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Provider Education To Promote Implementation of Clinical Practice Guidelines^*

^* From the Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, North Worcester, MA.

Correspondence to: Judith K. Ockene, PhD, MEd, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Ave, North Worcester, MA 01655; e-mail: Judith.Ockene{at}umassmed.edu

Study objectives: Although the interest in and promulgation of clinical practice guidelines have significantly increased in the past 2 decades, concern exists about their actual implementation. This article focuses on one strategy to encourage guideline implementation at the clinician level: clinician education. The objectives of the article are to review educational strategies, to consider them within the context of complementary strategies carried out at the organizational and clinic setting levels, and to outline challenges and recommendations for clinicians’ continuing education.

Methods: Experience and data from relevant randomized clinical trials within an educational framework are reviewed.

Observations: Implementation of clinical practice guidelines requires a variety of skills, including assessment, appropriate delineation of a treatment and monitoring plan, patient tracking, and patient counseling and education skills. Continuing education strategies must reflect the content and teaching methods that best match the learning objectives. The pressures of current-day practices place limits on the resources, particularly clinician time, that are available for continuing education. Organizational resources must be committed to build the complementary supportive systems necessary for improved clinician practice. In addition to physicians, education must be directed at nonphysician clinicians, office staff, and administrators who also are responsible for guideline implementation.

Conclusions: To meet the challenges of developing clinician motivation, balancing competing demands, and treating patients with complex medical conditions, all within time constraints, clinical leaders need to design education activities that have leadership support, reflect compelling evidence, use multiple strategies and teaching techniques, and engage learners in skill building and problem solving.

Key Words: implementing guidelines • medical education

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