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This is to certify that the

thesis entitled

INCORPORATION OF EDUCATIONAL AND
EXPERIENTIAL VARIABLES IN THE
NEEDS ASSESSMENT PROCESS
FOR NEWLY EMERGING SPECIALTIES

presented by

Elouise Elaine Jordan

has been accepted towards fulfillment
of the requirements for

Ph . D . degree in Administration
and Higher Education

 

Wat...

Major professor

Date April 17, 1981

 

0-7639

 

 

MSU

LIBRARIES
‘53-

 

 

 

RETURNING MATERIALS:
Place in book drop to
remove this checkout from
your record. FINES will
be charged if book is
returned after the date
stamped below.

 

Wm

‘ 102:,

 

 

 

APR r1020 5:.

 

 

 

 

 

Copyright by
Elouise Elaine Jordan

1981

INCORPORATION OF EDUCATIONAL AND
EXPERIENTIAL VARIABLES IN THE
NEEDS ASSESSMENT PROCESS
FOR NEWLY EMERGING SPECIALTIES

BY

Elouise Elaine Jordan

A DISSERTATION

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

Department of Administration and Higher Education

1981

ABSTRACT

INCORPORATION OF EDUCATIONAL AND
EXPERIENTIAL VARIABLES IN THE
NEEDS ASSESSMENT PROCESS
FOR NEWLY EMERGING SPECIALTIES

BY

Elouise Elaine Jordan

STATEMENT OF THE PROBLEM.

 

This study was designed to develop a process
evaluation system which would incorporate (1) a method
of identifying an educational and experiential profile of
professional learners and (2) a feedback mechanism to help
continuing professional education decision makers constantly

improve the quality and focus of their programs.

DESIGN AND INSTRUMENTATION

 

The design of this study was an adaptation of
Stufflebeam's evaluation process design focusing on the
three components of delineating, obtaining, and providing
information for educational decision makers who develop
continuing education programs. The target group for this

study were the physicians attending the annual scientific

Elouise Elaine Jordan

assembly of the American College of Emergency Physicians.
The evaluation instrument was designed to gather
student profile data on experiential and educational back-
grounds and to determine if these variables influence the
participants' perception of the level, or the professional
value, or their recommendations for continued offering of
continuing education courses in which they were enrolled.
The research design identified four groups of
emergency physicians with the most divergent experiential
and educational backgrounds. The first two groups were
those who had practiced emergency medicine full time for
five years or more and those who had practiced it only on
a part time basis. The other two groups were those which
constituted the largest populations with similar medical
education backgrounds. These were emergency medicine and

surgery.

CONCLUSIONS

 

The overall student profile data indicated that
emergency medicine was the major educational background of
the respondents but other medical areas comprising 10% or
more of the population were Surgery, Family Practice and
Internal Medicine.

The experiential data indicated that of those who
participated in the continuing medical education program

less than 10% were physicians who practice emergency

Elouise Elaine Jordan

medicine part time, but that 65% of the total population in
this study were physicians who had practiced emergency
medicine for five or more years.

Additional data on the participants' perceptions of
the level, professional value and recommendations for the
individual continuing medical education courses was compiled
and included in the report to the decision makers for needs

assessment and evaluation for planning future programs.

RECOMMENDATIONS

 

Some of the specific questions used in this study
should be revised to gather more specific data and give a
broader range of responses for participants. The evaluation
needs assessment instrument should be expanded to gather
more data from the respondents regarding specific continuing
education needs they wish to identify.

To be of significant value, the process of gathering
information as delineated in this study must be incorporated
into the overall educational planning and evaluation system
of an organization. This system should be expanded to
include the self-directed professional learner as well as
other organizational decision makers. In such a system it
would be possible to simultaneously meet the needs of the

individual and the organization.

© 1981

AUDREY LYNN SUTFIN

All Rights Reserved

DEDICATION

To the memory of my father
Roy A. Stewart
who encouraged me to accept life's obstacles
as challenges to reach the full potential

for growth.

iii

ACKNOWLEDGMENTS

Without the love and encouragement of my children
Audrey, Linda and Laura, this endeavor could never have
been accomplished. Also the love and support of my mother
and my sisters often stood in the gap between my own frailty
and the distant goal. I am deeply grateful to them and to
a group of friends whose assistance and inspiration I will
always treasure: Ronald Thompson, Joan and Edward Parker,
William Drake, Marilyn Hayden, Benson Munger, Charlie
Maclean and Sara Knaggs.

To Dr. Max Raines, my dissertation chairman, I am
especially indebted. His humanitarian concern for the
student and dynamic approach to educational theory continue
to influence my professional life. I would also like to
thank Dr. Lawrence Lezotte, my research advisor, whose
scholarly direction and personal encouragement was indis-
pensable in the research design and data analysis for this
dissertation. My deep appreciation goes to Dr. Richard
Featherstone and Dr. Joseph Papsidero who not only worked
patiently with me as members of my doctoral committee, but
also as mentors in educational theory and practice through

the seminars they taught at Michigan State University.

iv

I also want to thank Arthur Auer, the executive
director of the American College of Emergency Physicians,
and other ACEP staff members who allowed me the freedom to
work simultaneously on my research and on the continuing
education projects of the College. I am especially grate-
ful to Clara Blair for her special ability and patience in
turning my scribbled pages into precise, neat copy for

publication.

LIST OF

LIST OF

Chapter

I.

II.

III.

TABLE OF CONTENTS

TABLES . . . . . . . . . . . .

FIGURES O O O O O O O O O O O 0

INTRODUCTION . . . . . . . . . . .

Statement of the Problem . . . . . . .
Statement of Purpose . . . . . . . .
Research Questions . . . . . . . . .
Procedures . . . . . . . . . . .
Underlying Assumptions . . . . . . .
Limitations . . . . . . . . . . .
Need for this Study . . . . . . . .

HISTORICAL OVERVIEW OF CONTINUING EDUCATION
IN EMERGENCY MEDICINE . . . . . . . .

Emergence of Need for Emergency Medical

Services . . . . . . . . . . .
Development of Emergency Departments . . .
Formation of New Specialty Society . . .

Growth of Continuing Education in Emergency
Medicine . . . . . . .
Recognition of Value of Continuing

Professional Education . . . . . . .
Needs Assessments . . . . . . . . .
Student Profiles in Needs Assessments . .
Evaluation Purpose and Process . . . . .

INSTRUMENTATION AND METHODOLOGY . . . .

Delineation of Information Needs . . . .
Plan for Obtaining Information -- Research
Design . . . . . . . . . . . .
Evaluation Policies . . . . . . . .
Instrumentation Assumptions . . . . . .
Plan for Providing Information . . . . .

vi

Page

viii

13

13
I4
15

15

16
20
22
23

26
29
33
35

35
36

Chapter

IV.

APPENDI

A.

B.

BIBLIOG

DATA ANALYSIS .

Research
Research
Research
Research
Research
Research
Research
Research
Research

SUMMARY,

Purposes

Discussion of Result
Student Profile .

Conclusions . .

Weaknesses and Limit

Evaluation System

CES

Page
0 O O O O O O O O 38
Group Identification and Data Analysis . . 38
Question 1 . . . . . . . . 39
Question 2 . . . . . . . . 45
Question 3 . . . . . . . . 45
Question 4 . . . . . . . . 48
Question 5 . . . . . . . . 48
Question 6 . . . . . . . . 50
Question 7 . . . . . . . . 53
Question 8 . . . . . . . . 53
Question 9 . . . . . . . . 56
CONCLUSIONS, AND RECOMMENDATIONS . 67
C O O O O O O O O O O O 68
. . . . . . . . 68
O O O O O O O O O 69
O O O O O O O O O 71
ations of This Study . 72
Recommendations for a Planning and
. . . . . . . . 73
Sixth Annual ACEP/EDNA Scientific Assembly
Course Evaluation Form . . . . . . . 78
Graph Summaries of Professional Value
and Level of Individual Courses,
Tables 19 through 26 . . . . . . . 79
O O O O O O O O O O O O 87

RAPHY .

vii

10.

ll.

12.

13.

LIST OF TABLES

Sample Sizes and Percentages for the Eight
Largest Medical Specialty Education Areas .

Specialty Training . . . . . . . . .

Sample Sizes and Percentages of Membership in
Organizations Other Than ACEP . . . . .

Membership in

Specialties Other Than ACEP . .

Professional Value . . . . . . . . .

Participant's

Identification of Course Level .

Should It Be Offered . . . . . . . . .

Sample Sizes,
Statistical
T-Tests for

Sample Sizes,
Statistical
T-Tests for

Sample Sizes,
Statistical
T-Tests for

,Experience

Sample Sizes,
Statistical
T—Tests for

Degrees of Freedom, T-Values and
Probabilities for Significant
Emergency Medicine Graduates .

Degrees of Freedom, T-Values and
Probabilities for Significant
Surgeons . . . . . . . .

Degrees of Freedom, T-Values and
Probabilities for Significant
Those with Five Years or More

Degrees of Freedom, T—Values and
Probabilities for Significant
Those Who Practice Part Time .

Summary of the Sample Sizes and Means of
Emergency Medicine Graduates and Others to

All Fourteen Courses for Value,

Level and

Recommendation . . . . . . . . . .

Summary of Sample Sizes and Means of Response

of Surgeons

and Others to All Fourteen

Courses for Value, Level and Recommendation

viii

Page

41
42

43

44

46

47

49

51

52

54

55

57

58

Table Page

14. Summary of the Sample Sizes and Means of

Responses of Those with Emergency Medicine

Practice of Five Years or More and Others

to All Fourteen Courses for Value, Level

and Recommendation . . .‘ . . . . . . 59
15. Summary of the Sample Sizes and Means of

Responses of Those Who Practice in Emergency

Medicine Part Time and Others to All Fourteen

Courses for Value, Level and Recommendation 60
16. Sample Size and Means for Each Group on the

Value of Individual Courses . . . . . . 61
17. Sample Size and Means for Each Group on the

Level of Individual Courses . . . . . . 63
18. Sample Size and Means for Each Group on the

Recommendation for Offering Courses in the

Future . . . . . . . . . . . . . 65
19. Professional Value of Courses: Emergency

Medicine Grads -- Others . . . . . . . 79
20. Professional Value of Courses: Five Years or

More Practice -- Others . . . . . . . 80
21. Professional Value of Courses: Part Time

Practice -- Others . . . . . . . . . 81
22. Professional Value of Courses: Surgeons --

Others 0 O O O I O O O O I O O O 82
23. Level of Courses: Emergency Medicine Graduates

-- Others 0 o o o o o o o o o o o 83
24. Level of Courses: Surgeons -- Others . . . 34
25. Level of Courses: Five Years or More Practice

-- Others 0 O O O O O O O l O O O C 85
26. Level of Courses: Part Time Practice -— Others 86

ix

LIST OF FIGURES

Figure Page

1. Evaluation Process Design . . . . . . . 30

CHAPTER I
INTRODUCTION

”When Justice Oliver Wendell Holmes asserted that
education begins when what is called education is over, his
words were prophetic of our times . . . continuing profes-
sional education is a worldwide activity. In the United
States it has developed into an art form." McCoy (1979)

By definition, a profession is comprised of persons
who have a specialized body of knowledge acquired through
rigorous formal education and thereafter continually refined
and corrected by science and experience.

