Qualitative Interviewing: The Art of Hearing Data

Background
Educational meetings are widely used for continuing medical education. Previous reviews found that interactive workshops resulted in moderately large improvements in professional practice, whereas didactic sessions did not.

Objectives
To assess the effects of educational meetings on professional practice and healthcare outcomes.

Search methods
We updated previous searches by searching the Cochrane Effective Practice and Organisation of Care Group Trials Register and pending file, from 1999 to March 2006.

Selection criteria
Randomised controlled trials of educational meetings that reported an objective measure of professional practice or healthcare outcomes.

Data collection and analysis
Two authors independently extracted data and assessed study quality. Studies with a low or moderate risk of bias and that reported baseline data were included in the primary analysis. They were weighted according to the number of health professionals participating. For each comparison, we calculated the risk difference (RD) for dichotomous outcomes, adjusted for baseline compliance; and for continuous outcomes the percentage change relative to the control group average after the intervention, adjusted for baseline performance. Professional and patient outcomes were analysed separately. We considered 10 factors to explain heterogeneity of effect estimates using weighted meta-regression supplemented by visual analysis of bubble and box plots.

Main results
In updating the review, 49 new studies were identified for inclusion. A total of 81 trials involving more than 11,000 health professionals are now included in the review. Based on 30 trials (36 comparisons), the median adjusted RD in compliance with desired practice was 6% (interquartile range 1.8 to 15.9) when any intervention in which educational meetings were a component was compared to no intervention. Educational meetings alone had similar effects (median adjusted RD 6%, interquartile range 2.9 to 15.3; based on 21 comparisons in 19 trials). For continuous outcomes the median adjusted percentage change relative to control was 10% (interquartile range 8 to 32%; 5 trials). For patient outcomes the median adjusted RD in achievement of treatment goals was 3.0 (interquartile range 0.1 to 4.0; 5 trials). Based on univariate meta-regression analyses of the 36 comparisons with dichotomous outcomes for professional practice, higher attendance at the educational meetings was associated with larger adjusted RDs (P < 0.01); mixed interactive and didactic education meetings (median adjusted RD 13.6) were more effective than either didactic meetings (RD 6.9) or interactive meetings (RD 3.0). Educational meetings did not appear to be effective for complex behaviours (adjusted RD -0.3) compared to less complex behaviours; they appeared to be less effective for less serious outcomes (RD 2.9) than for more serious outcomes.

Authors' conclusions
Educational meetings alone or combined with other interventions, can improve professional practice and healthcare outcomes for the patients. The effect is most likely to be small and similar to other types of continuing medical education, such as audit and feedback, and educational outreach visits. Strategies to increase attendance at educational meetings, using mixed interactive and didactic formats, and focusing on outcomes that are likely to be perceived as serious may increase the effectiveness of educational meetings. Educational meetings alone are not likely to be effective for changing complex behaviours.

Continuing education meetings and workshops: effects on professional practice and health care outcomes

Preface (1999) Preface (1990) 1. Subjects of Sex/Gender/Desire I. 'Women' as the Subject of Feminism II. The Compulsory Order of Sex/Gender/Desire III. Gender: The Circular Ruins of Contemporary Debate IV. Theorizing the Binary, the Unitary and Beyond V. Identity, Sex and the Metaphysics of Substance VI. Language, Power and the Strategies of Displacement 2. Prohibition, Psychoanalysis, and the Production of the Heterosexual Matrix I. Structuralism's Critical Exchange II. Lacan, Riviere, and the Strategies of Masquerade III. Freud and the Melancholia of Gender IV. Gender Complexity and the Limits of Identification V. Reformulating Prohibition as Power 3. Subversive Bodily Acts I. The Body Politics of Julia Kristeva II. Foucault, Herculine, and the Politics of Sexual Discontinuity III. Monique Wittig - Bodily Disintegration and Fictive Sex IV. Bodily Inscriptions, Performative Subversions Conclusion - From Parody to Politics

Postmodern Subjects, Postmodern BodiesThinking Fragments: Psychoanalysis, Feminism, and Postmodernism in the Contemporary WestYearning: Race, Gender, and Cultural PoliticsGender Trouble: Feminism and the Subversion of Identity

Social research, issues, methods and process

Gender, health and theory: conceptualizing the issue, in local and world perspective.

