental research which investigated general practitioners knowledge in psychiatry field beside effects of CME on them. Statistical Society of the study was 300GPs, affiliated to DUM Sin autumn 2013, which Iran CME Act includes them. Simple random sampling of 300 physicians according to Morgan table, was carried out and sample size was n = 86.

In this study, inclusion criteria were: being GPs registered in CME interventions in the field of psychiatry, GPs were not required to use the internet in training session, the educational intervention don’t be in the form of an online base training. On the other hands, GPs if they were unwilling or unable to full time participate full time in training session were excluded. GPs outside of Dezful, Khuzestan provinces, Iran were excluded.

The self-administered questionnaire consists of two parts: the first part included demographic information and three questions that were related information such as age, marital status, and work experience. The second part was related to general practitioner`s knowledge about concepts and modern medical treatments in psychiatry, which included 35 multiple choice questions for before training and 35 multiple choice questions for after training.

To determine the questionnaire justifiability, content and face validity index was used and the questions was revised by six expert professors of DUMS. Then, at a distance of 10 days and on 15 GPs Test re-test method was applied to determine questionnaire external validity. The Pearson correlation coefficient between scores of the questionnaire in the first and second times was obtained 0.8.Also, Cronbach's α method was applied to specify questionnaire internal validity and that was 0.83. V

After obtaining the necessary permits from CME leaders in DUMS, 86 self-administered questionnaires were filled out by GPs one to two hours before training to gather data from subjects. Then the training session held for one hour and 30 minutes after training session there test questionnaires were filled out by GPs.

Then, for data analysis, inferential tests such as Pearson and Spearman correlation coefficient test, ANCOVA and T-test were used. Data were analyzed by SPSS18.0 software.

 Results

The number and percentages of demographic characteristics of GPs in DUMS attendees in this study are presented in Table 1.

Table1.Demographic Characteristics of the GPs in DUMS

As shown in tables 2 and 3, before and after education, there is a statistically significant difference among the mean scores of GP’s knowledge related to the field of psychiatry in the DUMS (9.34 vs. 11.98). The difference suggests the impact of CME on the GP’s knowledge according to the field of psychiatry.

Table 2.The central tendencies and dispersion indices represent the scores of GP’s knowledge in the field of psychiatry in DUMS

* Differences between mean scores of GPs before and After Psychiatry training session

According to table 3, in the field of psychiatry, CME programs had more impact on knowledge of female GP’s. Moreover, the impact of CME in the field of internal medicine on the knowledge of GPs was inversely related to their age. There was no significant relationship between work experience and level of knowledge in the field of internal medicine.

Table 3. Results of the univariate analysis of covariance (ANCOVA) for evaluating the knowledge of GP’s of DUMS in the field of psychiatry.

^**significant with the p value of 0.001

According to the Spearman correlation coefficient which is shown in table 4, in the field of psychiatry, there is not significant reverse association between sex and the level of knowledge in GPs working in DUMS (p >0.05).Furthermore, there is not any significant relationship among age, work experience and the level of knowledge.

Table 4. The relationship between individual characteristics (age and work experience) with the level of knowledge in GPs affiliated to DUMS  in the field of psychiatry.

Discussion 

In the field of psychiatry, we investigated the efficacy of CME among GPs affiliated to DUMS. About 22 percent of differences in the effect of psychological education on GP’s knowledge were attributed to sex difference (data not shown).It has concluded that there is a significant alteration in the knowledge of GPs before and after education in the field of psychiatry.

Based on the data obtained from DUMS, we clearly showed that there is a noticeable positive change in the knowledge of GPs after performing the CME programs in the field of psychiatry. This study is in concomitance with the previous studies carried out by Rutz et al (9, 10).

The effectiveness of CME programs can be evaluated at various levels including knowledge, attitudes, and skills of participants besides patient’s care. The most common method which can be used to assess the efficacy of education is investigating the impact of training on participant’s knowledge. According to aforementioned reasons, it is necessary and rational to study the effectiveness of CME programs. On the other hand, CME programs are considered as necessary educational activities that maintain, develop, and increase the knowledge and professional performance of physicians. Continuing education is the most important way to inform physicians of new healthcare programs.

Both the fast development of medical sciences and protection of patients, who have the right to be cured by expert and knowledgeable physicians, are prominent examples of why CME has been targeted to be improved (11-15).Regarding the results of this study and based on the ideas of physicians who engage in CME programs, the necessity of revision in these programs is evident and inevitable.

It has been emphasized that individual differences such as sex, should be considered during evaluation of CME in the field of psychiatry (16). Considering the field of psychiatry, we studied the effect of individual characteristics such as sex, age and work experience on the knowledge of GPs affiliated to DUMS. As the data show, CME programs in the field of psychiatry have more effect on female GPs in comparison to male physicians (table 4). This study indicates that there is not any significant linear correlation among age, sex and work experience.

Obviously social, emotional and intellectual development of human is not confined only to childhood, but including entire life cycle ranging from birth to end. On the other word, the education is not exclusive for primary schools, high schools, colleges and official course contents, but education should be continuous. As it is obvious, continuing education has put the educational programs in a new and important way. To be a constructive and dynamic process, the principle of continuing education requires formal and informal trainings which should be linked and coordinated with each other and also be compatible with the individual features (age, sex, work experience), economic and social needs of human during the entire life. Thus, it is necessary to revising the CME programs and producing comprehensive medical education programs as in Iran the Ministry of Health and Medical Education is responsible for.

We showed that when the individual characteristics of GPs (age and work experience) increase, the knowledge of GPs concomitantly decrease which may be due to less eagerness and more Preoccupation in more experienced GPs. In a study carried out by Brøndt et al, it was found that in the Danish GPs, who were not members of a CME group and did not take part in outreach visits, a higher likelihood of suffering from burnout and high burnout was seen in comparison to those who were members of a CME group or received outreach visits (17, 18). We interestingly found that increasing in the mean scores of young and older physicians after continuing education is similar to each other and there is no significant difference between them. In spite of our expectations, it appears that CME programs have not different effects on the knowledge of young GPs in comparison to older (data not shown).

Our study limitations were that all presenters were given the core content and learning objectives during training session, it is possible that differences in presentation style and old knowledge of GPs led to different responses in terms of both knowledge and CME activity preference. Also, during the training session, it is possible that some GPs entered or left the training room and don’t give the all content of training session. An additional limitation in this study was the lack of demographic data collected on participates such as subject's grade point average to graduation.

In conclusion, CME programs area inevitable necessity for all fields and jobs, especially in the field of medicine. It is important to plan and perform different programs in this active area.

Acknowledgements

Financial support and Research committee approval: This article is the result of a research project approved by the Dezful University of Medical Sciences, Department of Research and Information Technology with the code of DUR-108.The authors would also like to show their gratitude to the vice chancellor for the spiritual support of Islamic Azad University of Dezful.

Conflict of Interest: The authors declare that they have no conflict of interests.