Historically, professionals have accepted personal
responsibility for keeping abreast of new developments in
their respective fields of knowledge. In the last few
decades, scientific, technological and societal changes have
caused considerable difficulty for professionals in main-
taining competency and credibility.

The major complicating influence in keeping abreast
of new concepts is the expansion of the knowledge base in a
vast array of expertise, especially those related to science

and technology.

Maintaining professional competency is further com-
plicated by societal changes which affect the roles and
responsibilities of modern professionals. Schein (1972)
points out that the changing roles are caused by "a corre-
lated and interdependent set of changes in society. Problems
which previously were not even acknowledged as legitimately
in the domain of a given profession are now being recognized
and defined as legitimate and important areas of concern."

One of the reasons for this change is that modern
Americans are better educated, more inquisitive and intro-
duced regularly by mass media to new and often controversial
technological, sociological and scientific concepts which
heretofore had been the domain of professional knowledge.
This public information base and evolving societal roles
contribute to changes in client/professional relationships.
Clients today are less in awe of the professionals than they
were in years past, and no longer passively accept profes-
sional judgment and actions. The spread of malpractice suits
against real estate agents, architects, corporate directors,
and health care professionals is clear evidence of this
change.

LegiSIators, who have heard the consumer's challenges
and demands, have further complicated the professional edu-
cation arena by mandating continuing education for relicensure.
Phillips (1978) indicates that "mandatory continuing education

for licensed professionals is steadily becoming the rule

rather than the exception." State licensing boards have
statutes requiring continuing education for relicensure for

a wide variety of professionals, including certified public
accountants, realtors, social workers, lawyers, administrators
of nursing homes and health care practitioners.

Some indications are that in the wake of these increas-
ing demands the professions which have traditionally taken
the responsibility of updating and policing their own ranks,
may lose some of their autonomy. Based on a national study
of current professional accreditation practices, the Newman
Report (1971) specifically recommended that (1) the composi-
tion of established accrediting organizations should be changed
to include representatives of the public interest; and (2)
federal and state governments should reduce their reliance
on established professional organizations for determining
eligibility for federal support.

Another dimension of the continuing professional edu-
cation (CPE) labyrinth comes from the professional societies.
To help stem the tide of external involvement and/or intrusion,
professional organizations have also begun to require contin-
uing education for membership. Williams (1979) summarizes
the state of the art of continuing professional education.
Shastates that the concept of maintaining competence through
continuing education "appears to have achieved an acceptance
and status comparable to that enjoyed by motherhood." She

further asserts:

Motivated by the consumer movement, supported by
professional associations, and increasingly mandated
by state legislatures, continuing education for the
professions now appears to be regarded as the panacea
that will guarantee improvement of health care, ensure
well-designed buildings, and eliminate functional
illiteracy from the classroom. Despite the unanswered
question of how continuing education relates to compe-
tency, the move toward requiring periodic relicensure
or recertification for those already admitted to
practice based on evidence of participation in contin-
uing education is gathering momentum with each legis-
lative session. Concomitant is the increase in
occupations or professions for which licensing is

the entrance requirement into the field.

STATEMENT OF THE PROBLEM

 

Often traditional continuing education programs are,
in the best procrustean tradition, designed to fit the needs
of the students to the interest or expertise of the faculty.
Even when programs are planned specifically for an intended
audience, program planners do not have clear indications of
the unique needs of the practitioner/learner and must base
decisions regarding content and level of courses on the
planner's perception of participants' needs. Groen (1956)
indicates that these "teacher or planner-oriented approaches
are both limited and limiting since they may only inciden-
tally or accidentally meet the needs of the learner and
probably less often of the client/patient."

If the amount of new information/skills were very
small, these planning methods would be less problematic,
but with the present knowledge explosion, it is imperative

that educational methods be efficient, practical, and

focused to the specific needs of the learners.. Even with
improved educational methods and accurate needs assessment,
the expanding knowledge base makes it virtually impossible
for professionals to maintain indepth competency in broad
areas of knowledge and has led to increased specialization.
Two major professions which have experienced this special-
ization are education and medicine.

Newly emerging specialties have some important
traits in common. One of them is that the body of knowledge
which will comprise this new profession must be identified.
Often this delineation of professional responsibilities is
an eclectic combination of roles of several different tradi-
tional specialists.

Knowles (1970) identifies one of these new educa-
tional specialists, the adult educator. He devotes an entire
chapter to the topic of "Andragogy: An Emerging Technology"
and another chapter to the "Role and Mission of the Adult
Educator." In these discussions he indicates that the Adult
Educator must be perceived as a new specialist performing
specialized roles which require specialized training. To
defend his proposal that this new specialist is needed, he
states that:

. . . the time is past when any good teacher or principal
has the equipment necessary to manage a public school
adult-education program or a good professor or dean can
administer a university division of education, or any

good personnel man can direct a training program in
industry.

The adult educator is described as a professional

whose competencies are an eclectic combination of administra-

tion, teaching, counseling and organizational skills. Knowles

asserts that this new specialist must function

. both as a line officer -- managing the adult

education activities for which he is directly respon-
sible -- and as a staff officer -- influencing policies
that affect the educative quality of the total organi-
zational environment and providing consultative and
training services to all personnel in the organization
regarding their part in the educative process.

Another newly emerging professional in education is

the evaluation specialist, and he/she has the same eclectic

pattern of role identification.

Provost (1969) identifies an ideal evaluation team

whose professional abilities include a series of interface

and technical roles. This evaluation team would include:

1.

6.
7.

Several nondirective evaluation specialists skilled
in small group process work and ethnological
techniques.

One or more psychometrists familiar with a wide
range of cognitive and affective instruments and
capable of rapidly designing ad hoc instruments.

A research-design specialist capable of drawing
carefully—defined samples, designing experiments,
and directing the statistical analysis of data.

One or more technical writers familiar with
educational "language" and evaluation concepts.

A data processing unit with capacity for data stor-
age, retrieval, and statistical analyses as directed.

Subject specialist consultants.
A status figure capable of communicating directly

with the superintendent of schools and all program
directors.

Portions of these roles from many areas of expertise
are subsumed in the role of the evaluation specialist as
defined by Stufflebeam (1971). He delineates three general-
ized roles: (l) the interface role, (2) the technical role,
and (3) the administrative role. The interface role evolves
around the decision making process which includes identifying
decision situations, providing relevant information to impact
these decisions, and maintaining productive interactive com-
munication with all other persons involved in the decision
making. The technical role encompasses converting criterion»
statements into measures, sampling, data processing, and
interpretation. The administrative role includes deciding
planning, stimulating, coordinating and appraising the
evaluation process.

In the field of health care, specialization is also
growing rapidly. Breslow (1976) notes that this "increasing
division of labor . . . arises naturally from the growing
technology in health care and appears to be in a crescendo
phase." Research identifies more than 50 distinct health
care vocational or professional groups, and Brodie (1978)
indicates that "Each group seeks to identify itself with a
specialty health service, and many have established education
and training programs to provide practitioners with the know-
ledge and competencies they require for practice."

Emergency medicine is one of the new specialties

whose core of professional knowledge/skills is derived from

many areas of medicine but focuses on the initial diagnosis
and management/treatment of a broad range of medical emergen-
cies. In 1976 the "Core Content of Emergency Medicine" was
published in the Journal of the American College of Emergency
Physicians. It identified twenty-two areas of traditional
medicine, portions of which were requisite knowledge for the
practicing emergency physician.

The eclectic identification of knowledge and skills
for new professions poses special problems in the education
of the new specialists. Although educational components are
usually available in various University schools and depart-
ments, there is not a cohesive unification of these components
and a clear identification of the interrelationships as they
will apply to the specialized practice of the new professionals.

The formal education for these specialties often can
be established through interdepartmental cooperation until a
large enough student body is formed to establish a new depart-
ment. However, practitioners in the new specialty who have
already completed their formal education are in a unique sit-
uation. Since new specialties are usually established by
individuals'who were trained in one of the identified profes-
sional components of the new profession, these inaugural
members add a depth to the field which perhaps could not
occur in any other way; but they also present unique educa-
tional needs which must be met through continuing professional

education.

This process of evolution of a new specialty creates
a first generation of professionals who have extremely
diverse educational and experiential backgrounds. CPE planners
cannot even assume that these practitioners have essentially
the same formal professional educational background. Further,
as a given profession grows, there is no clearly defined
method to identify the traditional specialty area(s) from
which the new professionals are coming.

Therefore, one of the important needs which exists
for CPE planners in emerging specialties is a method of iden-
tification of an educational and experiential profile of the
professionals who are enrolling in CPE courses which they are
developing.

Chickering (1969) attests to the need of this back-
ground information in intelligent decision making. He states:
The evidence from research and from my own experience

is unequivocal. More effective education requires
taking more clear account of differences among students
and acting accordingly . . . sound decisions about what
is needed must derive from knowledge of where a student
is, where he wants to go, and what equipment he brings
for the trip. With such information at hand, intelli-
gent planning can occur.

Pochyly (1978) discusses this information need in
relationship to a ”process evaluation" which incorporates
adult education principles in continuing medical education.

He indicates that "evaluation in terms of process addresses
the issue of whether or not an instructor's activities are

consistent with factors which facilitate or interfere with

adult learning.” The first question he poses for such a

10

process evaluation is "Did the instructor understand the
backgrounds and educational needs of the physicians attending

the program?” This needs to be a continual feedback process.

STATEMENT OF PURPOSE

The major purpose of this study is to develop a
process evaluation model which will incorporate (l) a method
of identifying an educational and experiential profile of
professional learners and (2) a feedback mechanism to help
CPE decision makers constantly improve the quality and focus
of their programs. The target group for this study was the

newest medical specialty, emergency medicine.
RESEARCH QUESTIONS

Research questions which will be addressed are:

1. What are the major student profiles in terms of
longevity (i.e., years of practice/experience in
emergency medicine), current involvement in other
medical specialty areas, and medical education
background?

2. Do the participants perceive that the courses they
take are of significant professional value?

3. At what educational level do the participants
perceive the courses to be?

4. Do the participants recommend that the courses be
offered to others?

5. Do emergency medicine residency trained physicians
perceive the professional value and level of the
educational offerings they attend to be the same
as other participants perceive them?

6. Do physicians who have formal education backgrounds
in surgery perceive the professional value and level
of individual courses to be the same as other
participants perceive them?

ll

7. Do physicians who have practiced emergency medicine
full time for five or more years perceive the pro-
fessional value and level of individual courses to
be the same as other participants perceive them?

