The ISHA Continuing Medical Education Program at Clalit Health Services: Evaluation Report

The ISHA program, initiated and largely funded by the Jewish Federation of Cleveland, is devoted to improving the health of women in Israel. This program, which was a collaborative effort of the Jewish Federation of Cleveland and the Jewish Agency, was strategically designed as a multi-pronged effort that sought to bring about system-wide change through a series of projects aimed at both health providers and health service consumers. The Myers-JDC-Brookdale Institute was involved in the planning of the program from its inception, and has also monitored and evaluated the program.

A major component of the program was the ISHA Continuing Medical Education (CME) program, implemented by Clalit Health Services. Its goal was to improve the care of women in Clalit clinics through a training program designed to increase the awareness, knowledge, skills and self-efficacy of physicians. In addition, the program created an opportunity to develop a new method of physician group learning in the clinics. The program was implemented with ongoing exchange with key professionals from the Cleveland community and was based on an innovative distance learning method: e-learning in small peer groups, which took place on-site at the primary care clinics and was integrated with the regular work schedule. The program consisted of 18 lessons on central aspects of women’s health. Each lesson was developed and written by Israeli physicians with input from subject area experts from Cleveland. Between 2006 and 2008, this ambitious and innovative program was implemented in over 200 clinics. Over a thousand physicians participated in the program, and through them, it had the potential to influence the care of hundreds of thousands of women.

The evaluation examined the implementation of the program and its contribution to improving the physicians’ attitudes, knowledge, self-efficacy, skills and practice patterns regarding specific issues in women’s health, as well as the care experience and satisfaction of female patients. For example, it examined to what extent physicians attached importance and felt able to discuss key health topics with women patients – and actually did so. We also examined the extent to which they felt they had the skills to identify specific health problems, and to what extent they referred women to specific preventive tests. The report presents the main findings on all these issues.

Beyond the measurable outcomes related to women’s health, the program also contributed to Israeli health care by demonstrating the use of a new tool for distance learning which could be used for various topics and audiences. Clalit is already making use of this tool in training nurses and human resources personnel and in a course on preventive medicine for physicians in the health plan. Other Israeli health plans are also looking into possible use of these e-learning lessons on women’s health.