What is the aim of this review?
The aim of this Cochrane Review was to assess the effects of educational meetings on healthcare professionals’ practice and on patients’ health. Review authors searched for all relevant studies to answer this question and included 215 studies in the review.
Key messages
Educational meetings alone or as the main part of a larger strategy are probably better than no strategy for improving healthcare professionals’ practice and patients' health. They also may be better than other types of behaviour change strategies for improving healthcare professionals’ practice. But we do not know if some types of educational meetings are better than others.
What was studied in the review?
Educational meetings include courses, seminars, and workshops in various formats. Doctors and other healthcare professionals often use educational meetings as part of their continuing medical education. Medical societies and employers in the healthcare system also use educational meetings to present new knowledge or new types of care and to encourage best practice. These types of meetings can vary a lot. For instance, some may be very interactive, and other may be lecture-based. Types of people leading the meetings and numbers of people who attend also vary.
But do these types of meetings lead to change? The review authors assessed whether healthcare professionals who went to educational meetings were more likely to follow practices recommended to them. In addition, review authors assessed whether these meetings led to any improvements in patients’ health.
This review is an update of an earlier Cochrane Review.
What are the main results of the review?
Review authors included 215 relevant studies involving more than 28,000 healthcare professionals.
Most of the studies were from North America or Europe, although many other countries were also represented. Most studies took place in primary care or community-based care settings such as nursing homes, but many took place in hospitals and other secondary care settings. Most of the healthcare professionals in these studies were doctors, but the studies looked at other groups, including nurses, pharmacists, physiotherapists, and dentists. This review shows the following.
• Educational meetings alone or as the main part of a larger package, compared with no meetings
- Healthcare professionals are probably more likely to follow recommended practices (moderate-certainty evidence)
- This probably slightly improves patient health (moderate-certainty evidence)
• Educational meetings alone compared with other strategies to change healthcare professionals’ behaviour
- Healthcare professionals may be more likely to follow recommended practices (low-certainty evidence)
- We do not know about effects on patient health because we found no relevant studies
• Interactive educational meetings compared with lecture-based educational meetings
- We do not know about effects on healthcare professionals’ practice or on patients’ health because the certainty of evidence is very low
• Any other comparison of different types of educational meetings
- We do not know about effects on healthcare professionals’ practice or on patients’ health because the certainty of evidence is very low
How up-to-date is this review?
The review authors searched for studies in November 2016.
Compared with no intervention, educational meetings as the main component of an intervention probably slightly improve professional practice and, to a lesser extent, patient outcomes. Educational meetings may improve compliance with desired practice to a greater extent than other kinds of behaviour change interventions, such as text messages, fees, or office systems. Our findings suggest that multi-strategy approaches might positively influence the effects of educational meetings.
Additional trials of educational meetings compared with no intervention are unlikely to change the review findings; therefore we will not further update this review comparison in the future. However, we note that randomised trials comparing different types of education are needed.
Educational meetings are used widely by health personnel to provide continuing medical education and to promote implementation of innovations or translate new knowledge to change practice within healthcare systems. Previous reviews have concluded that educational meetings can result in small changes in behaviour, but that effects vary considerably. Investigations into which characteristics of educational meetings might lead to greater impact have yielded varying results, and factors that might explain heterogeneity in effects remain unclear. This is the second update of this Cochrane Review.
• To assess the effects of educational meetings on professional practice and healthcare outcomes
• To investigate factors that might explain the heterogeneity of these effects
We searched CENTRAL, MEDLINE, Embase, ERIC, Science Citation Index Expanded (ISI Web of Knowledge), and Social Sciences Citation Index (last search in November 2016).
We sought randomised trials examining the effects of educational meetings on professional practice and patient outcomes.
