REFERENCES1 The Royal College of Physicians and Surgeons of

Canada. Skills for the new millennium: report of thesocietal needs working group. CanMEDS 2000 Project.Ottawa: September 1996.

2 Davis D. Does CME work? An analysis of the effect ofeducational activities on physician performance orhealth care outcomes [Review]. Int J Psychiatry Med1998; 28: 21–39.

3 Davis D, O’Brien MA, Freemantle N, et al. Impact offormal continuing medical education: do conferences,workshops, rounds, and other traditional continuingeducation activities change physician behavior orhealth care outcomes? JAMA 1999; 282: 867–874.

4 Doucet MD, Purdy RA, Kaufman DM, Langille DB.Comparison of problem-based learning and lectureformat in continuing medical education on headachediagnosis and management. Med Educ 1998; 32:590–596.

5 Smits PB, Buisonjé CD de, Verbeek JH, et al. Problem-based learning versus lecture-based learning in post-graduate medical education. Scand J Work EnvironHealth 2003; 29: 280–287.

6 Smits PB, Verbeek JH, Nauta MC, et al. Factors predic-tive of successful learning in postgraduate medicaleducation. Med Educ 2004; 38: 758–766.

7 Karlinsky H, Dunn C, Clifford B, Atkins J, Pachev G,Cunningham K, Fenrich P, Bayani Y. Workplace injurymanagement: using new technology to deliver andevaluate physician continuing medical education. JOccup Rehabil 2006; 16: 719–730.

8 Fordis M, King JE, Ballantyne CM, et al. Comparison ofthe instructional efficacy of Internet-based CME withlive interactive CME workshops: a randomized con-trolled trial. JAMA 2005; 294: 1043–1051.

9 Hugenholtz NI, Croon EM de, Smits PB, et al.Effectiveness of e-learning in continuing medical edu-cation for occupational physicians. Occup Med (Lond)2008; 58: 370–372.

10 Parochka J, Paprockas K. A continuing medical educa-tion lecture and workshop, physician behavior, andbarriers to change. J Contin Educ Health Prof 2001; 21:110–116.

11 Turner S, Hobson J, D’Auria D, Beach J. Continuing

professional development of occupational medicinepractitioners: a needs assessment. Occup Med (Lond)2004; 54: 14–20.

12 Norman GR, Shannon SI, Marrin ML. The need forneeds assessment in continuing medical education.BMJ 2004; 328: 999–1001.

13 Grant J. Learning needs assessment: assessing theneed. BMJ 2002; 324: 156–159.

14 Grant J, Chambers G, Jackson G (eds.). The good CPDGuide. Sutton: Reed Healthcare, 1999.

15 Peck C, McCall M, McLaren B, Rotem T. Continuingmedical education and continuing professional devel-opment: international comparisons. BMJ 2000; 320:432–435.

16 Union Européenne des Médecins Spécialistes. TheEuropean Accreditation Council for ContinuousMedical Education. Brussels: UEMS, 2003.

17 Union Européenne des Médecins Spécialistes. UEMS-EACCME Reference Guide to the AccreditationProcess. Brussels: UEMS, 2007.

18 Abrahamson S, Baron J, Elstein AS, et al. Continuingmedical education for life: eight principles. Acad Med1999; 74: 1288–1294.

ABOUT THE AUTHOR

Dr André Weel is working as a senior occupational health

consultant at the Centre of Excellence, Netherlands

Society of Occupational Medicine, Utrecht, The Nether-

lands. This article is based on his lecture at the inter-

national symposium ‘Education and Training in Occupa-

tional Health’ in Leuven, Belgium, 29 May 2008, at the

occasion of the retirement of Professor Raphael

Masschelein.

CORRESPONDENCE ADDRESS

André Weel MD PhD, Centre of Excellence Netherlands

Society of Occupational Medicine, PO Box 2113, 3500 GC

Utrecht, The Netherlands.

Email: a.weel@nvab-online.nl.

450 TBV 16 / no. 10 / December 2008

Why RA patients delay before seeking medical advice

Effective treatment can only be given during theearly stages of RA if patients are seen early. How-ever, many patients delay for prolonged periodsbefore seeking medical advice. In-depth, semi-structured interviews were carried out with 24patients. Four main themes influenced the decision toseek medical advice: (i) symptom experience: theseverity of symptoms and their impact on func-tional ability; (ii) symptom evaluation: thepatient’s explanation for their symptoms andrecognition of their significance; (iii) knowledge

of RA and available therapies; and (iv) experienceof and attitudes towards health care providers.A significant and rapid impact of the disease onfunctional ability characterized those presentingearly. Many developed an explanation for theirsymptoms that related to preceding activities.Recognition that this explanation was inade-quate to explain symptom progression frequent-ly prompted a consultation. Only one patientsought advice because she thought that shemight have RA.Source: Rheumatology, August 18, 2008

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