ContextAlthough physicians report spending a considerable amount of time in
continuing medical education (CME) activities, studies have shown a sizable
difference between real and ideal performance, suggesting a lack of effect
of formal CME.ObjectiveTo review, collate, and interpret the effect of formal CME interventions
on physician performance and health care outcomes.Data SourcesSources included searches of the complete Research and Development Resource
Base in Continuing Medical Education and the Specialised Register of the Cochrane
Effective Practice and Organisation of Care Group, supplemented by searches
of MEDLINE from 1993 to January 1999.Study SelectionStudies were included in the analyses if they were randomized controlled
trials of formal didactic and/or interactive CME interventions (conferences,
courses, rounds, meetings, symposia, lectures, and other formats) in which
at least 50% of the participants were practicing physicians. Fourteen of 64
studies identified met these criteria and were included in the analyses. Articles
were reviewed independently by 3 of the authors.Data ExtractionDeterminations were made about the nature of the CME intervention (didactic,
interactive, or mixed), its occurrence as a 1-time or sequenced event, and
other information about its educational content and format. Two of 3 reviewers
independently applied all inclusion/exclusion criteria. Data were then subjected
to meta-analytic techniques.Data SynthesisThe 14 studies generated 17 interventions fitting our criteria. Nine
generated positive changes in professional practice, and 3 of 4 interventions
altered health care outcomes in 1 or more measures. In 7 studies, sufficient
data were available for effect sizes to be calculated; overall, no significant
effect of these educational methods was detected (standardized effect size,
0.34; 95% confidence interval [CI], −0.22 to 0.97). However, interactive
and mixed educational sessions were associated with a significant effect on
practice (standardized effect size, 0.67; 95% CI, 0.01-1.45).ConclusionsOur data show some evidence that interactive CME sessions that enhance
participant activity and provide the opportunity to practice skills can effect
change in professional practice and, on occasion, health care outcomes. Based
on a small number of well-conducted trials, didactic sessions do not appear
to be effective in changing physician performance.

Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes?

Most physicians believe that to provide the best possible care to their patients, they must commit to continuous learning. For the most part, it appears the learning activities currently available to physicians do not provide opportunities for meaningful continuous learning. At the same time there have been increasing concerns about the quality of health care, and a variety of groups within organized medicine have proposed approaches to address issues of physician competence and performance. The authors question whether CME will be accepted as a full partner in these new approaches if providers continue to use current approaches to planning and assessing CME. A conceptual model is proposed for planning and assessing continuous learning for physicians that the authors believe will help CME planners address issues of physician competence, physician performance, and patient health status.

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Achieving Desired Results and Improved Outcomes: Integrating Planning and Assessment Throughout Learning Activities

Interest in interprofessional education (IPE) and collaborative practice continue to grow (Frenk et al., 2010; Cox & Naylor, 2013) but whether IPE improves clinical outcomes is uncertain. A recent ...

Measuring the impact of interprofessional education on collaborative practice and patient outcomes.

Introduction:Since 1977, many systematic reviews have asked 2 fundamental questions: (1) Does CME improve physician performance and patient health outcomes? and (2) What are the mechanisms of action that lead to positive changes in these outcomes? The article's purpose is to synthesize the systemati

https://onlinelibrary.wiley.com/doi/pdf/10.1002/chp.21290

The Impact of CME on Physician Performance and Patient Health Outcomes: An Updated Synthesis of Systematic Reviews

Purpose Project Extension for Community Healthcare Outcomes (ECHO) uses tele-education to bridge knowledge gaps between specialists at academic health centers and primary care providers from remote areas. It has been implemented to address multiple medical conditions. The authors examined evidence of the impact of all Project ECHO programs on participant and patient outcomes. Method The authors searched PubMed, MEDLINE, EMBASE, PsycINFO, and ProQuest from January 2000 to August 2015 and the reference lists of identified reviews. Included studies were limited to those published in English, peer-reviewed articles or indexed abstracts, and those that primarily focused on Project ECHO. Editorials, commentaries, gray literature, and non-peer-reviewed articles were excluded. The authors used Moore's evaluation framework to organize study outcomes for quality assessment. Results The authors identified 39 studies describing Project ECHO's involvement in addressing 17 medical conditions. Evaluations of Project ECHO programs generally were limited to outcomes from Levels 1 (number of participants) to 4 (providers' competence) of Moore's framework (n = 22 studies, with some containing data from multiple levels). Studies also suggested that Project ECHO changed provider behavior (n = 1), changed patient outcomes (n = 6), and can be cost-effective (n = 2). Conclusions Project ECHO is an effective and potentially cost-saving model that increases participant knowledge and patient access to health care in remote locations, but further research examining its efficacy is needed. Identifying and addressing potential barriers to Project ECHO's implementation will support the dissemination of this model as an education and practice improvement initiative.

The Impact of Project ECHO on Participant and Patient Outcomes: A Systematic Review.

When most people in health care think of CME, they think of a large room full of physicians who have taken time off from their busy practices to listen to a series of speakers who lecture to them about the most recent advances in their respective fields. The information presented may or may not be relevant to the practice circumstances of members of the audience. And, even if it is, it may not be in a form that can be readily applied in practice. Almost all contemporary CME takes place in this way.

Creating a new paradigm for CME: Seizing opportunities within the health care revolution

At Sharp HealthCare in San Diego, California administrators, medical staff, and educators are working collaboratively on a “continuous medical education” project to link continuous quality improvement (CQI), quality assurance (QA), and continuing medical education (CME). The purpose of this project is to change the way physicians define quality health care and use education to impact their competence and performance as clinicians.



Given the rapid changes occurring within health care in this country and the failure of many previous attempts to link CME and health care delivery, a new paradigm is needed. Using the model of the Harvard Community Health Plan, the administrative and medical director of CME and four medical staff leaders at Sharp Memorial and Cabrillo hospitals spent several days in Boston learning the process of designing clinical algorithms. Currently four algorithms are being developed by these physicians and the algorithm development groups, assisted by the office of CME. The algorithms include the prevention of deep-vein thrombosis, management of abnormal mammograms, management of the hospitalized acute MI patient, and the management of the obstetric patient who fails to progress during labor.



The role of the office of CME and preliminary findings are described, along with a projection of the next steps in the implementation of these algorithms. Participating physicians' attitudes are also examined.

Joseph S. Green

Papers

Achieving Desired Results and Improved Outcomes: Integrating Planning and Assessment Throughout Learning Activities

Creating a new paradigm for CME: Seizing opportunities within the health care revolution

Continuous medical education: Using clinical algorithms to improve the quality of health care in hospitals