8. Do physicians practicing emergency medicine part
time perceive the professional value and level of
individual courses to be the same as other parti-
cipants perceive them?

9. Are there significant differences among the groups
in #5, 6, 7 and 8 above in their overall perceptions
of the Scientific Assembly courses on the variables
of professional value, level and recommendation?

PROCEDURES

 

The data for this study will be taken from the
largest annual scientific meeting of the specialty society.
The instrument will be a course evaluation form which will
be utilized for the learners to evaluate individual courses
offered and to gather data on the participants' professional

experiences and educational background.
UNDERLYING ASSUMPTIONS

The first major assumption is that the profile of
participants in the scientific meeting may not be identical
to the overall profile of members in the specialty. Another
assumption is that participants will be more candid in their

evaluation of courses if the responses are anonymous.

LIMITATIONS

Several important variables in this study cannot be

controlled. One is the identification of who will attend

12

an annual Scientific Assembly. This introduces questions
of the generalizability of this sample.

The sample will further be limited to those parti-
cipants who are willing to complete the evaluations. The
educational needs of those who will not comply with this

request may be very different from those who do comply.

NEED FOR THIS STUDY

 

The growth of medical and technological knowledge
demands the best educational processes to help health care
practitioners keep abreast of their area of specialization
and within the House of Medicine important questions are
being raised about:

1. the purpose and effectiveness of continuing
education

2. the best educational methods for teaching adult
professionals, and

i 3. needs assessment processes.

The Council of Medical Specialty Societies (CMSS) in
conjunction with the Accreditation Council for Continuing
Medical Education (ACCME) is in the process of revising stan-
dards for accrediting organizations which provide Continuing
Medical Education. Two areas which the new standards emphasize
are principles of andragogy and identification of appropriate
needs assessment and evaluation processes especially as they

relate to self-directed learning by professionals.

CHAPTER II

HISTORICAL OVERVIEW OF

CONTINUING EDUCATION IN EMERGENCY MEDICINE

This chapter will briefly review the historical
development of emergency medicine by tracing the emergence
of the specialty society and the concurrent growth and
development of continuing education activities. Then it
will give a review of the literature on the philosophy and
methodology of adult education, needs assessment and eval-
uation especially as they relate to professional continuing

education for emerging specialties.

EMERGENCE OF NEED FOR EMERGENCY MEDICAL SERVICES

 

In 1960, 42 million patients received emergency
medical treatment in hospitals across the United States; by
1979 this number had grown to nearly 82 million (AHA 1980).
The reasons for this tremendous increase have been theorized
by many, and several important factors emerge. Some of these
are the marked advance in medical knowledge and technology
which was spurred on by the advances made during Wbrld War II

and the Korean Conflict. Another factor was the increased

13

l4

mobility of the populace, which caused a maldistribution of
medical coverage especially for general practitioners. Even
though the medical schools continued to prepare trained
physicians, many of them moved into specialty areas other
than routine primary care. Concurrently, comprehensive medi-
cal insurance plans, as well as Medicare and Medicaid, became
increasingly available and made health care financially
feasible to vast numbers of American citizens who heretofore
had had limited access to the medical system. Mass media
also had an effect, both through news and through fictional
episodes, in making the public aware of medical advances and
in increasing medical care expectations.

The result of these and other factors was that the
American public placed a heavy demand for immediate, up-to-
date and effective medical care, much of which was delivered
through the emergency departments. When this pressure
emerged in the sixties, emergency departments were primarily
staffed by house physicians or other attending medical staff.
These physicians were not trained in emergency medicine, and

too often the coverage was inconsistent and sometimes inferior.

DEVELOPMENT OF EMERGENCY DEPARTMENTS

 

A number of physicians around the country became
increasingly concerned about the growing gap between the
demand and the ability to deliver emergency medical services.

In 1961 two groups of physicians, one in Alexandria, Virginia

15

and one in Pontiac, Michigan, incorporated to give consistent
quality coverage in local emergency departments.

As physicians began to practice full time emergency
medicine they recognized the need for continuing medical
education which would directly address the initial diagnosis
and management of a broad spectrum of emergency medical
services, as well as information on how to improve their
emergency departments.

Few traditional programs were sufficiently focused
to meet the needs of these new practitioners, and they

turned to one another for information exchange.

FORMATION OF NEW SPECIALTY SOCIETY

 

On August 16, 1968 eight physicians met in Lansing,
Michigan to discuss the formation of a professional society
for emergency medicine that would meet their unique educa-
tional and professional needs. This society was named the
American College of Emergency Physicians (ACEP).

The exceptional development of this new specialty
is seen in the dramatic growth from a few members in 1968
to over 10,700 in 1980, which makes it the 13th largest
medical specialty society in the United States. The College's

educational development is similarly impressive.

GROWTH OF CONTINUING EDUCATION IN EMERGENCY MEDICINE

 

At its inception ACEP established organizational

16

goals of education oriented to the practice realities of
emergency medicine, and in 1969 ACEP held its first Annual
Scientific Assembly in Denver, Colorado with 128 physicians
attending. It consisted primarily of one hour clinical
lectures followed by roundtable discussions with the
lecturers.

Gray (1978) points out the "immense forward strides"
in emergency medical continuing education that are reflected
in the 1978 Scientific Assembly from which this dissertation
data was gathered. He states: "Not only has the meeting
been expanded to include sessions for nurses and emergency
medical technicians, but much of the material for emergency
physicians has reached esoteric levels that would have seemed
implausible nine years ago." The meeting included philoso—
phical discussions on issues such as "The Right to Die," as
well as more than forty workshops and postgraduate courses.
Two hundred commercial and scientific exhibits, independent
study laboratories, and an advanced cardiac life support

course rounded out this impressive educational offering.

RECOGNITION OF VALUE OF CONTINUING PROFESSIONAL EDUCATION

 

In a brochure entitled, "ACEP's First Decade of
Achievement,” the authors reflect on the importance of the
growth and future of continuing medical education for the

emergency medicine practitioners and for their patients.

The founders of the College were determined to provide
quality educational experiences for emergency physicians.

17

There can be little question that their efforts have
been successful. It rests with future meeting planners
to assure the continued improvement of this important
service to those who practice and those who are recip-
ients of emergency medical care.

The same knowledge explosion, technical advances and
public awareness have influenced professional organizations
outside the health care area and highlight the importance
of quality, focused and expertly designed continuing profes-
sional education. This education should be based upon
(1) sound principles of adult education, (2) identified needs
of the learners, and (3) relevant evaluations which have
feedback loops to the decision makers to contribute to improved
educational activities in the future.

With this perspective the review of the literature
for this study focused on the three major areas of (l) philo-
sophy and methodology of adult education, (2) the state of
the art in needs assessment processes, and (3) the purpose
and process of evaluation. Especial attention was directed
toward the interactive loops among these variables and their
relationship to decision making in continuing professional
‘education.

The literature reveals that much energy has been
expended in recent years in defining adult education, adult
learner characteristics and their unique needs, and appro-
priate teaching methodologies for adults. A well known author

on this topic is Malcolm Knowles, who had a major role in

bringing to contemporary America the term and related concepts

18

of "andragogy." This word is especially intended to stand

in juxtaposition to the term "pedagogy,” which is derived
from the Greek words “pad" (child) and ”agogos" (leading)

and is traditionally defined as "the art and science of
teaching children.” Current concepts of adult education
emphasize that adults are not children and their education
must not be merely the archaic process of transmitting the
knowledge of the culture. Therefore the term "andragogy"

is more fitting because it is derived from the Greek word
"aner" which means man (especially as distinguished from

boy) and is defined as "the art and science of helping adults
learn." Knowles (1973) points out that this term was used

as early as 1833 in Germany and has been used extensively

in recent years in Yugoslavia, France and Holland. In fact,
this distinction between pedagogy and andragogy was so widely
accepted in Europe that in 1970 the University of Amsterdam
established a Department of Pedagogical and Andragogical
Sciences. Four crucial assumptions about adult learners are
the roots of the concept of andragogy. According to Knowles
(1970) these assumptions are that as a person matures,

1. his self concept moves from one of being a dependent
personality toward being a self-directing human being:

2. he accumulates a growing reservoir of experience
that becomes an increasing resource for learning;

3. his readiness to learn becomes oriented increasingly
to the developmental tasks of his social roles; and

4. his time perspective changes from one of postponed
application of knowledge to immediacy of application,

l9

and accordingly his orientation toward learning
shifts from one of subject-centeredness to one of
problem-centeredness.

Bryant (1979) indicates that adult education is an
open system in which learners are volunteers. He points out
that adult learners must feel the need to learn, perceive the
goals of the learning activities to be theirs and have a
sense of progress toward their goals.

Adult learners are more independent and self directing
than children and Suter et al (1980) indicate that they have
some attributes that can "significantly alter their ability
to function as effective learners." These attributes include
”well-developed personal motivation, values and expectations
regarding the learning experiences and assumption of respon-
sibility for learning and its application." Based on these
concepts they conclude that in pedagogy the educator teaches
the student, but in andragogy the educator helps the learner
to learn. Knowles (1973) suggests, "We have finally really
begun to absorb into our culture the ancient insight that the
heart of education is learning, not teaching, and so our focus
has started to shift from what the teacher does to what hap-
pens to the learners." Paul Leagans (1972) links andragogi-
cal concepts as a fourth dimension of progressive education.
He emphasizes that the adult learner's enrollment in a course
is usually based on "felt needs." The classes are hetero-
genous because of diverse student experiential and educational

backgrounds and each of these students is in search of

20

intensely relevant materials. This is clearly descriptive

of professionals in emerging specialties who come from a
variety of formal educational areas, have diverse experiential
backgrounds, and are deeply intent on gaining knowledge and
skills which will make the new profession effective and respec-
ted by other professionals and by their clients.

These adult education principles are now being accepted
by many who are involved in continuing education for profes-
sionals. Miller (1967) recommends a "process model" for
continuing education which is "built upon solid evidence about

the way adults learn."

NEEDS ASSESSMENTS

 

As these andragogical concepts are gaining acceptance
in professional continuing education, they are influencing
the direction toward professional needs assessment processes.
Milgrom (1979) in discussing continuing education for dentists
indicates ”that active learners can and should structure their
continuing education according to needs they identify. These
needs suggest the materials to be learned." He further asserts,
"Feedback (even so simple as a letter) is one means of identi-
fying problems."

Milgrom (1979), Stensland (1977) and Miller (1967) all
make a strong case for constructing education programs around
the needs of the practicing professionals. Groen (1956) makes

a special appeal for medical educators to design their programs

21

according to the expressed needs of the practicing physician
in the care of his patients. To do this requires a feedback
system from the professional learners to the program planners.
However, at this time educators do not have universally accep-
ted definitions or processes for gathering information.
Scissons (1978) indicates that although experts in adult
education agree that needs are important, there is little
agreement as to what needs are or how they should be used.

A review of the literature reveals a vast array of types of
needs.