Two review authors independently extracted data and assessed risk of bias. One review author assessed the certainty of evidence (GRADE) and discussed with a second review author. We included studies in the primary analysis that reported baseline data and that we judged to be at low or unclear risk of bias. For each comparison of dichotomous outcomes, we measured treatment effect as risk difference adjusted for baseline compliance. We expressed adjusted risk difference values as percentages, and we noted that values greater than zero favour educational meetings. For continuous outcomes, we measured treatment effect as per cent change relative to the control group mean post test, adjusted for baseline performance; we expressed values as percentages and noted that values greater than zero favour educational meetings. We report means and 95% confidence intervals (CIs) and, when appropriate, medians and interquartile ranges to facilitate comparisons to previous versions of this review. We analysed professional and patient outcomes separately and analysed 22 variables that were hypothesised a priori to explain heterogeneity. We explored heterogeneity by using univariate meta-regression and by inspecting violin plots.
We included 215 studies involving more than 28,167 health professionals, including 142 new studies for this update.
Educational meetings as the single intervention or the main component of a multi-faceted intervention compared with no intervention
• Probably slightly improve compliance with desired practice when compared with no intervention (65 comparisons, 7868 health professionals for dichotomous outcomes (adjusted risk difference 6.79%, 95% CI 6.62% to 6.97%; median 4.00%; interquartile range 0.29% to 13.00%); 28 comparisons, 2577 health professionals for continuous outcomes (adjusted relative percentage change 44.36%, 95% CI 41.98% to 46.75%; median 20.00%; interquartile range 6.00% to 65.00%))
• Probably slightly improve patient outcomes compared with no intervention (15 comparisons, 2530 health professionals for dichotomous outcomes (adjusted risk difference 3.30%, 95% CI 3.10% to 3.51%; median 0.10%; interquartile range 0.00% to 4.00%); 28 comparisons, 2294 health professionals for continuous outcomes (adjusted relative percentage change 8.35%, 95% CI 7.46% to 9.24%; median 2.00%; interquartile range -1.00% to 21.00%))
The certainty of evidence for this comparison is moderate.
Educational meetings alone compared with other interventions
• May improve compliance with desired practice when compared with other interventions (6 studies, 1402 health professionals for dichotomous outcomes (adjusted risk difference 9.99%, 95% CI 9.47% to 10.52%; median 16.5%; interquartile range 0.80% to 16.50%); 2 studies, 72 health professionals for continuous outcomes (adjusted relative percentage change 12.00%, 95% CI 9.16% to 14.84%; median 12.00%; interquartile range 0.00% to 24.00%))
No studies met the inclusion criteria for patient outcome measurements. The certainty of evidence for this comparison is low.
Interactive educational meetings compared with didactic (lecture-based) educational meetings
• We are uncertain of effects on compliance with desired practice (3 studies, 370 health professionals for dichotomous outcomes; 1 study, 192 health professionals for continuous outcomes) or on patient outcomes (1 study, 54 health professionals for continuous outcomes), as the certainty of evidence is very low
Any other comparison of different formats and durations of educational meetings
• We are uncertain of effects on compliance with desired practice (1 study, 19 health professionals for dichotomous outcomes; 1 study, 20 health professionals for continuous outcomes) or on patient outcomes (1 study, 113 health professionals for continuous outcomes), as the certainty of evidence is very low.
Factors that might explain heterogeneity of effects
Meta-regression suggests that larger estimates of effect are associated with studies judged to be at high risk of bias, with studies that had unit of analysis errors, and with studies in which the unit of analysis was the provider rather than the patient.
Improved compliance with desired practice may be associated with: shorter meetings; poor baseline compliance; better attendance; shorter follow-up; professionals provided with additional take-home material; explicit building of educational meetings on theory; targeting of low- versus high-complexity behaviours; targeting of outcomes with high versus low importance; goal of increasing rather than decreasing behaviour; teaching by opinion leaders; and use of didactic versus interactive teaching methods.
Pre-specified exploratory analyses of behaviour change techniques suggest that improved compliance with desired practice may be associated with use of a greater number of behaviour change techniques; goal-setting; provision of feedback; provision for social comparison; and provision for social support. Compliance may be decreased by the use of follow-up prompts, skills training, and barrier identification techniques.