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Participatory learning: a Swedish perspective
  1. Anna Kiessling
  1. Correspondence to:
    Anna Kiessling
    MD, Centre for Clinical Education, House 40, Floor 6, Karolinska Institute, Danderyd University Hospital, SE-182 88 Stockholm, Sweden;

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During recent years, numerous recommendations and practice guidelines on the subject of secondary prevention of coronary heart disease have been produced throughout Europe. Congresses, educational meetings, and lectures have been held with the purpose of facilitating the implementation of evidence based clinical practice. Furthermore, printed educational materials including reviews and clinical guidelines have been provided to all physicians concerned. Despite all this effort, the gap is still wide between what is achieved in clinical practice, and what could be achieved according to scientific evidence based goals for secondary prevention in patients with coronary heart disease.1 The reason for this is probably that there are several barriers and complexities between the guidelines and a behavioural change in real clinical practice.2,3

The means of changing this lies in the choice of educational method, rather than producing more scientific evidence. A recent comment from a European perspective on guidelines and global risk states that “The real task facing cardiovascular medicine is implementation of these recommendations into clinical practice”.4

Thus, the question is: How to perform this? Which physicians are the key target population? Cardiologists, internists, generalists and, or general practitioners? Perhaps the patients? Which implementation methods should be used? Are these methods evidence based? How should the results be evaluated?


A recent Swedish study using the case method learning technique—that is, a participatory learning method—holds promise and shows significant results in secondary prevention of patients with coronary heart disease, even at the patient level in primary care.5

The reason why we focused on education for general practitioners, and not for specialists, is that the main cohort of patients with stable coronary heart disease, at least in Sweden, is taken care of by generalists. However, coronary heart disease patients represent only a minority of the patients treated at those …

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