A bi-national perspective on continuing medical education.

This paper presents a review and comparison of qualitative improvements in the organization, needs assessment, educational methodology, evaluation, and research in continuing medical education (CME) in the United States and Canada. Although accreditation now establishes minimal standards for CME and reduces the chances of irresponsible programs, some organizational issues (such as commercial sponsorship) and educational issues (how to "accredit" journal reading) remain unresolved. There are many examples of excellent, innovative CME programs offered by medical schools, and specialty societies have been instrumental in upgrading CME by serving as sponsors of accreditation and special projects. There is some evidence that the national health system of Canada has influenced the organization and content of Canadian CME, and these changes may soon affect U.S. programs as well. CME research has grown, with two types of research evident: the biomedical model, which assesses the efficacy of CME interventions by quantitative methods; and a model that uses grounded, ethnographic, methods to assess physician learning and performance change. Given the improvements of the past 20 years, the criticisms that focus exclusively on the lack of ideal educational planning for all CME programs are not so much wrong as dated and perhaps irrelevant. In developing their programs, CME leaders can begin to emphasize the physician learner and the clinical and social environment in which learning occurs.