IF YOU'VE BEEN planning CME activities for any time at all, you have no doubt heard of linkage — linking needs to results, linking needs and results to learning objectives, and linking needs, results, and objectives to outcomes. It's at the core of exemplary performance in Accreditation Council for CME Essential Area 2, and it may surprise you to know that linkage actually produces better CME activities.

Step 1: Select Sources of Needs. See the chart below for an example of how to initially organize your needs assessment.

Step 2: Synthesize your needs. Boil down all of the needs you reviewed into just those that will be used to build your activity. Synthesize the final list into bulleted statements. You might end up with four to eight key needs. Write those bulleted needs down on paper.

Step 3: State a desired educational result. Take each of the bulleted needs and ask yourself, “What do I intend to achieve from this educational activity relative to that specific need?” This is a fundamental step that is frequently missing in the planning process. If you are able to make these “results statements,” you will immediately have an educational activity that is well-focused, and you should be able to measure its outcomes. By the way, the definition of exemplary performance in ACCME Element 2.1 (planning) is that you link identified need to desired result! With the example below, you will now have this all important documentation.

Identified need: The American Heart Association guidelines state that high levels of hyperlipidemia in patients with diabetic comorbidity is the cause of increased morbidity in those patients.

Desired result: Identify your diabetic patients; screen for hyperlipidemia; place on appropriate lipid lowering medication(s).

Step 4: Prepare learning objectives. Now that you know the need and desired result, you can prepare learning objectives that are written in terms of physician performance or patient health outcomes. Visualize learning objectives as the stepping stones that take you from the identified need to the desired educational result. Each set of need/results statements should have at least one learning objective. Consider writing your objectives in the second person (“you” or “your” phrases) so that the physician personally identifies with the objective. Here is an example of this next stage of linkage:

Objective: Decrease cardiovascular events of your diabetic patients with hyperlipidemia by improving their cholesterol profiles.

Step 5: Link Needs, Results, and Objectives to Outcomes. Always prepare your outcomes questions at the time of the planning process. Take each need/result statement and ask yourself what one question can be asked of learners about how they implemented change in their practice. In simple terms, the outcomes question may be the education results statement flipped into a question. Use this example as a guide:

Outcomes question: Have you implemented measures that would lower cholesterol for diabetic patients in your practice? If the answer is no, what barriers have prevented this from occurring?

Commercial supporters: Insist that CME providers observe these rules. This protects you by assuring that your vendors are fully complying with PhRMA and OIG rules, and ensures that you invest in outstanding education. One key is that the provider includes a line item in the budget for needs assessment and outcomes evaluation.

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Steven M. Passin is president of the CME consulting firm, Steve Passin & Associates in Newtown, Pa. He has also served as deputy health secretary for California. Contact him at Passin@PassinAssociates.com.

Types of Needs Assessments for Planning a CME Activity

Selected two or more sources of needs:

Expert Needs

• Planning committee

• Departmental chair

• Activity faculty

• Expert panels

• Peer-reviewed literature

• Research findings

• Required by a medical school authority

• Required by governmental authority/regulation/law

Participant Needs

• Previous related evaluation summary

• Focus panel discussions/interviews

• Needs assessment survey

• Other requests from physicians

• Requested by affiliated institutions or physician groups

Observed Needs

• Hospital/clinic quality assurance analysis

• Other clinical observances

• Mortality/morbidity data

• Epidemiological data

• National clinical guidelines (NIH, NCI, AHRQ, etc.)

• Specialty society guidelines

• Database analyses (e.g., Rx changes, diagnosis trends)

Environmental Scanning

• Evidence of offerings from other CME providers

• Lay press

• Direct-to-consumer ads

• Other societal trends