General practitioners in many settings rely heavily on specialist-based continuing medical education (CME) methods. These include direct consultation with experts, reviews in journal and textbooks, and formal continuing education activities. 123 A traditional hierarchical relationship results in a one-way transfer of knowledge from specialists to general practitioners 4. However general practitioners may wish to control their own educational agenda and to inform specialists of their learning needs. Learning centered on clinical cases is likely to be of greater use to family physicians than formal lectures 5. Some specialists may regard lectures as the principal method of transferring information and few may have given any serious consideration to alternative teaching methods. The disparity between what general practitioners want to learn from specialists and what specialists think they need can be a barrier to effective educational interaction if there is no negotiation between teachers and learners 6. This paper describes a quality improvement program which introduced a new method of CME with the objective of increasing satisfaction with CME in a group of board certified general practitioners in Israel, in order to try to bridge the needs/wants gap.

Adult learning theory and theories of how professionals maintain and develop competence emphasize the importance of self-directed learning and point to clinical practice and problem solving as key areas of interest 9. Many studies have shown that patient care provokes frequent information needs 10. General practitioners often rely on specialist-based CME because textbooks, journals, and other existing information tools are not adequate for answering clinical questions that arise in practice. Textbooks may become outdated quickly, journals are often not useful in daily practice and both methods are time-consuming and expensive. 1013 Computer systems that have been developed to help doctors are not widely used 101112. General practitioners have clear views of the content and style of teaching they wish to receive from their specialist colleagues 14. The satisfaction questionnaire developed by the family physicians in this program reflected a wish that teaching be directly related to theirclinical work.

In this quality improvement program, the family physicians' desire for two-way interaction and for effective mutual education was achieved by family physicians expressing clearly what they wanted from their specialist colleagues and by specialists developing greater educational expertise. Prior needs assessment is important for informing and directing the educational process. 14

Two models of educational interaction between family physicians and specialists are described here 2. The first model presented is based on traditional didactic lectures given by specialists to general practitioners. General practitioners may dislike didactic lectures but specialists often prefer this method. The second model consists of interactive sessions centred on clinical cases. This model was popular with both family physicians and specialists. Heale et al found that traditional lectures and large group lectures were the least preferred method of CME. 15 A transition from passive to interactive learning groups was also recommended in another study 16.

Systematic reviews 1718192021 of educational interventions have shown that continuing medical education can improve clinical performance and patient outcomes by changing doctors' behavior. The most effective methods described in these reviews include learning linked to clinical practice, interactive educational meetings, outreach events, and strategies that involve multiple educational interventions (for example, outreach plus reminders). The least effective methods are those most commonly used in general practice continuing medical education, namely, lecture-format teaching and unsolicited printed material (including clinical guidelines).

This report has described one method of increasing satisfaction with CME by increasing interaction between teachers and learners. Further study is required to test the association between the increase in satisfaction and changes in physician knowledge, competence and performance in this population.

None declared

LG and YF initiated the study and collected the data. LG wrote the original draft of the paper. JY conducted the statistical analysis of the data and wrote subsequent drafts of the paper. All authors read and approved the final manuscript.