The psychologists contribute to the need concept with
such well known theories as Maslow's (1954) ”Heirarchy of
Needs;" Garner's (1958) visceral, activity, sensory and escape
needs; and Fromm's (1955) five needs which he asserts "stem
from the conditions of (human) existence."

Others identify organizational needs, societal needs,
and individual educational needs. Scissons (1978) lists basic
needs, felt needs, expressed needs, real needs, normative needs,
comparative needs, criterion needs, prescriptive needs and
motivational needs, and contends that "the similarities and
differences between the different concepts of needs have to do
with whg defines them and 52! they are defined.”

Needs assessment tools are in the "fledgling stage"
according to Kaufman (1972), and he emphasizes the need "for
tools and/or techniques to be evolved or invented based on

unique circumstances and conditions." Kempfer (1955) proposes

22

that needs analysis be devised which will break down the
population in several components, analyze the needs of each
group and develop educational activities to meet the needs

of these unique populations. Barbulesco (1976) proposes that
one of the major purposes of needs assessment is providing
information for educational decision making and that the
needs assessment cycle should be a continuous process.

The concept of an ongoing needs assessment process
in Continuing Professional Education is also emphasized by
Schein (1978) who contends that the continuing process is
necessary because both the profession and the professional
are "dynamic, evolving systems whose needs change because of

changing environments and changing internal factors."

STUDENT PROFILES IN NEEDS ASSESSMENTS

 

The process of gathering data to identify a student
profile is illustrated by Davis (1978) who developed question-
naires to gather data from a target population of principals
of urban Title I schools prior to developing inservice programs
for them. He contends that program decision makers should
gather information from "prospective participants regarding
all modifiable aspects of.an inservice program" and use this
data in the development of continuing professional education
activities. Two areas of inquiry in this needs assessment
instrument were the experiential and educational backgrounds

of the respondents. For the experiential variable, Davis

23

offered a list of topics for which the respondents were asked
to indicate their level of interest on a Likert-type scale
and then to categorize their level of experience/familiarity
as being:

a. Expertise: practiced in area extensively and
could serve as a consultant.

b. Some Experience: worked in area, but not expert.

c. Some Knowledge: familiarity with some concepts, but
have not worked in this area.

d. No Knowledge: very slight or no experience or
knowledge in area.

Questions regarding the educational background included level
of academic attainment and major field of graduate study.

This student profile information was incorporated into the
planning process as the decision makers determined the breadth
and depth with which the topic should be introduced and

addressed.
EVALUATION PURPOSE AND PROCESS

Stufflebeam et al (1971) delegate the responsibility
for providing needs assessment information to the evaluator.
They state,

The evaluator must identify the specific roles or groups
which are clients for information, and to the best of
his ability, the levels of information to which they
will have access.

They also assert that, "the purpose of evaluation is not to

prove, but to improve."

24

Others agree with this stated purpose. Kempfer (1955)
states that the purpose of evaluation is "to stimulate growth
and improvement" and Knowles (1970) proposes that one of the
objectives in program evaluation is "to obtain information
that will promote continuous program improvement."

The principle of evaluation as a process to provide
information for decision making is found frequently in the
literature. Stufflebeam (1971) defines educational evalua-
tion as "a process of delineating, obtaining, and providing
useful information for judging decision alternatives." Pochyly
(1978) also refers to this process of feedback to the CME
planner. He compares evaluation of educational programs with
evaluation of patient care, pointing out that each can best
be done in terms of "process" and/or "outcome." After discus-
sing a variety of evaluation processes, he concludes that
evaluations will be accepted best if they are presented as a
"means for identifying unmet educational needs which can be
addressed in future programs." This perspective also gives
credence to the concept that education of practicing profes-
sionals is "a continuing process rather than a series of
unrelated events."

Milgrom (1979) compares some of the educational con-
cepts of Miller (1967) and Stensland (1977) regarding the
process of continuing education systems, and concludes that
“strategies must insure ongoing rather than episodic evalua-

tions of the learner and the learning goals, content and

25

method." Knowles (1970) suggests that in an ideal situation
an ongoing evaluation process would detect problem areas and
make corrections before they reach "crisis proportion," but
he contends that currently most programs do not have this
“ideal” process so they operate within an evaluation-by-
crisis system. The need to have feedback loops from the
evaluators to the decision makers is imperative to a meaning-
ful educational process, but the failure to accomplish this
step is evident. Stufflebeam et a1 (1971) point out that
even when some organizations provide for an ongoing evaluation
process, the information does not always get back to decision
makers in time to impact planning for future programs. They
purport that one of the major problems in many educational
organizations is a lack of "mechanisms for organizing, pro-
cessing, and reporting evaluative information."

This literature review clearly attests to the need
for an evaluation process model for continuing professional
education. This process must incorporate the principles of
andragogy recognizing the heterogenous student population
with diverse experiential and educational backgrounds and
the necessity of constructing educational programs around
the identified needs of the learners. One aspect of such
an educational process is an information gathering evaluation

with feedback loops to the program planners.

CHAPTER III
INSTRUMENTATION AND METHODOLOGY

Basic to the instrumentation processes of this
study were the principles of andragogy, which recognizes
the heterogenous traits of the self-directed learning pro—
fessionals, and the principle that evaluation research can
be a valuable process for improving educational programs by
supplying appropriate information to decision makers who
are planning future programs. This chapter identifies the
components of this latter principle and applies them to the
development of the evaluation instrument and processes used
in this study.

In Educational Evaluation and Decision Making,

 

Stufflebeam et a1 (1971) point out the need for evaluation
research models that are outside the realm of the classical
research model. They suggest that classical research pur-
poses and functions are not always the same as evaluation
research purposes and functions. The purpose of classical
research is to provide new universally valid knowledge, but
the primary purpose of evaluation research is to "delineate,

obtain, and provide information for making educational

26

27

decisions." This concept implies that evaluation research
may be highly particularized and specific to a particular
decision or cluster of related decisions rather than gener-
alizable to many or all settings. Only when the decision-
making context is highly generalizable and the intent is to
generate new knowledge can the purposes and methodologies
of classical research and evaluation research be equated.
Part of the argument against identifying evaluation
research processes as valid research methodology stems from
a general rejection of survey research methodology. Trow
(1967), however, strongly supports survey research to provide
information about populations as needed. He contends that
properly used descriptive research has major potential to
contribute "to sound knowledge and fruitful theory about the
institutions and processes of education." Smith (1959)
points out the need for a pragmatic approach to research
models indicating that survey research "should be actuated
by a very definite purpose, growing out of some felt need."
He contends that such research should originate in the actual
needs of the specific organization and result in a practical
solution of unsolved problems. Suchman (1967) recommends
that survey research focus on program improvement rather than
becoming routinized into statistical reports which are "ends
in themselves rather than means toward program improvement."

He states:

28

Our final comment on the state of survey research on
problems of program planning, operation, and evaluation
would stress the need to orient these surveys more
toward policy and less toward ”bookkeeping.” The col-
lection of data on health services has tended to become
routinized into statistical reports which actually have
very little utility for determining policy, the data
becoming ends in themselves instead of means toward
program improvement.

He concludes that when researchers fall into this ”bookkeep-

ing" mode, they fail ”to fulfill their unique contribution

of providing data for policy-making purposes."

The methodology and instrumentation of this study

is based on the philosophical concepts that:

l.

2.

3.

survey research is an appropriate means to gather
data,

the data should be provided to organizational
decision makers to impact program policy, and

the feedback process should become a continuous
process to improve educational programs.

The design of this study incorporates Stufflebeam's

definition of evaluation emphasizing the three major compo-

nents of delineating, obtaining and providing information

for educational decision makers.

The first system, a delineation of information needs,

is subdivided into:

1.

2.

a description of antecedents which make this infor-
mation important to decision makers;

a statement of the decision setting which includes
clientele for information, timing and specific
decision questions;

a statement of evaluation policies; and

a statement of evaluation assumptions.

29

The second system, a plan for obtaining information,
is subdivided into:
1. data collection process,
2. analysis of data, and
3. organization of data.
The third system, a plan for providing information,
is subdivided into:
1. preparation of reports,
2. dissemination of reports, and

3. incorporation of the feedback loop into the ongoing
educational decision making for future programs.

This study was undertaken to establish an educational
evaluation mechanism which would gather information regarding
the experiential and educational background of emergency
physicians who attend the annual scientific meeting conducted
by the specialty society to be used as one facet of a needs

assessment process. The evaluation design is shown in figure 1.

DELINEATION OF INFORMATION NEEDS

 

As the American College of Emergency Physicians
began to emerge as a specialty society it was comprised of
many second career physicians who practiced emergency medi-
cine full time and others who practiced it only parttime.
As the medical schools expanded studies to focus on emergency
medicine as a specific discipline and developed emergency

medicine residency programs, a new subgroup of members

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31

emerged. They were residency trained physicians who prac-
ticed emergency medicine full time.

At the same time that residency programs were devel-
oping, a certification board exam in emergency medicine was
also being developed by the American Board of Emergency
Medicine. To be eligible to take this certification board
exam, physicians must either be residency trained in Emer-
gency Medicine or have practiced emergency medicine full
time five years or more. This latter group of ”practice
eligible" physicians comprised a major portion of the ACEP
membership.

Although the leaders of the College were well aware
of the heterogenous group of physicians for whom they were
developing educational programs, they had very limited data
on the experiential and educational backgrounds of this
professional learner population. The program planners for
scientific meetings were asking several important questions
about their prospective learner population. The basic
question was: ”Are we meeting the educational needs of our
members who attend our Scientific Assembly?" Accepting the
concept that professional learners are able to and do take
the major responsibility for identifying and evaluating
their continuing education needs, the basic question was
refined to be: ”Do the physician learners perceive that
their professional education needs are being addressed by

the CME programs provided by their specialty society?"

32

To find answers to these questions the following

series of research questions about participants in the

Scientific Assembly were postulated:

1.

What are the major student profiles in terms of
longevity (i.e., years of practice/experience in
emergency medicine), current involvement in other
medical specialty areas, and medical education
background?

Do the participants perceive that the courses they
take are of significant professional value?

At what educational level do the participants
perceive the courses to be?

Do the participants recommend that the courses be
offered to others?

Do emergency medicine residency trained physicians
perceive the professional value and level of the
educational offerings they attend to be the same
as other participants perceive them?

Do physicians who have formal education backgrounds
in surgery perceive the professional value and
level of individual courses to be the same as other
participants perceive them?

Do physicians who have practiced emergency medicine
full time for five or more years perceive the pro-
fessional value and level of individual courses to
be the same as other participants perceive them?

Do physicians practicing emergency medicine part

time perceive the professional value and level of
individual courses to be the same as other parti-
cipants perceive them?

Are there significant differences among the groups
in #5, 6, 7 and 8 above in their overall percep-
tions of the Scientific Assembly courses on the
variables of professional value, level and recomr
mendation?

