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Worldwide perspectives on teaching and learning arebrought together in this issue of the Journal of Contin-

uing Education in the Health Professions (JCEHP). Thetheoretical understanding that there might be a single,good way to teach is challenged by Pratt, Arseneau, andCollins, who identify five teaching perspectives, each withthe potential to become good teaching. Teaching per-spectives are philosophical orientations to knowledge andlearning and to the role and responsibility of being aneducator. The authors advocate for understanding excel-lent teaching as a pluralistic concept that can occur inmultiple forms.

Lockyer, Fidler, Ward, Basson, Elliott, and Toewsstudied the intended changes of physicians. There was asignificant correlation between intended changes statedimmediately after an intensive day-long course, theamount of time spent on selected content during thecourse, and changes in practice reported at 6 months.

Casebeer, Grimes, Kristofco, Freeman, Gotuzzo,and Freedman evaluated a course planned in the UnitedStates and executed in Peru. They learned that it is logis-tically and financially feasible to conduct continuingeducation courses in developing countries if the organi-zation in the planning country has strong pre-establishedrelationships with the host institution.

The value of breaks during formal continuing med-ical education (CME) events was explored by Tipping,Donahue, and Hannah. They suggest that breaks areimportant to help physician-learners as they conceptu-ally integrate new material, make new meaning out oftheir experiences, and solve individual practice problemsin changing environments. Not only do they practice inchanging environments, but physicians’ roles differwithin the health systems where they practice. Sherrillstudied future physician executives enrolled in MD/MBAprograms and compared them with students enrolled intraditional undergraduate medical education. TheMD/MBA students scored higher than the MD studentsin their tolerance of ambiguity, a characteristic associ-ated with receptivity to new ideas and effective copingwith stress and difficult situations. A few graduating

physicians hold no intention of completing clinical res-idencies. As the number of physician executives increases,educators must respond to the new graduates who expectto transact business and develop policy in medicine.

Parochka and Paprockas studied the relationships ofa CME lecture and workshop, physician behavior, andbarriers to change. In testing the assumption that CMEcan cause a change in physician behavior, they report threeinfluential barriers to change: lack of consensus amongcolleagues and peers, lack of time for assessment inpatient counseling, and lack of reimbursement by thepatients’ insurance companies. The investigators suggestthat it is difficult to establish a situation in which a sin-gle educational intervention will be necessary and suf-ficient to effect a change in clinical practice.

Borduas, Gagnon, Lacoursière, and Laprise devel-oped a case from the childhood and adult patient recordsof a successful practitioner and teacher. They investigatedthe strategies used by physicians to stay abreast of impor-tant changes in practice. They found that use of the casestudy sensitized physician-learners to gaps between theircurrent performance and experts’ recommendations,while providing an opportunity to evaluate methods forclosing the gap.

The journal is introduced to the Cochrane Library byDavid Davis, who offers the first JCEHP commentary ona Cochrane review, “Audit and Feedback versus Alterna-tive Strategies.” Despite the conventional wisdom—whichpoints toward modifying or adding interventions—thereis not enough evidence to inform planners regarding howto enhance the effectiveness of audit and feedback.

The texts of the Tao te ching are reviewed by Stu-art Gilman. He suggests that educators should not focusevaluation and planning only on the cosmetic or visibleaspects of CME that are the easiest to grasp. He favorsevaluation of the learning spaces that a quality activityand a sound educational organization create when theyare in harmony with their purpose and audience.

Paul E. Mazmanian, PhDEditor

The Journal of Continuing Education in the Health Professions, Volume 21, p. 69. Printed in the U.S.A. Copyright © 2001 The Alliance forContinuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for HospitalMedical Education. All rights reserved.

Editorial

Learning, Evaluation, and the Tao of Continuing Medical Education