Those of us in the continuing medical education (CME) community have seen a growing movement over the past several years to emphasize the impact our programs are having on the practitioner community, and more importantly, patients. Commonly referred to as “outcomes,” CME providers are being asked more than ever to demonstrate to the medical community that the high quality educational programs we produce are not only educating doctors, but also having a lasting impact beyond the classroom.
One way CME providers have begun demonstrating outcomes is through published articles in the peer reviewed Journal of Continuing Education in the Health Professions. Below is a summary of a few recent articles that focus on CME programs that have shown positive outcomes in the patient and practitioner community.
CME Outcomes
The first article looks at a Pharmacist web-based training program on medication use in chronic kidney disease patients: Impact on knowledge, skills, and satisfaction. Chronic kidney disease (CKD) patients are multimorbid elderly at high risk of drug-related problems. A Web-based training program was developed based on a list of significant drug-related problems in CKD patients requiring a pharmaceutical intervention. The objectives were to evaluate the impact of the program on community pharmacists’ knowledge and skills and their satisfaction with the training.
Pharmacists were randomized to the training program or the control group. Training comprised a 60-minute Web-based interactive session supported by a clinical guide. Pharmacists completed a questionnaire on knowledge (10 multiple-choice questions) and skills (2 clinical vignettes) at baseline and a second time within 1 month. Trained pharmacists completed a written satisfaction questionnaire. Semidirected telephone interviews were conducted with 8 trained pharmacists. Changes in knowledge and skills scores were compared between the groups.
Seventy pharmacists (training: 52; control: 18) were recruited; the majority were women with <15 years’ experience. Compared with the control group, an adjusted incremental increase in the knowledge score (22%) and skills score (24%) was observed in the training group. Most pharmacists (87%–100%) rated each aspect of the program ―excellent” or ―very good.
The article concluded that, “after a Web-based training, pharmacists significantly improved their knowledge in nephrology and clinical skills in detecting and managing drug-related problems in CKD patients.” Pharmacists liked the Web-based continuing education program and that over a short time span, the program improved their knowledge and skills. The study maintained that, “A short Web-based continuing education program supplemented with a clinical guide is a convenient approach to training community pharmacists to detect, prevent, and manage clinically significant drug-related problems”
The second article looked at Confidence-based learning CME: Overcoming barriers in irritable bowel syndrome with constipation. This study described the use of confidence-based learning (CBL) in an activity designed to enhance learners’ knowledge, confidence in their knowledge, and clinical competence with regard to constipation-predominant IBS (IBS-C), a frequently underdiagnosed and misdiagnosed condition.
The online CBL activity included multiple-choice questions in 2 modules: Burden of Care (BOC; 28 questions) and Patient Scenarios (PS; 9 case-based questions). After formative assessment, targeted feedback was provided, and the learner focused on material with demonstrated knowledge and/or confidence gaps. The process was repeated until 85% of questions were answered correctly and confidently (ie, mastery was attained).
Of 275 participants (24% internal medicine, 13% gastroenterology, 32% family medicine, and 31% other), 249 and 167 completed the BOC and PS modules, respectively. Among all participants, 61.8% and 98.2% achieved mastery in the BOC and PS modules, respectively. Baseline mastery levels between specialties were significantly different in the BOC module; no significant differences were evident between specialties in final mastery levels.
The study concluded that, “Learners achieved mastery in topics pertaining to IBS-C regardless of baseline knowledge or specialty. These data indicate that CME activities employing CBL can be used to address knowledge and confidence gaps.” Accordingly, the authors noted that, “CBL can be an effective method of increasing knowledge and confidence in that knowledge in a CME activity, and that learners across different specialties can achieve mastery in topics of IBS-C despite varying levels of baseline knowledge.”
Discussion
In the future, we will continue to provide updates on recently published CME outcomes papers as well as addition peer reviewed articles looking at the impact of CME.
Improving patient outcomes should be the overarching goal of any professional medical education effort. CME providers should assess tactics to help improve how participants learn and understand how to implement the knowledge they receive into practical patient care. The learning that occurs presents a collective opportunity for peer synergy and also a collaboration of technologies.
As noted here, even the same kind of physicians learn in various ways and absorb information differently. It is the role of the educator and facilitated forum to provide learning opportunities that mirror how primary care physicians and specialists practice medicine at the point of care.