33

PLAN FOR OBTAINING INFORMATION -- RESEARCH DESIGN

 

Within the population of learners from this scienti-
fic assembly four groups were identified. The first two
groups were physicians with the most divergent experiential
backgrounds, those who had practiced emergency medicine full
time for five years or more and those who practiced emergency
medicine on a part time basis. The other two groups were
identified by their formal medical education backgrounds.
These were the two largest specialty groups within the popu-
lation, emergency medicine and surgery.

A standard course evaluation instrument was adapted
to incorporate the research questions for this study. The
program consisted of fourteen postgraduate courses which were
conducted simultaneously. The number of students in the
courses varied from 21 to 71, and the subjects included a
broad range of emergency topics.

The specific questions which were asked on the
evaluation forms were:

Professional value of this course for you:
a) significant b) little c) none

At what level would you classify this course as
presented: a) Advanced b) Intermediate c) Basic

Would you recommend that this course be offered for
others with education and experience similar to yours:
a) at the same level b) at a more basic level c) at
an advanced level d) not at all

How many years have you worked in the Emergency
Department:

Full Time a) 1-2 b) 3-4 c) 5-6 d) 7-8 e) 9 or over
Part Time a) 1-2 b) 3-4 c) 5-6 d) 7-8 e) 9 or over

34

If you are a member of a specialty organization other
than ACEP, please indicate: a) Family Practice

b) Internal Medicine c) Surgery d) Pediatrics

e) Other

 

What are your formal specialty training areas: (Mark
as many as are applicable) a) Emergency Medicine

b) Family Practice c) Internal Medicine d) Surgery
e) Pediatrics f) Other

 

These questions were on optical scan forms from
which data cards would be machine punched (Appendix A). To
‘rencourage compliance in completing the evaluation data forms
course monitors were assigned to the classrooms and they
handed each physician an evaluation form as he/she entered
the room. Course instructors explained the need for accu-
rate and complete information and the monitors collected the
forms as the participants left the room at the end of the
three hour session. Later the monitors reviewed each answer
sheet and marked over any forms that were filled out in ink
as well as verifying that erasures were complete and answers
were appropriately marked.

To determine the experiential and educational pro-
files of the physicians attending this scientific program,
summative data was gathered from the questions on formal
education and on longevity of practice in the emergency
department. Correlation analyses were used to determine
if any of the four groups differed significantly from
others on the perceptions of the professional value and

level of the courses.

35

EVALUATION POLICIES

 

The primary audience for this information is the
Scientific Meetings Committee which has the responsibility
for identifying educational needs and planning the educa-
tional programs for the organization. Since planning for
the next annual Scientific Assembly begins one month after
the preceding one, the evaluation information must be avail-
able to them within 30 days of the data collection. To
facilitate the data analysis to meet this deadline organiza-
tional priorities were set such that the evaluation data was
hand carried from the meeting site and was the priority
project of the continuing education department staff when
it arrived. It was further determined that the evaluation
instrument responses would be anonymous and only aggregate

scores would be available for analysis.

INSTRUMENTATION ASSUMPTIONS

The basic assumptions of this study were that devel-
oping the instrument to gather information anonymously would
result in more candid answers by the participants; that re-
questing the experiential and educational information only
once during the conference would yield more responses: that
requesting profile information during the first full educa-
tional session would result in more responses than asking

for the information later in the conference: that the

36

student profile was not generalizable to the entire popula—
tion of the society; and that the student profile of those
attending this scientific meeting would be somewhat similar
to the profile of those who would attend future meetings.
Since no logistically feasible and accurate method

of selecting random samples of physicians with various

educational and experiential backgrounds was available, the
decision was made to gather data from the entire population
of physicians enrolled in all of the postgraduate courses

during the first full educational session.

PLAN FOR PROVIDING INFORMATION

 

The American College of Emergency Physicians has an
eight step continuing education ”game plan" for educational
programs. The process begins and ends with a focus on
patient care because quality patient care is the raison
d'etre of CME and one of the major concerns of the medical
specialty society. The specific steps of this overall pro-
cess are:

1. needs assessment

2. definition of specific objectives

3. determination of major content areas
4. identification of resources

5. determination of teaching strategies
6. implementation of program

7. evaluation of program

8. application of learning to patient care practice.

37

Step 1, the needs assessment process, is the respon-
sibility of both the individual professional and the medical
organization. The individual must identify the areas of
his/her personal educational needs, and the organization
must assist in this process by providing self-assessment
instruments and other pertinent data. However, the organiza-
tional role extends beyond assisting members in identifying
their own continuing education needs. The College must
determine the needs of the membership as a group. This can
be accomplished by reviews of the literature, mortality and
morbidity reports, American Board of Emergency Medicine
certification exam data, practice profiles, medical chart
audits, health statistics, residency program feedback, pro-
gram evaluation, and member surveys.

The data from this study will become a vital part
of this educational game plan process by making a direct
feedback loop between evaluation and needs assessment. The
report to the decision makers will include the educational
and experiential profiles of the participants, as well as
data analysis of each course indicating the participants'
perceived professional value, level of material presented,

and recommendations for offering the course again.

CHAPTER IV
DATA ANALYSIS

The primary purpose of this study was to develop an
evaluation model which would incorporate a method of identi-
fying an educational and experiential profile of professional
learners and a feedback process to help continuing profes-
sional education decision makers constantly improve the qual-
ity and focus of their programs. Accordingly, data was
gathered on the educational and experiential background of
physicians enrolled in continuing education courses developed
by their national medical specialty society. The design of
the study called for the identification of physicians with
various backgrounds and an analysis of each group's percep-

tions of the value and level of courses they attended.
GROUP IDENTIFICATION AND DATA ANALYSIS

Data was first compiled to give the overall educa-
tional and experiential profile of all the participants in
the program. Then four major subgroups were formed. The
two groups which constituted the largest population with

similar educational backgrounds were emergency medicine

38

39

graduates (32.7%) and surgeons (18%). The two groups with
the most divergent experiential profile were those who had
practiced emergency medicine full time for five or more
years and those who only practiced emergency medicine on a
part time basis. Data from these groups was analyzed to
determine if significant differences existed in the parti-
cipants' perception of the value and level of courses.

Data was gathered from the entire population of
physicians attending the 14 courses offered during the first
major session of postgraduate courses at the annual scienti-
fic assembly of the American College of Emergency Physicians.
The total attendance for these courses was 737. Responses

were received from 654 which was an 88.7% return.
RESEARCH QUESTION 1

The first research question was:

What are the major student profiles in terms of
longevity (i.e., years of practice/experience in
emergency medicine), current involvement in other
medical specialty areas, and medical education
background?

The experiential variable was divided into the two
areas of (1) those who have practiced full time in the Emer-
gency Department for five or more years and (2) those who
practiced part time in the Emergency Department. The data
revealed 254 respondents had practiced emergency medicine

full time for five years or more and that only 48 were prac-

ticing emergency medicine part time. The formal medical

40

education variable included eight major specialty training
areas ranging from 33% to 1% of the total population. These
were: Emergency Medicine, 33.2%; Surgery, 18.1%; Family
Practice, 16.7%: Internal Medicine, 11.9%; Pediatrics, 2.6%;
Obstetrics and Gynecology, 1.5%; Psychiatry, 1.4%; and
Anesthesiology, 1.1%.

Table 1 gives the analysis of these eight educational
areas and Table 2 gives the analysis by course topics. Nine-
teen other specialty education areas were also identified but
each of them comprised less than 1% of the population. They
were: Orthopedics, Pathology, Neurology, Urology, Radiology,
General Practice, Rotating Internship, Ophthalmology, Criti-
cal Care, Pharmacy, Neurosurgery, Thoracic Surgery, Infectious
Diseases, Oncology, Psychosomatic Medicine, Industrial Medi-
cine, Aerospace Medicine and Flight Surgery (USAF).

The profile of participants who currently are members
of medical specialty societies other than ACEP identifies
four organizations with more than 1% of the population. They
are the American Academy of Family Physicians, 11.3%; the
American College of Surgeons, 5.0%; the American Society of
Internal Medicine, 4.3%: and the American Academy of Pedia-
trics, 1.7%.

Table 3 gives the analysis of these four specialty
societies and Table 4 gives the summary analysis by course
topic. Other organizations identified were the American

Psychiatric Association, Aerospace Medicine Association, the

41

TABLE 1

SAMPLE SIZES AND PERCENTAGES FOR THE

 

EIGHT LARGEST MEDICAL SPECIALTY EDUCATION AREAS

Medical Specialty
Education

 

Emergency Medicine

Surgery

Family Practice

Internal Medicine

Pediatrics

Obstetrics And Gynecology

Psychiatry

Anesthesiology

217

118

107

78

17

10

33.

18.

16.

11.

2%

1%

7%

9%

.6%

.5%

.4%

.1%

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42

 

 

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43

TABLE 3

SAMPLE SIZES AND PERCENTAGES OF

MEMBERSHIP IN ORGANIZATIONS OTHER THAN ACEP

Medical Specialty
Society

American Academy of Family
Physicians

American College of
Surgeons

American Society of Internal
Medicine

American Academy of
Pediatrics

74

33

28

11

11.3%

5.0%

44

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45

American College of Obstetricians and Gynecologists, the
American Society of Anesthesiologists, and the American

College of Preventive Medicine.

RESEARCH QUESTION 2

 

The second research question was:

Do the participants perceive that the courses they
take are of significant professional value?

The question on the evaluation instrument asked
participants to indicate the professional value of the
course to them as (a) significant, (b) little, or (c) none.

The overall responses to this question indicate that
92.1% of the physicians who responded perceived the courses
to be of significant value and 7.9% indicated that they were
of little value, but no one indicated that they were of no

value. Table 4 shows the analysis by topic.
RESEARCHQQUESTION 3

The third research question was:

At what educational level do the participants perceive
the courses to be?

The item on the evaluation instrument asked partici-
pants to classify the level of the course as (a) advanced,
(b) intermediate, or (c) basic. The data indicate that
22.4% identified the courses as advanced, 60.6% as inter-
mediate, and 17% as basic. Table 5 shows the analysis by

topic.

