Effects of the Clinical Environment on Physicians’ Response to Postgraduate Medical Education

Abstract

This study examined the effects of a medical education program on diabetes mellitus as a function of the extent to which participants’ clinical environments were made to facilitate recommended practices. One hundred fourteen internal medicine faculty and residents (four clinics) were offered a 3.5-hour diabetes seminar. One clinic served as a seminar-only condition; three clinics received an accumulation of environmental interventions: patient-specific seminar reminders, clinical materials, and easy access to a diabetes patient educator. Relative to control, any degree of environmental support significantly increased prescriptions for home-monitored blood glucose testing. Also, the group of physicians receiving reminders and clinical materials exhibited significantly more frequent utilization of glycosylated hemoglobin as a laboratory measure of metabolic status compared to other groups. No significant differences were obtained for utilization of three other laboratory tests and therapeutic modalities. Developers of postgraduate professional education should consider whether their programs can be strengthened by anticipating how the practice environment facilitates and hinders new professional practices.