Background: For continuing medical education (CME) to be effective, several key features must be realized. These include a learner-directed agenda of topics, presentation of information by trusted peers or local experts, and opportunity for practice and feedback. If the information comes from several sources--printed materials, peer discussion, patient questions, and presentation from the specialist community--the perception of need for and the durability of change are enhanced. Finally, motivation for change must be high enough for change to occur, yet not overwhelming.
Method: Facilitated small-group discussion among general practitioner colleagues with an expert specialist around clinic-based problems meets many of these requirements. When followed up by relevant literature, key concepts and practice changes are reinforced.
Results: We discuss our 3-year experience with the small-group format, comprising more than 25 sessions as either learners or facilitators. We describe the maturation of our group. We highlight the benefits to learners, including the relevance to clinical practice and the opportunity to ascertain the standard of care of peers. The benefits to the specialist are also discussed, including opportunities to learn which suggestions are difficult to implement.
Implications: Our experience demonstrates that this format is sustainable over the long term. The success of the small-group format at improving CME and patient outcomes deserves further evaluation.