Table 1

Summary of reviewed studies in chronologic order of publication

STUDY	TYPE AND PARTICIPANTS	FORMAT	CONTENT	OUTCOMES	RESULTS
Eliasson and Mattsson, 1999, Sweden¹	Descriptive study “literature review”; 400 GPs, 40 group leaders, 100 trained leaders	222 GPs met 1–2 times/mo; problem-based format, self-directed learning	Modules from daily work relevant to practice; case discussion	Occurrence; themes; effect of small CME groups	Small CME groups are less common than traditional CME activities A competent leader is crucial Group work might enhance knowledge development and facilitates adoption of new guidelines
Davis et al, 1999, Edmonton, Alta¹³	Descriptive study; 54 FPs, trained facilitator	4 pilot PBSGL sessions	9 clinical osteoporosis cases; effect of PBSGL was evaluated using pretests and posttests consisting of objective structured clinical examination stations and standardized patients	Improvement of knowledge and skills in diagnosing and managing osteoporosis	The program format, content, and participant satisfaction were highly rated by PCPs Participants expected the program to have a substantial effect on their practices 98% of participants improved their pretest scores, with a mean increase of 13%
Peloso and Stakiw, 2000, Saskatoon, Sask¹⁴	Descriptive study; 12–15 participants (8 GPs), a trained facilitator, an expert, a pharmacist, a drug representative, internal medicine residents	> 25 sessions over 3 y (evening sessions with a meal); expert made 10-min presentation about the topic followed by summary of 2–3 teaching points then discussion of relevant EBM articles	Cases from the practice presented in 3–4 min then discussions guided by the facilitators in small groups	Advantages to GPs; benefits to facilitators, experts, and sponsor	PBSGL format was more attractive and relevant to practice and led to practice change more than other forms of CME Facilitators acquired new knowledge and skills Experts interacting with GPs improved communication Program built rapport between GPs and sales representative
McSherry and Weiss, 2000, Canada¹⁵	Descriptive study; 658 GPs across Canada	86 peer-led workshops with program’s educational materials (video case studies and a handbook); peer discussion in small groups	Algorithm for benign prostatic hyperplasia management and practice recommendations	Questionnaires before and after the workshops to evaluate “intent to change”	Peer-led small group CME can successfully encourage use of new practice guidelines in primary care
Verstappen et al, 2003, Netherlands¹⁶	Multicentre RCT; 174 GPs in 26 groups	During 6 mo of intervention, GPs discussed 3 consecutive, personal feedback reports in 3 small group meetings and made plans for change	Clinical problems with appropriate testing according to evidence-based guidelines	A decrease in number of tests/6 mo/physician according to EBM guidelines; a decrease in inappropriate tests as defined in the guidelines	PBSGL strategy resulted in modest improvement in test ordering by PCPs
Allen et al, 2003, Nova Scotia¹⁷	Descriptive study; 31 GPs from 3 communities, experienced facilitator	Videoconference link; 4 modules (each 1 h); evaluation done to assess knowledge and change in practice	Modules from the Foundation for Medical Practice Education on clinical cases from practice	Value of discussion; ease of facilitation; effect of videoconferencing; educational content; intended practice change; cost	Evidence of gained knowledge Negative effect of videoconferencing on the facilitator leading the discussion GPs reported practice changes from participating in the modules Videoconferencing can be used in PBSGL
De Villiers et al, 2003, South Africa¹⁸	Descriptive study; GPs, facilitators	Up to 12 GPs per group; 3 sessions over 9 mo; evaluation done by NGT	Topics from clinical practice	Improvement in knowledge, skills, and patient care	NGT was an effective tool for program evaluation The program improved GPs’ knowledge, skills, and patient care
Herbert et al, 2004, British Columbia¹⁹	2 × 2 RCT; 200 FPs, group facilitators	Monthly meeting in 28 peer learning groups; evaluation by measuring prescribing preference before and 6 mo after the intervention	Case-based educational module, EBM, guidelines about prescribing in hypertension discussed in small groups	Changes in prescribing preferences (ie, probability that patient will receive the EBM medication as first-line therapy)	EBM educational interventions combining feedback and interactive group discussion led to modest changes in physicians’ prescribing
Macvicar et al, 2006, Scotland²¹	Descriptive study; 41 GPs, trained facilitators	5 groups over 12 mo; each group decided the frequency and location of meetings (usually 2 h); 1 group used videoconferencing; evaluation done by pretest and posttest questionnaire	Different modules from the practice selected by the group members	Assess effectiveness of PBSGL on participants’ knowledge, skills, and attitudes in relation to EBM; knowledge of small group functioning	PBSGL has positive effect on learning in applying evidence and on small group function
Sommers et al, 2007, San Francisco, Calif²⁰	Descriptive study; 98 GPs	11 groups met regularly in their offices or clinics	GPs present dilemma cases, share experience, review evidence, and draw implications for practice improvement	Meeting and attendance; clinical dilemma cases; clinician feedback; clinician group discussion	Attendance was stable PBSGL was feasible and acceptable Useful method of practice-based learning and improvement
Armson et al, 2007, Canada⁴	Descriptive study; program started in 1992 and grew to more than 3500 physicians across Canada by 2007; more than 450 experienced trained facilitators were involved	GPs met an average of 90 min/mo or twice/mo in small, self-formed groups of 4–10 FPs	Standardized format modules from clinical practice cases and topics using EBM approach	Change in practice	Success of the program is evident in effect on clinical practice, increasing numbers of members, and growth in interest in the program internationally
Murrihy et al, 2009, Australia²²	Descriptive study; 32 FPs in 6 groups, facilitated by experienced psychologists	6 groups completed 8 sessions, 2 h each, during a 6-mo period	Basic knowledge about CBT; role play scenarios, training workshops	Enhanced brief CBT knowledge and counseling skills	FPs’ knowledge and skills in actual use of brief CBT improved considerably
Kanisin-Overton et al, 2009, Scotland²³	Descriptive study; interprofessional education (GPs and PNs); 19 participants including facilitators	GPs met once/mo	Clinical modules equally challenging and relevant to both GPs and PNs	Assess learning in multiprofessional groups; assess benefits of PBSGL	Peer facilitators are crucial to PBSGL effectiveness Mutual respect and equity were important PBSGL is appropriate for CPD of mixed groups of GPs and PNs

CME—continuing medical education, CBT—cognitive behavioural therapy, CPD—continuing professional development, EBM—evidence-based medicine, FP—family physician, GP—general practitioner, NGT—nominal group technique, PBSGL—practice-based small group learning, PCP—primary care provider, PN—practice nurse, RCT—randomized controlled trial.