Effects of continuing professional development on clinical performance: Results of a study involving family practitioners in Quebec

François Goulet; Eveline Hudon; Robert Gagnon; Eliane Gauvin; Francine Lemire; Isabelle Arsenault

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Table 1

Sociodemographic data: Group 1 comprised CFPC members reporting 250 hours of CPD over 5 years, group 2 comprised physicians reporting 50 hours of CPD yearly, and group 3 comprised physicians reporting little or no CPD activity.

CHARACTERISTICS	GROUP 1, N (%) (N = 70)	GROUP 2, N (%) (N = 77)	GROUP 3, N (%) (N = 68)
Age group, y^{^*^†^‡}
• < 40	12 (17.1)	4 (5.2)	2 (2.9)
• 40–49	25 (35.7)	26 (33.8)	16 (23.5)
• 50–59	18 (25.7)	23 (29.9)	12 (17.6)
• 60–69	7 (10.0)	22 (28.6)	28 (41.2)
• ≥ 70	8 (11.4)	2 (2.6)	10 (14.7)
Sex^{^*^†}
• Male	49 (70.0)	65 (84.4)	58 (85.3)
• Female	21 (30.0)	12 (15.6)	10 (14.7)
PIV program
• Age > 65 y	12 (17.1)	13 (16.9)	19 (27.9)
• Subject of complaint	15 (21.4)	19 (24.7)	16 (23.5)
• Concerning information received	8 (11.4)	10 (13.0)	12 (17.6)
• Office practice (no privileges)	4 (5.7)	5 (6.5)	8 (11.8)
• Methadone	16 (22.9)	14 (18.2)	2 (2.9)
• Examination failures or randomly selected	3 (4.3)	3 (3.9)	0 (0.0)
• Other^§	12 (17.1)	13 (16.9)	11 (16.2)
Physician’s country of graduation
• Canada	50 (71.4)	58 (75.3)	57 (83.8)
• Other	20 (28.6)	19 (24.7)	11 (16.2)
Principal place of practice^{^*^†}
• Institution	38 (54.3)	21 (27.3)	17 (25.0)
• Private practice	32 (45.7)	56 (72.7)	51 (75.0)
Residency in family medicine^{^*^†^‡}
• No	17 (24.3)	49 (63.6)	57 (83.8)
• Yes	53 (75.7)	28 (36.4)	11 (16.2)

CFPC—College of Family Physicians of Canada, CPD—continuing professional development, PIV—professional inspection visit.
↵* Significant difference (P < .05) was observed between groups 1 and 2.
↵† Significant difference (P < .05) was observed between groups 1 and 3.
↵‡ Significant difference (P < .05) was observed between groups 2 and 3.
↵§ Other included physicians who had changed their professional addresses more than twice, those who had acted as replacement physicians in remote regions, those who had changed their fields of practice, those who had renewed their restrictive licences, those referred by the review committee, those practising cosmetic medicine, and those practising psychotherapy more than 25% of the time, performing therapeutic acts more than 60% of the time, or practising outside of their specialties more than 30% of the time.

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Table 2

Number and proportion of physicians with satisfactory scores on quality-of-practice criteria: Group 1 comprised CFPC members reporting 250 hours of CPD over 5 years, group 2 comprised physicians reporting 50 hours of CPD yearly, and group 3 comprised physicians reporting little or no CPD activity.

CRITERIA	GROUP 1, N (%) (N = 70)	GROUP 2, N (%) (N = 77)	GROUP 3, N (%) (N = 68)
Quality and quantity of CPD^{^†^‡}	58 (82.9)	59 (76.6)	0 (0)
Record keeping^{^†^‡}	42 (60.0)	41 (53.2)	17 (25.0)
Investigation^{^*^†^‡}	54 (77.1)	46 (59.7)	27 (39.7)
Diagnosis^{^†^‡}	55 (78.6)	54 (70.1)	33 (48.5)
Treatment^{^*^†^‡}	57 (81.4)	58 (75.3)	34 (50.0)

CFPC—College of Family Physicians of Canada, CPD—continuing professional development.
↵* Significant difference (P < .05) was observed between groups 1 and 2.
↵† Significant difference (P < .05) was observed between groups 1 and 3.
↵‡ Significant difference (P < .05) was observed between groups 2 and 3.

