Audit with Feedback as a Audit with Feedback as a CME Tool for Radiation CME Tool for Radiation Oncologists: Oncologists: Evaluation of efficacy, Evaluation of efficacy, perception and perception and cost-effectiveness cost-effectiveness Dept. Radiation Oncology, The Cancer Institute (TCI) Singapore Tom Shakespeare MBBS, MPH, GradDipMed(ClinEpi), FRANZCR, FAMS
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Audit with Feedback as a CME Audit with Feedback as a CME Tool for Radiation Oncologists:Tool for Radiation Oncologists:Evaluation of efficacy, perception and Evaluation of efficacy, perception and
cost-effectivenesscost-effectiveness
Dept. Radiation Oncology,The Cancer Institute (TCI) Singapore
Tom Shakespeare MBBS, MPH, GradDipMed(ClinEpi),
FRANZCR, FAMS
BackgroundBackground
CME efficacy differs between medical specialties
little research of CME for radiation oncologists
literature review: no study evaluating RO-specific CME interventions*
*Shakespeare 2003. Ann Acad Med Singapore
BackgroundBackground
Primary CME: lectures, conferences
Secondary CME: eg audit with feedback (AWF), reminders– Secondary CME more effective than primary
CME: meta-analysis (Davis, JAMA, 1992)
– AWF effective: RCTs/meta-analysis (O’Brien et al, 2001, Cochrane Database)
TCI AWF CME programTCI AWF CME program
Commenced targeted AWF meeting for QI / CME June 2001
no other RO-specific CME program
TCI AWF CME programTCI AWF CME program
1. Fortnightly random chart audit– 2 records per consultant– independently scored using a 10-item checklist – checklist targets RO behavior-based on
RANZCR recertification instrument
Date:
Consultant:
Patient ID:
Treatment site:
Departmental file: Registry sheet completed
Letter to referring doctor
Rx intent described
Tumour stage described
Treatment chart: Treatment site described
Laterality doublet noted
RT dose point specified
Isodose plan: Isodose plan signed
Simulation film: Patient name
Film countersigned
Items audited in CME program checklist
TCI AWF CME programTCI AWF CME program
2. Departmental CME meetingaudit results presentedcase management discussedfeedback provided by senior peers (case and
audit)ranked audit results displayed at end
Study objectivesStudy objectives
Evaluation of educational endpoints– program perception– professional practice (behaviour and
performance)– cost-effectiveness
MethodsMethods
Chart reviewall new patients seen by ROs at 2 time points
– 2 months before program implementation (T0)– months 13-14 of the program (T1)