Performance improvement CME can yield excellent data; however, it can take a considerable amount of time to collect the data and analyze results, and it can be expensive. Fortunately, all providers can evaluate and/or assess practice changes in their CME activities without having to follow the formal American Medical Association PI CME three-stage model.

Baseline: Current Practice

To evaluate change in clinical behavior effectively, providers must first evaluate current clinical practice. Consider using pre-activity registration forms to collect practice information from your pre-registrants. Ask questions that are tied back to the identified practice gap, e.g., “Are you currently using spirometry to aid your diagnosis of chronic obstructive pulmonary disease?” This information can yield surprising results. For example, a literature review, interviews with leading physicians, and national surveys might uncover a need for education; however, physicians at a local level may already be performing according to current clinical guidelines. In this situation, your educational activity will reinforce knowledge.

Pre- and Post-Activity Evaluation

Case-based learning has been shown to be more effective than didactic formats at translating knowledge into practice, and it provides a direct measurement path between the adoption of new knowledge and self-reported practice performance. Consider designing activities to be interactive and case-based, detailing patient medical history at clinical presentation and following the patient through treatment and follow-up. Using the identified practice gap, work with faculty to develop case-based educational outcomes measurement, or EOM, questions that will evaluate changes in knowledge acquired in the activity, competence with the information, and ability to apply it to practice through the case studies. Compare pre- and post-activity data to evaluate improvements and set the stage for follow-up several months later to determine practice changes in an actual clinical setting.

Change: Intent Versus Actual

Use either EOM questions within the activity or activity evaluation forms to ask participants if they plan to make changes to their clinical practice as a result of participating in your CME activities. For example, “You indicated that you were planning to use spirometry in your office for patients with COPD; have you done so? If yes, have you seen any improvement in patient health outcomes? Please list them. If you answered, no, what barriers have prevented you from using spirometry in your clinical practice?” Using the same data gathered from your pre- and post-activity groups, follow up with participants several months after the activity to determine what changes (if any) they have made. Compare these data with data from physicians who registered but did not attend the activity, and evaluate whether or not there are statistically significant differences between the groups.

Then share your EOM data with the greater CME community or publish them to maximize transparency, including actual participation numbers and response percentages. With innovative thinking, all providers can develop activities that demonstrate change in performance or practice.

Ann C. Lichti, CCMEP, is the vice president of health care education strategy for Veritas Institute for Medical Education Inc. Reach her at

The opinions expressed are those of the author and do not constitute the views of Veritas Institute for Medical Education Inc.

More of Ann Lichti’s columns: Strategies for Demonstrating ROE

How CME Activities Can Address Disparities in Healthcare