Mandatory practice self-appraisal: moving towards outcomes based continuing education.

Most organized physician continuing educational activities are undertaken without assessing their effects on long-term changes in physician practice patterns, patient outcomes or return on investment. Practice audit and practice self-appraisal are two activities that can be used to achieve these objectives. It is recommended that these be promoted from an educational perspective. A series of principles, including the mandatory application of practice audit and practice self-appraisal are proposed to guide the process. The identification of issues relating to learning, diffusion of information and behavioural change required to facilitate this change are briefly discussed.