Outcomes-Based CME National CPD Accreditation Meeting Dave Davis, MD Senior Director, Continuing Education & Performance Improvement.

Outcomes-Based Outcomes-Based CMECME

National CPD National CPD Accreditation MeetingAccreditation Meeting

Dave Davis, MDSenior Director, Continuing Education & Performance Improvement

Thinking that lectures will change outcomes? Just plain dumb….

OutlineOutlineYou first:

-Your objectives-Your challenges

Me next:-One useful model of CME/CPD-Several Problems in CME & Ten minutes of

research findingsAll of us…..Overcoming the problems: the

first annual Canadian CPD Outcomes exercise

Wrap-up

a useful model:a useful model: Nowlen’s Models of Continuing Education

CME problem #1: the CME problem #1: the perception thingperception thing

CME Problem 2: confusing CME Problem 2: confusing dissemination with implementationdissemination with implementation

DiffusionDiffusion: distribution of information and the : distribution of information and the practitioners’ natural unaided adoption of practitioners’ natural unaided adoption of policies and practicespolicies and practices

DisseminationDissemination: communication of information : communication of information to clinicians to improve their skillsto clinicians to improve their skills

ImplementationImplementation: putting a guideline in place, : putting a guideline in place, involves effective communication, involves effective communication, overcomes barriers by administrative and overcomes barriers by administrative and educational techniqueseducational techniques

(after Lomas)...

Problem #3: not paying attention to the research, especially mine

Effective CME: what do the studies of CE say? The effect of interventions on performance and health care outcomes JAMA 1995;274:700-705

0 10 20 30 40

print, AV

conferences

Academic detailing

Opinion leaders

Pt mediated

Reminders

Audt and feedback

+PP

interv#

+PP refers the number of studies that showed positive effectsInterv# refers to the number of studies with the particular interventions

Does formal CME work?: graphic representation of effect of variables (JAMA 1999; 282:867-874)

0 5 10 15

Didactic

Interactive

Mixed

Single

Multiple sessions

+PP

interv#

Interv# refers to the number of studies with the particular interventions+PP refers the number of studies that showed positive effects

Another problem: Another problem: no, or only self-assessment – e.g. regular no, or only self-assessment – e.g. regular roundsrounds

Teenage Teenage kidskids

Golf game this aft…

Diabetic ketoacidosis?patient on 5A

Charts Charts overdueoverdue

Pre-Pre-eclampsia eclampsia patient in patient in ERER

Applying the Research…Applying the Research…

Adapted from Straus et al, EBM 2005

Implementation toolsImplementation tools

objective assessments, e.g., quality objective assessments, e.g., quality rounds…rounds…

How could How could we do we do better?better?

What’s the role of other team members in making this better?

Our department's performance in XX management

What’s What’s the the evidence?evidence? How do How do

we we compare compare with…?with…?

NO, okay maybe a few, NO, okay maybe a few, targeted didactic targeted didactic

lectureslectures

Putting it together: Pathman, PROCEED and a CME-based implementation planning guide

Davis et al, BMJ, 2003

Warning: interaction aheadWarning: interaction aheadWhat’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 informationMore information:

E-mail

Web

ddavis@aamc.orgwww.aamc.org/initiatives/ceiwww.mededportal.org