Increasingly the second wave of EBHC has emphasised patient perspectives, evidence-based patient choice and evidence-based patient care. At least at the level of policy and representation, there has been a movement away from an emphasis on distanced cohort data with increased attention given to the applicability of data for individual patients and clinical contexts. Despite this, as Holmes and O'Byme emphasise in Chapter 3, EBM and EBP have remained reliant on epidemiological data and reductive approaches to care regardless of linguistic and rhetorical shifts. It is for this reason that we place this chapter in Part 111 ('Evidence on the Margins') rather than in Part II ('Evidence in the Clinic'). Whilst this is perhaps slightly provocative -there is some penetration of patient views on evidence into clinical environments -patient understandings of what constitutes effectiveness have been consistently marginalised. As shown in the data presented below, while patient perspectives are continuing to shape clinical work and clinical practices, they often vary significantly from those of biomedical clinicians and EBMfEBP advocates. A refocusing on what patients themselves understand as evidence becomes an inevitable conclusion. In this chapter we ask British patients themselves 'what is evidence?' and in a particularly controversial context: the use of complementary and alternative medicine (CAM) in the context of cancer. There is perhaps no more divisive a public and academic debate than that of the use of CAM in the treatment of cancer and such debates tend to feature those operating at the extremes of the 'evidence debate' (that is, those espousing meta-analysis of clinical trials versus those who treat on the basis of individual need). This very public debate has largelyfocusedon the'lackofproof'discourseespousedbyCAM scepticsrather than the'lack of a need for proof' discourse of CAM advocates. While there are stakeholders pursuing a more nuanced position, there has been little movement in the area of CAM and cancer in terms of health policy or health delivery in the UK. Most CAM use for cancer is private, making it a fascinating case study of patient decision making taking place outside conventional medicine facilities and involving considerations around what works and what constitutes evidence of effectiveness.

Patient understandings of evidence and therapeutic effectiveness

Comment on: "Conceptualizing mainstream health care providers' behaviours in relation to complementary and alternative medicine" by Hirschkorn and Bourgeault.

The second of two related articles examining quality assurance in university continuing professional education (CPE). Proposes an action framework which is the outcome of research comprising three elements: postal questionnaires which examined the attitudes, aims and practices of specialist and non‐specialist providers of university CPE; an analytical review of practice in other branches of education, and in health, welfare and construction, including BS 5750; and case study research conducted with professional bodies and employers. Argues that a context‐specific approach to quality is required, which would remove both the market and the customer as determinant concepts and would, instead, concentrate on developing quality to fit the character of a distinct and complex educational practice.

Context specificity and quality continuing professional education. Part 2: towards a meaningful approach

Within the last decade there have been significant developments in the relationship between complementary and alternative medicine (CAM) l and biomedical provision. Rhetorics of integration have become increasingly commonplace and an air of consensus, about the incorporation of CAM, as an accompaniment or supplement to conventional treatments, has become apparent. Regardless of the potential barriers to successfull integration (Barrett 2003; Hughes 2004; Coulter 2004) the rising tide of popularity of these medicines amongst both providers and consumers has helped cement CAM as a key public health and health care/provision issue (Bodeker and Kronenberg 2002; Giordano et al. 2003). But with the emergence of consensus comes the potential for a less critical and distanced analysis of the integrative process. This is a tendency, we argue, that should be resisted.

Philip Tovey

Papers

Patient understandings of evidence and therapeutic effectiveness

Comment on: "Conceptualizing mainstream health care providers' behaviours in relation to complementary and alternative medicine" by Hirschkorn and Bourgeault.

Context specificity and quality continuing professional education. Part 2: towards a meaningful approach

Introduction: Towards a Critical Social Science of CAM in nursing and midwifery

Towards the mainstreaming of complementary and alternative medicine