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Open Access Open Badges Research article

Improving knowledge and changing behavior towards guideline based decisions in diabetes care: a controlled intervention study of a team-based learning approach for continuous professional development of physicians

Lisa Kühne-Eversmann* and Martin R Fischer

Author Affiliations

Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ziemssenstr. 1, Munich 80336, Germany

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BMC Research Notes 2013, 6:14  doi:10.1186/1756-0500-6-14

Published: 15 January 2013



Continuing Professional Development (CPD) courses should ideally improve a physician’s knowledge and change their professional behavior in daily practice towards a best clinical practice reference model and guideline adherence. Interactive methods such as team-based learning and case-based learning, as compared to lectures, can impart sustainable knowledge and lead to high satisfaction among participants. We designed an interactive case-based CPD-seminar on diabetes care using a team-based learning approach to evaluate whether it leads to an improvement of short-term knowledge and changing of behavior towards guideline based decisions and how this learning approach is perceived by participants.


Questionnaires and an electronic voting system were used to evaluate motivation, acceptance and knowledge of voluntary participants. Furthermore, we analyzed data on index diagnostic tests and referrals of patients with diabetes of participating physicians over a period of six months before and after the course in comparison with a matched control group in a quasi-experimental design.


Participants (n=103) rated the interactivity and team-based discussions as the main reasons for enhanced learning. They also expected that the course would change their professional behavior. Participants scored a mean of 43.9% right answers before and 62.6% after the course (p<0.001). The referral to diabetes specialists increased by 30.8% (p<0.001). Referral for fundoscopy also increased (8.5%, n.s.) while it dropped in the control group. Furthermore, the participating physicians tested their patients more often for microalbuminuria (7.1%, n.s.).


Our team-based learning CPD-approach was highly accepted and resulted in an increase of short-term knowledge. It significantly increased the referral to diabetes specialists in daily practice whereas all other key professional behavior indicators did change but not significantly.

Team-based learning; Continuing professional development; Continuing medical education; Postgraduate education; Guideline adherence; Objective behavior change