Imagine your colleague prescribes a drug that has no/minimal evidence that it works. "We're scientists," you say, "Physicians should practice based on science not fiction or wishful thinking."
- So what is the evidence that all the money and time spent on CME is producing results?
- How can we measure outcomes if we don't collect data?
- Who is going to collect the data and who is going to pay for it?
- Is satisfaction an outcome?
- "Widely used CME delivery methods such as conferences have little direct impact on improving professional practice" (Davis 1995). The data on the effectiveness of standard CME is not impressive.
- "Based on a small number of well-conducted trials, didactic sessions do not appear to be effective in changing physician performance" (Davis 1999).
- "Education in small doses (days) is ineffective, likely because it pales in comparison with the prior 20 years of education physicians have already received. Guideline dissemination is too passive to effect behavior change without active implementation strategies" (Smith 2000).
- "Didactic sessions alone are unlikely to change professional practice" (O'Brien 2001).
- "Even though the most-effective CME techniques have been proven, use of least-effective ones predominates. Such use of ineffective CME likely reduces patient care quality and raises costs for all, the worst of both worlds" (Bloom 2005).
- "Educational meetings alone are not likely to be effective for changing complex behaviours" (Forsetlund 2009).
- "Presentation of research data in most CME programs is inadequate to allow learners to make fully informed therapeutic decisions. " (MacLeod 2010)
- Study of hypertension CME found no change in case vs. control for patients with uncontrolled hypertension. A clinically insignificant change of 2mm overall. (Allaire 2011)
References
- Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA. 1995 Sep 6;274(9):700-5. PMID 7650822 http://jama.ama-assn.org/content/274/9/700.full.pdf+html
- Davis D, O'Brien MA, Freemantle N, Wolf FM, Mazmanian P, Taylor-Vaisey A. Impact of formal continuing medical education: Do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? JAMA. 1999 Sep 1;282(9):867-74. PMID 10478694. http://jama.ama-assn.org/content/282/9/867.long
- Smith WR. Evidence for the effectiveness of techniques To change physician behavior. Chest. 2000 Aug;118(2 Suppl):8S-17S. PMID 10939994 http://chestjournal.chestpubs.org/content/118/2_suppl/8S.long
- Thomson O'Brien MA, Freemantle N, Oxman AD, Wolf F, Davis DA, Herrin J. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2001;(2):CD003030. PMID 11406063.
- Bloom BS. Effects of continuing medical education on improving physician clinical care and patient health: a review of systematic reviews. Int J Technol Assess Health Care. 2005 Summer;21(3):380-5. PMID 16110718.
- Forsetlund L, Bjørndal A, Rashidian A, Jamtvedt G, O'Brien MA, Wolf F, Davis D, Odgaard-Jensen J, Oxman AD. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD003030. PMID 19370580. http://apps.who.int/rhl/reviews/CD003030.pdf
- Presentation of evidence in continuing medical education programs: a mixed methods study. Allen M, MacLeod T, Handfield-Jones R, Sinclair D, Fleming M. J Contin Educ Health Prof. 2010 Fall;30(4):221-8. PMID: 21171027
- Measuring the impact of a continuing medical education program on patient blood pressure. Allaire BT, Trogdon JG, Egan BM, Lackland DT, Masters D. J Clin Hypertens (Greenwich). 2011 Jul;13(7):517-22. PMID: 21762365