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Table 3

Number and proportion of physicians whose practice was judged to be satisfactory: According to A) sex, B) residency in family medicine, C) age group, and D) principal place of practice.

A)	SEX
QUALITY-OF-PRACTICE COMPONENT	MALE, N (%)	FEMALE, N (%)	P VALUE

Record keeping	74 (43.8)	26 (60.5)	.06
Clinical investigation plan	97 (60.2)	30 (69.8)	.29
Diagnosis	108 (73.0)	34 (85.0)	.15
Treatment and follow-up	115 (71.0)	35 (85.4)	.07
B)	RESIDENCY IN FAMILY MEDICINE
QUALITY-OF-PRACTICE COMPONENT	YES, N (%)	NO, N (%)	P VALUE

Record keeping	51 (42.9)	48 (53.3)	.16
Clinical investigation plan	67 (58.8)	60 (69.0)	.14
Diagnosis	75 (72.8)	67 (81.7)	.17
Treatment and follow-up	79 (69.3)	70 (81.4)	.07
C)	AGE GROUP, Y
QUALITY-OF-PRACTICE COMPONENT	< 40, N (%)	40–49, N (%)	50–59, N (%)	60–69, N (%)	≥ 70, N (%)	P VALUE

Record keeping	13 (72.2)	42 (63.6)	21 (40.4)	17 (30.4)	7 (35.0)	<.001
Clinical investigation plan	15 (83.3)	51 (76.1)	28 (54.9)	23 (44.2)	10 (62.5)	.002
Diagnosis	16 (88.9)	56 (87.5)	31 (66.0)	29 (64.4)	10 (71.4)	.02
Treatment and follow-up	14 (82.4)	57 (85.1)	37 (72.5)	30 (57.7)	12 (75.0)	.02
D)	PRINCIPAL PLACE OF PRACTICE
QUALITY-OF-PRACTICE COMPONENT	INSTITUTION, N (%)	PRIVATE, N (%)	P VALUE

Record keeping	47 (63.5)	53 (38.4)	.001
Clinical investigation plan	57 (76.0)	70 (54.3)	.003
Diagnosis	62 (87.3)	80 (68.4)	.005
Treatment and follow-up	64 (87.7)	86 (66.2)	.001

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Table 4

Number and proportion of physicians with each composite score of satisfactory rating results for quality of practice: Group 1 comprised CFPC members reporting 250 hours of CPD over 5 years, group 2 comprised physicians reporting 50 hours of CPD yearly, and group 3 comprised physicians reporting little or no CPD activity.

GROUP	*PROPORTION ACHIEVING COMPOSITE SCORE,^ N (%)**				MEAN (SD)COMPOSITE SCORE^*	MEDIAN COMPOSITE SCORE^*
GROUP	0	1	2	3	MEAN (SD)COMPOSITE SCORE^*	MEDIAN COMPOSITE SCORE^*
Group 1 (n = 70)	8 (11.4)	5 (7.1)	3 (4.4)	55 (78.6)	2.5 (1.1)	3
Group 2 (n = 77)	16 (20.8)	8 (10.4)	10 (13.0)	43 (55.8)	2.0 (1.2)	3
Group 3 (n = 68)	28 (41.2)	8 (11.8)	9 (13.2)	23 (33.8)	1.4 (1.3)	1

CFPC—College of Family Physicians of Canada, CPD—continuing professional development.
↵* The composite score was obtained by adding 1 point for each of the 3 components of quality of clinical practice (investigation, diagnosis, and treatment plan) that was judged satisfactory.

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Table 5
Results of stepwise multiple linear regression analysis
VARIABLE^* β WEIGHT P VALUE F VALUE MEAN SQUARE
Group 3^† −0.19 .006 9.88 13.26
Principal place of practice −0.17 .01 6.15 8.25
Age of physician −0.15 .03 5.66 7.59
Methadone program 0.14 .05 4.24 5.69

↵* The following variables were included in the regression model: group (dummy coding), age group, sex, country of graduation, professional inspection visit program (dummy coding), place of practice, residency in family medicine, number of continuing professional development credits or hours in a 5-year period, and methadone program.

↵† Group 3 comprised physicians reporting little or no continuing professional development activity.