Did you know that if you rotate your right foot clockwise and then try to draw the number six in the air with your right hand, your foot will reverse direction? There's nothing you can do about it — it just happens. For some reason, as I sat in the plenary session at the Alliance for CME Annual Conference in January, that little factoid popped into my head and wouldn't leave as R. Van Harrison, PhD, professor of medical education and director of CME with the University of Michigan Medical School, Ann Arbor, spoke about CME and systems theory. (See page 11 for more about the plenary.) While my foot is going about its business, my hand, bent on its own task, totally alters the course my foot takes — just like doctors who learn about a great new therapy in a CME activity, but won't prescribe it if their patients' insurance won't cover it. All of a sudden, they're going counterclockwise to your intended outcome.

Then you add in some of the other systems that may be in play: Say, the optimal drug may not be in that physician's organizational formulary. Or the patient saw another drug on TV and refuses to take the drug the doctor recommends. Or the drug is so expensive that the patient can't afford it. Or new research comes out two days after the activity that indicates another approach might be better. The disease itself may mutate, rendering the recommended therapy obsolete. And so on.

The barriers to getting healthcare workers to put what they learn to use — much less showing that it leads to healthier patients — are many, and the number of barriers increases with the complexity of the information the activity is trying to convey. It's not enough to identify a gap in knowledge when doing a needs assessment: CME providers ideally also should assess all these potential barriers to implementing a new practice and including ways to hurdle them, whenever possible, in the activity's objectives. And, of course, tracking the outcomes to identify what helps — and what hinders — participants once they take that nugget of information back to the real world.

Whatever it is that pushes them into using or not using what they learned may have nothing whatsoever to do with what you taught, and it may be completely out of the physician's hands as well. But forewarned is forearmed, and I would think it would increase an activity's effectiveness to at least be able to address some of the unexpected boons and barriers participants might face in trying to implement what they learned into their practices.

If that doesn't work, just talk to the hand.

Sue Pelletier,
(978) 448-0377,