46

TABLE 5

PROFESSIONAL VALUE

 

EMERGENCY MEDICINE TOPICS

 

 

S IGNIFICANT LITTLE NONE
Radiology of the Chest 100.0% -0- -0-
(21)
Interpretation of Dysrhythmias 87.0% 8.5%
(62) (6)
Emergency Medicine Case Presentations 88.6% 8.6%
(31) (3)
Hand Injuries 100.0%
(49)
Ophthalmology 88.2% 11.8%
(30) (4)
Arrhythmias 88.6% 10.0%
(62) (7)
Gynecological Emergencies 94.3% 4.3%
(66) (3)
Trauma Management 92.6% 7.4%
(25) (2)
Initital Evaluation and Resuscitation 87.9% 12.1%
(58) (8)
Radiology of the Abdomen 92.0% 8.0%
(23) (2)
Pediatric Respiratory Problems 88.4% 7.0%
(38) (3)
Clinical Procedures 88.6% 9.1%
(39) (4)
Toxicology 94.7% 5.3%
(54) (3)
Pediatric 85.7% 14.3%
(36) (6)
TOTALS (594) (51)
92.1% 7.9%

 

 

47

TABLE 6

PARTICIPANT'S IDENTIFICATION

EMERGENCY MEDICINE TOPICS

 

Radiology of the Chest

Interpretation of Dysrhythmias

Emergency Medicine Case Presentations

Hand Injuries

Ophthalmology

Arrhythmias

Gynecological Emergencies

Trauma Management

Initial Evaluation and Resuscitation

Radiology of the Abdomen

Pediatric Respiratory Problems

Clinical Procedures

Toxicology

Pediatric

TOTALS

OF COURSE LEVEL

ADVANCED

28.6%
(6)

19.7%
(14)

20.0%
(7)

14.5%
(7)

11.8%
(4)

18.6%
(13)

15.7%
(11)

55.5%
(9)

10.6%
(7)

12.0%
(3)

67.4%
(29)

6.8%
(3)

12.5%
(7)

25.8%
(10)

(130)
22.4%

INTERMED.

66.7%
(14)

57.7%
(41)

65.7%
(23)

65.5%
(32)

76.5%
(26)

74.5%
(52)

74.5%
(52)

55.6%
(15)

71.2%
(47)

50.0%
(15)

7.0%
(3)

38.2%
(17)

66.7%
(38)

64.5%
(27)

(350)
60.6%

BASIC

 

15.5%
(11)

14.5%
(5)

18.4%
(9)

11.8%
(4)

7.1%
(5)

5.7%
(4)

7.4%
(2)

12.1%
(8)

28.0%
(7)

16.3%
(7)

50.0%
(22)

19.5%
(11)

7.1%
(3)

(98)
17.0%

48

RESEARCH QUESTION 4

The fourth research question was:

Do the participants recommend that the courses be
offered to others?

The item on the evaluation instrument asked parti-
cipants to give their recommendations on whether the course
should be offered for others with education and experience
similar to theirs (a) at the same level, (b) at a more basic
level, (c) at an advanced level, or (d) not at all. The
data analysis reveals that 79% recommended that they be
offered at the same level, 9% suggested a more basic level
and 11% a more advanced level. Only 10% of the respondents
recommended that the courses not be given again. The speci-

fic analysis by topic is shown in Table 6.

RESEARCH QUESTION 5

 

The fifth research question was:

Do emergency medicine residency trained physicians
perceive the professional value and level of the
educational offerings they attend to be the same
as other participants perceive them?

To determine the answer to this question an individ-
ual analysis was made for each of the fourteen courses on
each of the questions regarding professional value and level.
The population was divided into two groups: emergency medi-
cine residency graduates and all others taking the course.

The analyses showed only three items with significant

differences at the .05 level. Two of these were on the

49

TABLE 7

SHOULD IT BE OFFERED

 

EMERGENCY MEDICINE TOPICS

 

Radiology of the Chest

Interpretation Of Dysrhythmias

Emergency Medicine Case Presentations

Hand Injuries

Ophthalmology

Arrhythmias

Gynecological Emergencies

Trauma Management

Initial Evaluation and Resuscitation

Radiology of the Abdomen

Pediatric Respiratory Problems

Clinical Procedures

Toxicology

Pediatric

TOTALS

SAME

90.5%
(19)

74.6%
(53)

65.7%
(23)

85.7%
(42)

67.6%
(23)

71.4%
(50)

85.7%
(60)

81.5%
(22)

68.2%
(45)

80.0%
(20)

20.9%
(9)

77.5%
(34)

80.5%
(46)

64.3%
(27)

 

(475)
79.0%

 

 

MORE MORE NOT
BASIC ADVANCED AT ALL
4.8% -0- -0-

(1)
4.2% 5.6% 1.4%
(3) (4) (1)
5.7% 20.0%
(2) (7)
2.0% 8.2%
(1) (4)
11.8% 17.6%
(4) (6)
5.7% 17.1%
(4) (12)
4.5% 5.7% 1.4%
(3) (4) (1)
7.4% 7.4%
(2) (2)
10.6% 15.2% 1.5%
(7) (10) (1)
12.0% 8.0%
(3) (2)
16.5% 25.6% 14.0%
(7) (11) (6)
9.1% 4.5% 2.5%
(4) (2) (1)
8.8% 5.5%
(5) (3)
21.4% 14.5%
(9) (6)
(55) (65) (10)
9.0% 11.0% 1.0%

 

 

50

course level variable for radiology of the chest and the

- course level variable for gynecological emergencies. Emer-
gency medicine residency graduates ranked both of these at

a higher level than did the others in the class. The third
statistically significant difference was on the professional
value of the course on clinical procedures. Again the emer-
gency medicine residency graduates rated this course higher.
Table 8 gives the sample sizes, the T-values, and the

statistical probabilities for these items.

RESEARCH ggESTION 6

 

The sixth research question was:

Do physicians who have formal education backgrounds
in surgery perceive the professional value and level
of individual courses to be the same as other parti-
cipants perceive them?

Again the T-test was employed to identify any signi-
ficant differences that existed between the surgeons and
all others who attended the courses on the variables of
professional value and level. The data on surgeons also
shows significant differences on these two variables. On
the professional value question the surgeons indicated a
higher value both in the course on tachy- and bradyarrhyth-
mias and in the course on pediatric trauma. On the course
level question the surgeons identified the course on eval-
uation and resuscitation of the multiply injured patient

and the one on trauma management at a lower level than others

did. Table 9 identifies the specific data on these variables.

51

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53

RESEARCH QUESTION 7

The seventh research question was:

DO physicians who have practiced emergency medicine
full time for five or more years perceive the pro-

fessional value and level of individual courses to

be the same as other participants perceive them?

The subjects in this group were those who had prac-
ticed emergency medicine for five or more years. The T-test
data on this question revealed a significant difference at
the .05 level on the value of the course on emergency oph-
thalmology and on the level Of the course on radiology of
the abdomen. The ophthalmology course was perceived by this
group to be much less valuable, but the level Of the radio-

logy course was perceived to be higher. The specific data

for these analyses are shown in Table 10.

RESEARCHgQUESTION 8

The eighth research question was:

Do physicians practicing emergency medicine part time
perceive the professional value and level of individual
courses to be the same as other participants perceive
them?

The number of physicians who practice emergency medi-
cine part time was much smaller than anticipated and in some
cases there were not enough subjects in a course to give
valid data for correlation analyses. The data did indicate

that for the course on pediatric trauma these physicians

rated the course lower on the professional value, and for

54

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56

the course on clinical procedures they rated the course
higher on the professional value. The data for these two

T-tests is shown in Table 11.

RESEARCH QUESTION 9

 

The ninth research question was:

Are there significant differences among the groups in
#5, 6, 7, and 8 above in their overall perceptions of
the Scientific Assembly courses on the variables of
professional value, level and recommendation?

Summary data indicated that there were no significant
differences in the overall responses of the four groups on
any of the three variables. Tables 12 through 15 give the
specific summary data on these items; Tables 16 through 18
give the specific data by course topic; and Tables 19 through

26, which can be found in Appendix B, give similar data in

graph form.

57

TABLE 12

SUMMARY OF THE SAMPLE SIZES AND MEANS OF EMERGENCY‘MEDICINE

GRADUATES AND OTHERS TO ALL POURTEEN COURSES FOR

 

VARIABLE

Value

Level

Recommendation

VALUE, LEVEL AND RECOMMENDATION

 

GROUP

 

Emergency Medicine Graduates
Others

Emergency Medicine Graduates
Others

Emergency Medicine Graduates
Others

214
429

212
417

205
411

MEANS

 

1.91
1.92

1.06
.98

2.06
1.99

58

'

TABLE 13

SUMMARY OF SAMPLE SIZES AND MEANS OF RESPONSE OF
SURGEONS AND OTHERS TO ALL FOURTEEN COURSES FOR

VALUE, LEVEL AND RECOMMENDATION

 

 

VARIABLE GROUP N MEANS
Value 'Surgeons 115 1.90
Others 530 1.92
Level Surgeons 112 1.00
Others 518 1.01
Recommenda- Surgeons 111 2.07
tion

Others 505 2.00

59

TABLE 14

SUMMARY OF THE SAMPLE SIZES AND MEANS OF RESPONSES OF THOSE WITH

EMERGENCY MEDICINE PRACTICE OF 5 YEARS OR MORE AND OTHERS TO ALL

FOURTEEN COURSES FOR VALUE, LEVEL AND_RECOMMENDATION

 

VARIABLE GROUP

Value 5 Years Practice
Others

Level 5 Years Practice
Others

Recommendation 6 Years Practice

Others

252

391

244

386

248

369

MEANS

 

1.91

1.92

1.04

.98

1.99

2.02

60

TABLE 15

_ SUMMARY OF THE SAMPLE SIZES AND MEANS OF RESPONSES OF THOSE WHO
PRACTICE EMERGENCY MEDICINE PART TIME AND OTHERS TO ALL FOURTEEN

COURSES FOR VALUEJ LEVEL AND RECOMMENDATION

 

VARIABLE GROUP N MEANS
Value Part-Time 48 1.91
Others 427 1.92
Level Part-Time 46 1.00
Others 417 1.00
Recommendation Part-Time 43 2.00

Others 415 2.02

Ih—I

lye!

ICU

lib

I6)

61

TABLE 16

 

SAMPLE SIZE AND MEANS FOR EACH GROUP
ON THE VALUE OF INDIVIDUAL.COURSES'

 

 

 

 

 

 

 

 

 

Course

Tonic GrouE N Means

Radiology-Chest EM Medicine 8 2.00
Surgeons 2 2.00
5 Years + 13 2.00
Part-Time 0

Dysrhythmias EM Medicine 21 1.90
Surgeons 18 2.00
5 Years + 32 1.87
Part-Time 7 2.00

EM. Medicine Cases EM Medicine 9 1.88
Surgeons 7 1.83
5 Years + 17 1.94
Part-Time 2 2.00

Hand Injuries EM Medicine 16 2.00
Surgeons 8 2.00
5 Years + 15 2.00
Part-Time 5 2.00 .

