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Implementing the guidelines in Continuous Medical
Education by the Audit méthod.
Josiane ALBOUY (Regional Work Inspection for the
 Région Centre ),  Annie DESCAMPS, Guy
DOUFFET, Eric DRAHI, Philippe NICOT (UNAFORMEC).

• The educational goals 
• Identifying the expectations, beliefs and
  representations from the patient with low back
  pain.
• Identifying the expectations, beliefs and
  representations from the practitioners of
  patients with low back pain
• Analysing pain in its bio-psycho-sociological
  aspects
• Identifying a symptomatic low back pain
• Appropriating the guidelines made by the ANAES on
  patients treated and their diseases diagnosed for
  acute and chronic low back pain
• Using an analogical visual scale to assess the
  pain
• Knowing when advice or care from a psychologist
  or psychiatrist is required
• Talking about pain with their patients
• Negotiating with the patients for the therapy
  procedures
• Working in collaboration with the work physician
  on the ergonomics of the job and the
  psychological conditions from the work
  environment
• Working in collaboration with the medical
  consultant and the social assistants to
  anticipate on a possible chronic ill health
• Carrying out an audit on practice on the care of
  a patient with low back pain.
• Planning of the formation
• This formation consisting in 2 days (a formation
  of 14 hours) took place
• according to the following sequences
• Module 1 The patients itinerary in the health
  system
• Module 2 The guidelines

• Background
• The implementation of
• guidelines is a cause of
• concern in all developed countries.
• In France particularly,
• guidelines seem to
• have a limited effect on the
• practice. Among the most efficient
• methods to implement
• guidelines, we find the
• medical audit and the interactive
• continuous medical formation
• (FMC).
• The UnaformeC, pioneer in the
• interactive continuous medical
• education, uses the practices
• audit as a tool to reinforce the
• educational benefits. If this

• Résults
• This formation shows how feasible the method is.
• Out of 21 participants, 8 General Practitioners
  completed the first step and 17 the second one.
• All the General Practitioners who participated
  the first step went through the second one..
• The number of questions given in the audit
  guides increased between the first and second
  rounds of audits.
• The number of answers which conform to the
  guideline created by the participants increased
  in the second collection.
• A third round is planned after 6 months to ensure
  with time that practices are improved..

With the audit guideline, we sent the
participants the  Valat Score which makes it
possible to assess the probability for low back
pain to become a chronic disease. We added
instructions to use it for all patients with low
back pain included in the protocol.
DISCUSSION The audit is a useful method during
the formations in order to assess the
participants acquired knowledge It concerns
self-measuring methods, for which only anonymous
general results are given to the
participants. One of the major problems lies in
the pertinence of the questions in the audit. We
may improve the situation by working with
criteria defined by the participants themselves,
within the framework of a process for constant
quality improvement. When the criteria are
created from a guideline on clinical practice,
used as an explicit documentary source, it is a
real way to implement the guideline. Conclusion
This method can be put into practice. One to
two criteria may be defined during sequences of
three hours formations..
SFDRMG - UnaformeC Union Nationale des
Associations de Formation Médicale Continue 261
rue de Paris 93556 MONTREUIL CEDEX
FRANCE Courriel unaformec_at_wanadoo.fr Toile
http//www.unaformec.org