outcomes-based cme national cpd accreditation meeting dave davis, md senior director, continuing...
TRANSCRIPT
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