Opthalmolggx EM Medicine 13 1.92
Surgeons 9 1.77
5 Years + 11 1.72
Part-Time 3 2.00

Arrhythmias EM Medicine 26 1.88‘
Surgeons 16 1.86
5 Years + 36 1.88.
Part-Time 4 1.75

Gxnocologz EM Medicine 31 1.96
Surgeons 13 1.92
5 Years + 22 1.95

Part-Time 3 2.00

Course

logic

Trauma

Resusitation

 

Radiology-Abdomen

 

Pediatric
Respitatory

 

Clinical
Procedures

Toxicologz

Pediatric Trauma

 

TABLE 16 -- Continued

Group

EM Medicine
Surgeons

5 Years +
Part-Time

EM’Medicine
Surgeons

5 Years +
Part-Time

EM Medicine
Surgeons

5 Years +
Part-Time

EM Medicine
Surgeons

5 Years +
Part-Time

EM Medicine
Surgeons
5 Years +

”Part-Time

EM Medicine
Surgeons

5 Years +
Part-Time

EM Medicine
Surgeons

5 Years +
Part-Time

62

 

18
10
15

10

13

12

19

17
12
18

16

13

1.99
1.91
1.94-
2.00

Course

Togic

Radiology-Chest

 

Dysrhythmias

 

EM. Medicine Cases

M

63

SAMPLE SIZE AND MEANS FOR EACH GROUP

 

 

Hand Injuries

 

AQphthalmolggz

Arrhxthmias

 

Gznecologz

ON LEVEL OF INDIVIDUAL COURSES

 

Group

EM Medicine
Surgeons

5 Years +
Part-Time

EM Medicine
Surgeons

5 Years +
Part-Time

EM Medicine
Surgeons

5 Years +
Part-Time

EM Medicine
Surgeons

5 Years +
Part-Time

EM Medicine
Surgeons

5 Years +
Part-Time

EM Medicine
Surgeons

5 Years +
Part-Time

EM Medicine
Surgeons

5 Years +
Part-Time

10

12

20
18
31

26
16
37

3O
12
21

Means

1.50
1.50
1.33

1.00
.94
1.00 .
1.28

1.22
1.00
1.17
1.00

1.12
1.12
1.06
1.00.

1.00
.88
.90'

1.00

1.15
1.06'
1.162
1.25

1.23
1.08
1.14
1.00

Course

Topic

Trauma

 

Resusitation

 

Radiology-Abdomen

 

Pediatric
Respitatory

 

Clinical
Procedures

 

Toxicologz

Pediatric Trauma

 

TABLE 17 -- Continued

Group

EM Medicine
Surgeons

5 Years +
Part-Time

EM Medicine
Surgeons

5 Years +
Part-Time

EM Medicine
Surgeons

5 Years +
Part-Time

EM Medicine
Surgeons

5 Years +
Part-Time

EM Medicine
Surgeons
5 Years +

{Part-Time

EM Medicine
Surgeons

5 Years +
Part-Time

EM Medicine
Surgeons

5 Years +
Part-Time

64

 

“HM“

17
10
16

10

13

12

18

17
11
17

16

11

Means

1.14
1.00
1.27

.66

1.05

.70
1.87
1.00

.80
.50
1.07
1.00

.83
1.28
.94
1.33

.55
.68
.66
.82
1.09
1.00'
1.18
1.00

1.09
.80

lu—l

lm

[O

I):

In

65
TABLE 18

.SAMPLE SIZE AND MEANS FOR EACH GROUP

ON RECOWENDATION FOR OFFERING COURSES IN THE FUTURE

 

 

 

 

 

 

 

Course
Topic Group N Means
Radiology-Chest EM Medicine 10 1.90
Surgeons 2 2.00
5 Years + 13 1.92
Part-Time 0 -_
Dysrhythmias EM Medicine 17 2.11
Surgeons 16 2.12
5 Years + 31 1.93
Part-Time 5 2.00
EM. Medicine Cases EM Medicine 9 2.33'
Surgeons 7 2.42
5 Years + 16 2.12.
Part-Time 2 2.50
Hand Injuries EM Medicine 14 2.00
Surgeons 8 1.87
‘5 Years + 15 2.06
Part-Time S 2.00
thhalmologz_ EM'Medicine 13 2.15
Surgeons 9 2.11
5 Years + 10 2.00
Part ~Time 3 1 - 66‘
Arrhythmias EM Medicine 25 2 . 20
Surgeons 15 2.13
5 Years + 36 2.02
Part-Time 4 2.00~
quocologz EM Medicine 30 2-05
Surgeons 12 2-00
5 Years + 22 2.04

Part-Time 3 2'33

Course

Topic

Trauma

Resusitation

 

Radiologerbdomen

 

Pediatric
Respitatory

 

Clinical
Procedures

 

Toxicologz

Pediatric Trauma

 

TABLE 18 -- Continued

Group

EM Medicine
Surgeons

5 Years +
Part-Time

EM Medicine
Surgeons

5 Years +
Part-Time

EM’Medicine
Surgeons

5 Years +
Part-Time

EM Medicine
Surgeons

5 Years +
Part-Time

EM Medicine
Surgeons
5 Years +

_Part-Time

EM Medicine
Surgeons

5 Years +
Part-Time

EM Medicine
Surgeons

5 Years +
Part-Tine

66

 

16
12
18

16

13

1.93
2.00'
1.94

2.00 .

CHAPTER V

SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS

Professionals are not new to the world. But in the
past, professionals have formed unprogressive castes.
The point is that professionalism has now been mated
with progress. The world is now faced with a self-
evolving system, which it cannot stop . . . If mankind
can rise to the occasion, there lies in front a golden
age of beneficient creativeness.

A. N. Whitehead (1926)

This prophetic utterance clearly describes the modern

professional who is engaged in evolving systems which have

been greatly accelerated in recent years by scientific and

technological knowledge explosions. Medicine is one of

these professions which is constantly bombarded with so much

new information that no one person can keep abreast of it

all.

This has resulted in a rapid growth in specialization

as physicians focus on narrower specific areas for indepth

knowledge and skills. This study focused on the newest

medical specialty, Emergency Medicine, and its unique con-

tinuing professional education milieu. This chapter will

summarize the purpose of this study, discuss conclusions

about the data results and make recommendations for further

research.

67

68

PURPOSES

The major purposes of this study were:

1. to develop a process evaluation system for identi-
fying the educational and experiential variables
of participants who attend the scientific assembly
of the specialty society, and

2. to provide an information feedback loop to the
program planners to assist-them in improving the
quality and focus of future programs.

Basic to this study were two major philosophical
concepts. One was that the principles of adult education
are relevant to continuing professional education. Within
this concept especial focus is placed on the principle that
professionals themselves ultimately determine their own con-
tinuing education needs, and their perception of a program's
relevance to their professional practice is very important
in their evaluation of continuing education courses.

The other philosophical concept was that the primary

purpose of evaluation in continuing professional education

is to improve the educational process.

DISCUSSION OF RESULTS

 

This section will summarize and discuss the profile
findings and the students' overall perceptions of the pro-
fessional value, level, and recommendations for future

offerings of the courses.

69

STUDENT PROFILE

 

The relevant variables for the student profile were
(1) the formal medical education background and (2) the
amount of experience in the practice of emergency medicine.
To give some indication of the physicians' current involve-
ment in other specialty societies, the respondents were
asked to indicate current membership in medical specialty
organizations other than ACEP.

Emergency medicine was identified as the major area
of medical educational background, representing 32.7% of the
total population. The other three major areas were: Sur-
gery, 18.0%; Family Practice, 16.3%; and Internal Medicine,
11.9%. Current membership in these other medical societies
did not correlate with educational background figures. The

largest membership organization was the American Academy of

Family Physicians (AAFP) with 11.3%, the American College
of Surgeons was 5.0% and the American Society of Internal
Medicine was 4.3%.

From this analysis, the most important data for the
decision makers was the large number of physicians'who were
members of AAFP, because this membership is contingent on
the physicians completing at least 150 hours in each three
year period of documented CME specifically in family prac-
tice. Membership in ACEP is also contingent on completion

of 150 hours of continuing medical education and it

70

specifically must be in emergency medicine. This dual
educational requirement could be very burdensome to the
physicians.

To alleviate this situation both organizations
must be cognizant of the problem and cooperate in giving
dual approval for courses which are relevant to both family
practice and emergency medicine. Based on the data gathered
for this dissertation, this cooperative effort was initiated
and appropriate courses within subsequent scientific assembly
meetings have been approved for both ACEP Category I and
for AAFP Prescribed Hours.

In the experiential data findings the most surprising
information was the small percentage of physicians who prac-
tice emergency medicine part time. Whereas 29% of the total
membership of the College consists of those who practice part
time, only 11.2% were identified in the Scientific Assembly

data.

The other experiential data revealed that 65% of the
total scientific assembly population were physicians who had
practiced emergency medicine for five or more years compared
to 50% of the total College membership. Since one of the
eligibility requirements to take the certification examina-
tion in emergency medicine is either a two year residency
in emergency medicine or five years of experience in an emer-
gency department, many of these "practice eligible" physicians
may be needing board review courses to prepare for these

examinations in the future.

71

CONCLUSIONS

 

In the overall analysis, the data indicate that no
significant differences exist between the four groups and
others on any of the three variables of value, level, and
recommendation. However, in the analysis of specific courses
some items did appear with significant differences.

The emergency medicine graduates indicated a higher
-professional value to them for the course on clinical proce-
dures. This may be a reflection of the fact that since
residency programs have only been in existence for a few
years emergency medicine graduates have had limited practice
in emergency departments. The course was based on actual
clinical encounters with typical multiplicity of variables
faced in actual practice. This group also identified the
level of the courses'in radiology of the chest and gynecology
higher than the others. There is no apparent explanation

for this phenomenon.

The general response of participants indicates that
physicians in all groups were fairly well satisfied with the
courses for which they registered and recommended that they
be offered again for others of similar experience and back-
grounds. However, the study gives no indication of whether
the satisfaction is the result of wise self-selection on the
part of the registrants, a well developed program by the
planners, exceptional faculty, or a myriad of other possible

factors.

72

WEAKNESSES AND LIMITATIONS OF THIS STUDY

 

The primary purpose of this study was to establish
a system for gathering and analyzing experiential and educa-
tional background information to be incorporated into the
overall program planning for scientific meetings as a seg-
ment of the needs assessment process. To be of significant
value this data must be gathered on a continuing basis to
determine trends and changes and make appropriate program—
ming adjustments.

The evaluation instrument in this study did not
allow a broad enough range of choices on the professional
value of the courses. The only responses were significant,
little or none. It is recommended that in future research
this be expanded to at least five choices. The concept of
the course value could also be expanded to allow more expli-
cit feedback regarding ways the courses may impact the
physician's practice. Responses for a question of this
nature might include valuable as a general review; as new
knowledge, attitude or skill; as confirmation of recently
acquired information; as preparation for specialty board
examination; or other responses specific to individual
course content.

Another weakness of the evaluation instrument was
that it did not gather enough data from the respondents
regarding specific continuing education needs they wish to

identify. This could be improved by listing core content

73

areas and having responses computer tabulated and/or by
giving open ended questions and having respondents write

in their requests for new courses.

RECOMMENDATIONS FOR A PLANNING AND EVALUATION SYSTEM

 

According to the information in the literature
review, one major need in professional continuing education
is a process which links needs assessment and evaluation
systems to program decision makers. This study focuses on
provision of information to the decision makers who plan
educational programs; however, there are several other
major groups of decision makers who could gain from such
profile and evaluation information. One of these groups is
composed of the individual self-directed professionals who
develop their own education game plans.

