Continuing Medical Education Effect on Clinical Outcomes Effectiveness of Continuing Medical Education: American College of Chest Physicians Evidence-Based Educational Guidelines

Department of Family Medicine, Virginia Commonwealth University, Richmond, VA 23298-0048, USA.
Chest (Impact Factor: 7.48). 04/2009; 135(3 Suppl):49S-55S. DOI: 10.1378/chest.08-2518
Source: PubMed


As opportunities for quality improvement become more visible, educational planners, health services researchers, and policymakers search for strategies that lead to better clinical outcomes. Continuing medical education (CME) is one such strategy, but the impact of CME is poorly defined in relation to clinical outcomes, and efforts to standardize definitions of clinical outcomes are in varied stages of development.
The Johns Hopkins University Evidence-based Practice Center conducted a systematic review of the effectiveness of CME for the Agency for Health Care Research and Quality. From the review, 37 studies were used by the guideline panel to answer questions about improvement in clinical outcomes. Recommendations were made using the American College of Chest Physicians guideline grading system.
Multiple media, multiple techniques of instruction, and multiple exposures to content are suggested to meet instructional objectives intended to improve clinical outcomes.
There are models to describe and guide the planning and evaluation of CME, and there are models to measure quality of care. Research and practice of CME must be defined in relation to guideline implementation and quality improvement and other interventions and systems intended to improve or measure clinical outcomes. Further research is required to identify the qualities essential for measuring causal linkages thought to exist among CME, physician behavior, and clinical outcomes.

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    • "This model assesses training effectiveness by measuring participants' reactions to an educational activity (level 1); changes in participants' knowledge, skills, or attitudes (level 2); transfer of learning to practice/observed changes in behaviour (level 3); and finally, the results of the newly acquired behaviour on organizational outcomes such as productivity and quality (level 4). According to this model, the effects of current approaches to the assessment of the impact of accredited CPD activities should ideally be evaluated focusing on participants' participation, satisfaction, and changes in knowledge, behaviour, and patient outcomes [7], [8], [9]. In practice, however, most CPD providers only assess levels 1 and 2 outcomes using pre- and post-activity self-administered questionnaires. "
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    ABSTRACT: Continuing professional development (CPD) is one of the principal means by which health professionals (i.e. primary care physicians and specialists) maintain, improve, and broaden the knowledge and skills required for optimal patient care and safety. However, the lack of a widely accepted instrument to assess the impact of CPD activities on clinical practice thwarts researchers' comparisons of the effectiveness of CPD activities. Using an integrated model for the study of healthcare professionals' behaviour, our objective is to develop a theory-based, valid, reliable global instrument to assess the impact of accredited CPD activities on clinical practice. Phase 1: We will analyze the instruments identified in a systematic review of factors influencing health professionals' behaviours using criteria that reflect the literature on measurement development and CPD decision makers' priorities. The outcome of this phase will be an inventory of instruments based on social cognitive theories. Phase 2: Working from this inventory, the most relevant instruments and their related items for assessing the concepts listed in the integrated model will be selected. Through an e-Delphi process, we will verify whether these instruments are acceptable, what aspects need revision, and whether important items are missing and should be added. The outcome of this phase will be a new global instrument integrating the most relevant tools to fit our integrated model of healthcare professionals' behaviour. Phase 3: Two data collections are planned: (1) a test-retest of the new instrument, including item analysis, to assess its reliability and (2) a study using the instrument before and after CPD activities with a randomly selected control group to explore the instrument's mere-measurement effect. Phase 4: We will conduct individual interviews and focus groups with key stakeholders to identify anticipated barriers and enablers for implementing the new instrument in CPD practice. Phase 5: Drawing on the results from the previous phases, we will use consensus-building methods to develop with the decision makers a plan to implement the new instrument. This project proposes to give stakeholders a theory-based global instrument to validly and reliably measure the impacts of CPD activities on clinical practice, thus laying the groundwork for more targeted and effective knowledge-translation interventions in the future.
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    ABSTRACT: Early American physician education lacked quality and consistency. Poorly funded institutions with weak curricula and little patient contact before graduation trained our earliest doctors. With the advent of the twentieth century, a reformation of medical education took place that created the foundation of our modern American medical education system. The importance of physician education increased, leading to the production of specialty boards and requirements for continuing medical education and culminating in a continuous certification process now required of all specialties including the American Board of Emergency Medicine. While the utility of continuing medical education has been questioned, technological advances, the Internet, and improved education techniques are helping physicians practice modern medicine in a time of rapidly expanding science.
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    ABSTRACT: Current approaches to evaluation in continuing medical education (CME) feature results defined as changes in participation, satisfaction, knowledge, behavior, and patient outcomes. Few studies link costs and effectiveness of CME to improved quality of care. As continuing education programs compete for scarce resources, cost-inclusive evaluation offers strategies to measure change and to determine value for resources spent. © 2009 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.
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