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Effectiveness of traditional lectures and case methods in Swedish general practitioners’ continuing medical education about COPD: a cluster randomised controlled trial
  1. Hanna Sandelowsky1,2,
  2. Ingvar Krakau1,3,
  3. Sonja Modin1,
  4. Björn Ställberg4,
  5. Sven-Erik Johansson1,2,
  6. Anna Nager1
  1. 1 NVS, Section for Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
  2. 2 Academic Primary Health Care Centre, Stockholm, Sweden
  3. 3 Division of Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
  4. 4 Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
  1. Correspondence to Dr Hanna Sandelowsky; hanna.sandelowsky{at}


Objectives To study the effects of continuing medical education (CME) about chronic obstructive pulmonary disease (COPD) for general practitioners (GPs) by comparing two commonly used CME methods with each other and no CME (reference group).

Design A pragmatic cluster randomised controlled trial with primary healthcare centres (PHCCs) as units of randomisation.

Setting, participants and interventions 24 PHCCs in Stockholm County, Sweden, were randomised into two CME intervention arms: case method learning (CM) (n=12) and traditional lectures (TL) (n=12). A reference group without CME (n=11) was recruited separately. GPs (n=255) participated in the study arm to which their PHCC was allocated: CM, n=87; TL, n=93; and reference, n=75. Two 2-hour CME seminars were given in a period of 3 months.

Primary outcome measures Changes in scores between baseline and 12 months on a 13-item questionnaire about evidence-based COPD management (0–2 points/question, maximum total score 26 points).

Results 133 (52%) GPs completed the questionnaire both at baseline and 12 months. Both CM and TL resulted in small yet significantly higher total scores at 12 months than at baseline (CM, 10.34 vs 11.44; TL, 10.21 vs 10.91; p<0.05); there were few significant differences between these CME methods. At both baseline and 12 months, all three groups’ scores were generally high on questions about smoking cessation support and low on those that measured spirometry interpretation skills, interprofessional care and management of multimorbidity.

Conclusions Neither short CM nor short TL CME sessions substantially improve GPs’ skills in managing COPD. It is justified to challenge the use of these common CME methods as a strategy for improving GPs’ level of knowledge about management of COPD and other complex chronic diseases characterised by multimorbidity.

Trial registration number NCT02213809; Results.

  • continuing medical education
  • professional training
  • case method learning
  • traditional lectures
  • primary care physicians
  • COPD
  • chronic diseases
  • primary care
  • cluster randomized controlled trial

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  • Contributors HS, IK, SM, BS and AN conceived and designed the study. HS and BS were two of the five CME leaders. HS collected the data. HS, BS, S-EJ and AN analysed the data. HS wrote the paper. All authors edited, revised and approved the final manuscript.

  • Funding This work was supported by employment in and grants from the Stockholm County Council (grand register number LS 1110-1339, LS 1301-0078 and LS 1411-1373), employment in Dalarna County Council, and an unrestricted research grant from AstraZeneca Inc.

  • Competing interests HS has received honoraria for educational activities from Boehringer Ingelheim, Novartis, AstraZeneca, and TEVA and an unrestricted research grant from AstraZeneca. AN has received compensation for educational activities from AstraZeneca and SM from Novartis. BS has received honoraria for educational activities and lectures from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Meda, Novartis, and TEVA and has served on advisory boards arranged by AstraZeneca, Novartis, Meda, TEVA, GlaxoSmithKline, and Boehringer Ingelheim.

  • Patient consent Not required.

  • Ethics approval Regional Ethical Review Board of Stockholm (ref 2013/232-31/5).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data analysed in this study are available from the corresponding author in response to requests that comply with ethical principles of good research.

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