The rationale for identifying the individual pro-
fessionals as decision makers is based on adult education
theories and the nature of professions.

As mentioned in chapter two of this study, Knowles
(1970) distinguishes between pedagogy (the art and science
of teaching children) and andragogy (the art and science of
helping adults learn). Andragogical principles include the
following concepts:

As a person matures he becomes more self-directing;
his growing reservoir of experience becomes an increas-
ing resourse for learning; and his time perspective

changes from one of postponed application of knowledge
to immediacy of application, and accordingly his

74

orientation toward learning shifts from one of
subject-centeredness to one of problem-centeredness.

A major distinction between pedagogy and (adult)
continuing professional education is the difference between
an educational experience which is institutionally dominated
and one which is self-directed. This is clearly delineated
by Suter, et a1 (1980):

In preparatory education the institution defines the
goals and objectives and determines the programs of
instruction to attain them.
The institution determines entrance qualifications and
governs degree or certification requirements. By contrast:
In continuing education, professionals choose programs
to fit their needs, move in and out of programs at
their discretion, and select institutions that suit
their objectives and learning styles. Any application
of acquired knowledge, skills or attitudes is very
often the professional's own decision and initiative.
This transition from preparatory to continuing professional
education has major implications for the planning and eval-
uation of continuing professional education.

Since the professional still accepts the responsi-
bility for maintaining his or her own knowledge, skills and
competency, he/she is a crucial decision maker in the plan-
ning and evaluation system. For these individual planners
a profile of aggregate scores on professional assessment
instruments for others with similar educational and experi-
ential backgrounds could help identify potential areas of

educational needs. This profile would be especially valu-

able to professionals in emerging specialties because they

75

have much more variation in educational and experiential
backgrounds than do the traditional specialties.

In Emergency Medicine the profile could be estab-
lished from data gathered from the certification examination
administered by the American Board of Emergency Medicine,
continuing medical education questions from the Study Guide
in Emergency Medicine and from the self-assessment exam, the
"Physician's Evaluation and Educational Review of Emergency
Medicine" (PEER II). This data base could be established
by asking the same profile questions from respondents who
engage in these evaluative activities. Questions in each
of these three activities must also be identified by one of
the 22 Core Content areas of Emergency Medicine so that
aggregate scores from these respondents can be grouped.
These two data bases can then be combined to identify
strengths and weaknesses within the various content areas
for physicians within specific educational and experiential
profiles. As individual physicians planned their educa-
tional activities, they could request this normative data
regarding physicians with profiles similar to theirs and
this could serve as one aspect of an individual needs
assessment process.

The other major group of decision makers who should
be served by the planning and evaluation system is the spe-
cialty society's decision makers. The experiential and

educational profile of members would be valuable for policy

76

making bodies to determine the current composite of member-
ship, and as an ongoing data gathering process it could
identify changing patterns within the membership. The
aggregate scores and the profiles could also furnish infor-
mation to the decision makers who deal with member compe-
tency and to those who plan continuing education programs.

For the program planners the specific profile infor-
mation and the aggregate scores in each of the 22 Core
Content areas would be very valuable in decisions regarding
the major areas of program emphasis. In an ongoing evalua-
tion system this emphasis would shift as educational needs
changed.

Another important aspect of the planning and eval-
uation system for program planners would be the feedback
from individual members who identify their perceptions of
professional needs both in content and in depth of topics.

In addition, new information is constantly being
generated by research, and the planning and evaluation sys-
tem must provide decision makers with the state-of-the-art
in the multiple content areas of the profession. For the
program planners, information can be most readily derived
from the faculty and others who are directly involved with
research. This information should be relayed to the indi-
vidual professional through the specific programs which are

developed.

77

To help the individual decision maker determine
which educational activity will give him/her the most
practice-relevant information, program brochures must
clearly state the level and content of each offering.

This can be accomplished by clearly stated, specific
learning objectives for each course. To help the individ-
ual determine whether or not he/she has a clear understand-
ing of the new information, each course should have a
‘”content post-test which correlates with the stated objec-
tives. In addition, the syllabus should contain literature
references and justifications for the questions and for
future study.

The original problem statement for this study was:

Often traditional continuing education programs are,
in the best procrustean tradition, designed to fit the
needs of the students to the interest or expertise of
the faculty. Even when programs are planned speci-
fically for an intended audience, program planners do
not have clear indications of the unique needs of the
practitioner/learner and must base decisions regarding
content and level of courses on the planner's percep-
tion of participants' needs.

The proposed planning and evaluation system could
be an important step toward alleviating the problem because
within this system both the individual and the organiza-
tional decision makers would have important data from which

to develop efficient, practical and accurately focused

educational game plans.

APPENDIX A

SIXTH ANNUAL ACEP/EDNA SCIENTIFIC ASSEMBLY
COURSE EVALUATION FORM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIXTH ANNUAL ACEP/EDNA SCIENTIFIC ASSEMBLY g: 3‘ :1 «f «'4‘ . 52: .3 A . a;
. o w .- h z a 7 ': o‘ 5
Course Evaluation Form 3 m ~— ‘f H TI '2. 7- '.” " “3 ’
cg ? - N n v In up Is a:
’ 32H5‘35§3$.L;'
uss PENCIL ONLY. ERASE cou- 2.533 *5 I .. ... .. _ ‘”
PLET ELY WHEN NECESSARY. MAKE E 3 §
vourr MARKS FIRM AND CLEAII. g g
:92: *
g. .‘ r1 r " '~ I #7
-==- :5 aura“
. §g§- Cm F. c- w‘ n j '1 A I;
CourseTItle: 9.4-; as 7. F ..- g a ‘3: .fl
5§5§§ 8 2 c - e. m 6 m‘ o s
:sgtg -— - L. ...‘ U L. E. -'
Instructorzfi
Content Evaluation
Questions 1-10 will be provided by your instructor (optional)
1, 1, A 5' E b E
= K ? H .1
2 2. A a c c E
3. 3. 4 a‘ g b e"
4, 4, A E c '6 E'~
t: r. ‘,= :- -’
5. 5. .A a c o E
6. 6. A a' C o E
7. 7. A E c B E
a. a. A a ‘c‘ o‘ E
9- ".3 9. A a c~ 5 E
to to A 'a i: I3 E
. Instructional Methods Evaluation
11. Professional value ofthiscowse Ioryou: aisigniiicant bi little clnone "- B C
12 Thecomse Organization was: alexcellent bl good clfair ‘dlpOOI' 12. B C D
13. Practical value ofsyllabus materials: alexcellent bl good clfair dlpoor 13. A a c 6
14. At what level would you Classify this course as presented: aIAdvanced bllntermediate ClBasic 14. A a E.
15. Would you recommend that this course be offered for others with education and experience
similartoyours? alat thesame level blatamore basic level clat an advanced level dlnot at all 15. A a C
PLEASE MARK YOUR FEEDBACK NUMBER IN THE UPPER RIGHT CORNER; OMIT QUESTIONS
16-20 IF YOU HAVE ALREADY GIVEN THIS INFORMATION IN ANOTHER COURSE.
How many years have you worked in the Emergency Department?
16. FullTime: a) 1-2yrs bl3-4yrs cl5-6yrs dl7-8yrs el9yrsorover 15. A 5 C' D E
17. PartTirne: a) 1-2yrs bl3-4yrs CIS-Gyrs dl7—8yrs el9yrsorover 17. A a c o i
18. For NursesOnly: What isyour present academic level: a) LPN b) Diploma
c) Associate d) Baccalaureate e) Mastersorabove 13, A '9' C 6 En
19. For Nurses Only: If you are a Nurse Practitioner, what is your specialty area?
alAdult b) Family c) Pediatric d) Emergency Nurse 9) Other 19. A 5 E 5 E
(Pleasespecity) “ “ " t "
20. For Physicians Only: If you are a member of a specialty organization other than ACEP, please indicate.
alFarni:y Practice b) Internal Medicine cl Surgery d' Pediatrics e) Other ' 20. A E E B E
(Pleasespecify) “ "‘ "‘ "
Fm“ Physicians Only: What are yOur farmal specialty training areas? (mark as many as are applicable)
21. Emergency Medicine 21. A
27. Famiiy Puctice 22, A
23. lnternalhiomicme 23. A
21. Surgery 24_ A
25. Pediatrics 25. A
26. Other 26. A
iPlea:espec.ty) 0
CON L'vIENl S:

2' 'r‘te Additirmai Comments On Reverse Side
Thank you for your feedback. It will be used. 0 10915

APPENDIX B

GRAPH SUMMARIES OF PROFESSIONAL VALUE AND
LEVEL OF INDIVIDUAL COURSES,
TABLES 19 THROUGH 26

PROFESSIONAL VALUE OF COURSES

TABLE 19

 

 

Emergency Medicine Grads - Others

LG'I

VALUE:

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79

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“s .15'.

 

';._"4'11T§.‘;’1 :n.

 

6. I , .JW‘WEMAn

5 Illlflffliflfliflilfliflfltflififlifliflifllllllfll ._

'L t WWWM-

 

 

5 IlllllII"HillllHHHHlHlHIHHlHIHlHHIHIHHHHI
8'1 ifi£fl%flflmfi$&'.vofi- '” TW»~ WWMMHA

 

II“ I i l lllllllllllllllllllllflllllllllllllllllll”Ilium

 

b I
6'1
6 I IHHHHHIHHHHIMHHHilHIHHlllHlHIHHH-Hll
5 IlWHlllMlllllllMflMfllfllflfllmlllllllllllimfll

"WWWJQ 'mw‘pm f" .i U:~"~.

 

 

 

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*'*WftfmwfiwlffibgAflw.WWmvs '

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8 8 ' I assmmm» m . >. .5..— .wt MZTKWW” ,

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G I

 

 

 

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Med . Others

 

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PROFESSIONAL VALUE OF COURSES

TABLE 20

 

5 Years Or More Practice - Others

 

VALUE

80

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6 I ' r ‘ .. meF-Ziz I ~ '1 7‘ . \2' I. . :0 if" “at ' V .r w} i T I

 

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PROFESSIONAL VALUE OF COURSES

TABLE 21

Part-Time Practice - Others

 

 

VALUE:

NO: NO} “IO?

N

NOS

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PROFESSIONAL VALUE OF COURSES

TABLE 22

 

 

Sgggeons - Others

VALUE:

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TABLE 23

 

 

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TABLE 25

 

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TABLE 26

 

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BIBLIOGRAPHY

BIBLIOGRAPHY

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Atwood, H. M. and Ellis, J. "The Concept of Need: An
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Barbulesco, C. "Educational Needs Assessment Related to
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88

Dubin, S. W. and Okun, M. "Implications of Learning Theories
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McCoy, K. "Continuing Education for Members.” Association
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Milliken, J. "CME: The Campaign for Professional Recogni-
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Stensland, P. G. "Continuing Professional Education: Strat-
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