Outcomes-Based
CME
National CPD
Accreditation Meeting
Dave Davis, MD
Senior Director, Continuing Education &
Performance Improvement
Thinking that lectures will change
outcomes? Just plain dumb….
Outline
You first:
-Your objectives
-Your challenges
Me next:
-One useful model of CME/CPD
-Several Problems in CME & Ten minutes of
research findings
All of us…..Overcoming the problems: the
first annual Canadian CPD Outcomes
exercise
Wrap-up
a useful model: Nowlen’s Models of
Continuing Education
CME problem #1: the
perception thing
CME Problem 2: confusing
dissemination with implementation
Diffusion: distribution of information and
the practitioners’ natural unaided adoption
of policies and practices
Dissemination: communication of
information to clinicians to improve their
skills
Implementation: putting a guideline in
place, involves effective communication,
overcomes barriers by administrative and
educational techniques
(after Lomas)...
Problem #3: not paying attention to
the research, especially mine 
Physicians and others not self-aware: objective needs
assessment, performance feedback important
Knowledge necessary but not sufficient for change;
didactics lousy at changing performance
What works? Interactivity; sequencing; predisposing,
enabling and reinforcing strategies
‘CME’ > conferences; = practice-based tools (reminders,
audit-feedback, protocols & training)
Docs pass through stages of learning: awareness,
agreement, adoption to adherence
…………Cochrane reviews, AHRQ/EB reviews, others
Effective CME: what do the studies of CE say? The
effect of interventions on performance and health
care outcomes JAMA 1995;274:700-705
Audt and feedback
Reminders
Pt mediated
Opinion leaders
+PP
interv#
Academic detailing
conferences
print, AV
+PP refers the number of studies that showed positive effects
0 refers to the
10number of studies
20 with the30particular interventions
40
Interv#
Does formal CME work?: graphic representation of
effect of variables (JAMA 1999; 282:867-874)
Multiple sessions
Single
+PP
interv#
Mixed
Interactive
Didactic
Interv# refers to the number of studies with the particular interventions
+PP refers the number of studies that showed positive effects
0
5
10
15
Another problem:
no, or only self-assessment – e.g. regular
rounds
Golf
game this
aft…
Charts
overdue
Diabetic
ketoacidosis?
patient on 5A
Preeclampsia
patient in ER
Teenage
kids
Applying the Research…
Adapted from Straus et al, EBM 2005
Implementation tools
Systematic
reviews
Studies
Self/educational
experiences
objective assessments, e.g., quality
rounds…
Our
department's
performance
in XX
management
What’s the
evidence?
What’s the role of
other team
members in making
this better?
How could
we do
better?
How do we
compare
with…?
NO, okay maybe a few,
targeted didactic
lectures
Putting it together: Pathman, PROCEED
and a CME-based implementation
planning guide
Davis et al, BMJ, 2003
Methods/
Stages
Predisposing
Enabling
Reinforcing
Awareness
Agreement
Adoption
Adherence
Warning: interaction ahead
What’s the clinical problem?
How do you KNOW it’s a problem? Evidence, Data
What are the barriers to fixing it?
How WOULD you fix it?
–
–
–
–
Awareness
Agreement
Adoption
Adherence
Accountability
What Stakeholders will you need ‘at the table’
How will you know when it’s fixed? What metrics would you use?
Other thoughts, ideas
More information:
E-mail
Web
[email protected]
www.aamc.org/initiatives/cei
www.mededportal.org