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It is generally agreed that CME is important to keep up with recent advances of medicine and to hone existing knowledge and skills of doctoring. In an earlier editorial (1993), the point that effective CME needs to go beyond “predisposing” activities was made. To be effective, the doctor needs to be enabled and empowered to make the necessary changes to his knowledge base and way of practice. This editorial takes up the discussion further.

For CME to work, it should be targeted at “filling the valleys” of ignorance and not “topping the hills” of knowledge. The usual behaviour is to attend CME on topics that one likes and are familiar or good at already. Topics that one needs reinforcement are paradoxically left out subconsciously. A point has been made that doctors may not therefore choose to learn what they really need. One way out is to do a systematic check down a list of topics related to one’s area of practice, be it general practice, internal medicine, surgery or O & G and for each topic ask oneself what is the perceived confidence level and mastery of that topic. In this way, one can objectively identify topics for attention.

Next, CME providers should organise programmes that are enabling such as helping the doctor to develop decision making skills, problems solving skills and clinical psychomotor skills. Problem based teaching, workshops and small groups work on clinical problems encountered in practice are more valuable than “show and tell” sessions. To get doctors into this second gear may require some persuasion and coaxing. Doctors need to feel secure before they are willing to jump into problem solving sessions. Trainers need therefore to be nurturing in approach.

Finally, to make CME effective requires some planning at a regional or national level. Since administratively, Singapore can be divided into east, central and west, this becomes a convenient grouping to plan CME programmes for a roll on programme for a year or two years. Of course, Singapore being geographically small, one may elect to plan nationally. The whole exercise of planning is to ensure that there is a broad spread of topics for doctors to choose from. It is not sensible to have 5 teaching sessions on ACE inhibitors and none on rational use of antibiotics for instance. With a national or national plan of topics, providers of CME can better position themselves to make CME truly effective. Then we need not worry about people signing their names and disappearing or getting into forty winks.  


Goh LG, Effective CME. SMA Newsletter, July 1993