Surgical continuing medical education: format and impact.

A survey of 140 continuing medical education (CME) offerings in surgery for 1975-1976 was undertaken. In no instance was there evidence of evaluation of learning or behavior changes after the experience on the part of the sponsors. Estimated cost from the data obrained, 83 courses, was approximated at two million dollars. There is no evidence that this modality achieves the objective of improved patient care. A change from the education-based existing system to a competency-based evaluation system is proposed. The latter, a multicomponent system, has an objective cognitive skills measurement and a measurement of behavior as major elements. Computer simulation-modeling using patient-problems is proposed to define deficits and to be used as an active participatory educational modality. Development of practice profiles, establishment of a data base for determining patient outcome, including morbidity and mortality data, and identification of measures to determine rate of adoption of innovation and loss of obsolescent concepts are required to define behavioral changes. Under the guidance of academic and professional societies working in the community, an effective competency-based educational system dedicated to improved patient care can be specified and implemented.