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The Majority of Accredited Continuing Professional Development Activities Do Not Target Clinical Behavior Change

Légaré, France MD, PhD; Freitas, Adriana PhD; Thompson-Leduc, Philippe; Borduas, Francine MD; Luconi, Francesca PhD; Boucher, Andrée MD; Witteman, Holly O. PhD; Jacques, André MD

doi: 10.1097/ACM.0000000000000543
Research Reports

Purpose Continually improving patient outcomes requires that physicians start new behaviors, stop old behaviors, or adjust how they practice medicine. Continuing professional development (CPD) is the method most commonly used by physicians to improve their knowledge and skills. However, despite regular physician attendance at these activities, change in clinical behavior is rarely observed. The authors sought to identify which of Bloom’s domains (cognitive, affective, or psychomotor) are targeted by the learning objectives of CPD activities offered by medical associations, regulatory bodies, and academic institutions in the province of Quebec, Canada.

Method The authors evaluated the objectives of 110 accredited CPD activities offered to physicians and other health professionals from November 2012 to March 2013. The objectives of each activity were extracted and classified into learning domains using Bloom’s taxonomy.

Results Ninety-six percent of the learning objectives analyzed targeted the cognitive domain, which consists of six levels of increasing complexity: knowledge, comprehension, application, analysis, synthesis, and evaluation. Half (47%) targeted knowledge and comprehension, whereas only 26% aimed to improve skills in analysis, synthesis, and evaluation.

Conclusions Most accredited CPD activities within this sample were generally not designed to promote clinical behavior change because the focus of these activities was on remembering and understanding information instead of preparing physicians to put knowledge into practice by analyzing information, evaluating new evidence, and planning operations that lead to behavior change. Educators and CPD providers should take advantage of well-established theories of health professional behavior change, such as sociocognitive theories, to develop their activities.

Dr. Légaré is full professor, Department of Family Medicine, Université Laval, and clinical investigator, Public Health and Practice-Changing Research Group, Centre Hospitalier Universitaire de Québec (CHU de Québec) Research Centre, Quebec City, Quebec, Canada.

Dr. Freitas is project coordinator, Public Health and Practice-Changing Research Group, CHU de Québec Research Centre, Quebec City, Quebec, Canada.

Mr. Thompson-Leduc is an epidemiology student, Université Laval, Quebec City, Quebec, Canada.

Dr. Borduas is associate professor, Office of the Vice-Dean of Education and Continuing Professional Development, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada.

Dr. Luconi is assistant dean of continuing health professional education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.

Dr. Boucher is vice dean of continuing professional education, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.

Dr. Witteman is assistant professor, Department of Family and Emergency Medicine, director of research, Office of Education and Continuing Professional Development, Université Laval, and research scientist, Public Health and Practice-Changing Research Group, CHU de Québec Research Centre, Quebec City, Quebec, Canada.

Dr. Jacques is advisor to the president, and executive director, Collège des Médecins du Québec, Montreal, Quebec, Canada.

Funding/Support: This study was funded by a Partnership for Health System Improvement grant from the Canadian Institutes of Health Research (2010–2013; grant no. 200911PHE-216868-PHE-CFBA-19158) and by the Ministère de la Santé et des Services Sociaux du Québec, QC, Canada. France Légaré holds a Canada Research Chair position. The following continuing medical education organizations provided funding for this study: Vice-décanat à la pédagogie et au développement professionnel continu–Secteur DPC, Faculty of Medicine, Université Laval, Quebec, QC, Canada; Practice Enhancement Division, Collège des médecins du Québec, Montreal, QC, Canada; Fédération des médecins spécialistes du Québec, Montreal, QC, Canada; Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada; Université de Montréal, QC, Canada; and Centre for Continuing Health Professional Education, McGill University, Montreal, QC, Canada.

Other disclosures: None reported.

Ethical approval: Ethics approval for the project was received from the institutional review board of the Centre Hospitalier Universitaire de Québec on June 30, 2012.

Correspondence should be addressed to Dr. Légaré, Public Health and Practice-Changing Research Group, CHUQ Research Centre (CRCHUQ), Hôpital St-François d’Assise, 10, rue Espinay, Quebec, QC, Canada, G1L 3L5; telephone: (418) 525-4444 ext. 52428; fax: (418) 525-4194; e-mail: France.Legare@mfa.ulaval.ca.

© 2015 by the Association of American Medical Colleges