The objective is to study and improve educational methods for the dissemination of professional standards for clinical care. The American Association of Oral and Maxillofacial Surgeons already has criteria and standards of care, i.e., parameters, which will be disseminated in May, 1991. These parameters are comprehensive and developmental, that is they cover the spectrum of speciality care and they will be revised continually as new knowledge of the results of patient care become available.
The specific aims of the research are: 1) to develop, evaluate, and compare specific methods to educate surgeons about using parameters and contributing to their further development; 2) to measure diffusion of the parameters by periodic surveys of the knowledge and attitudes of surgeons; and 3) to measure changes in the behavior of surgeons by reviewing patient records for evidence of increasing compliance with professional parameters. A combination of formal and informal methods of educational intervention is likely to be needed in order to effect changes in practitioner behavior. Interventions focused on practical information, related to prior experience and linked to perceived patient care needs, as well as information received from certain """"""""opinion leaders"""""""", are believed to be important determinants of clinical behavior. Four treatments (educational programs) are planned which test hypotheses about the nature of information about parameters and their source. Mailed questionnaires, distributed at three time points-- before, during, and after intervention--will be sued to measure changes in attitudes, knowledge, and self-reported behavior. The changes over time will measure the diffusion of changes in knowledge and attitudes across the specialty. A patient record review--conducted after the intervention--will abstract records of patients seen before, during and after the intervention. Analysis of the frequency of use of specific recommended treatments will measure the diffusion in behavioral changes over time. The basic design is an interrupted time series with several treatment groups and a control group but without random assignment to treatments. Analysis of the different time points will permit testing whether the inferences made from the research are invalidated by the nonrandomization of the design. The proposed research provides a rigorous test of the effectiveness of education in the use of parameters and comparison of various educational interventions.
| Gruppen, L D; Margolin, J; Wisdom, K et al. (1994) Outcome bias and cognitive dissonance in evaluating treatment decisions. Acad Med 69:S57-9 |
