Though it may still be in its infancy in this country, outcomes measurement for continuing medical education is gaining momentum. The Accreditation Council for Continuing Medical Education is nudging providers in that direction by requiring that a CME provider have a strong emphasis on the assessment of results in order to achieve exemplary compliance—i.e., a six-year accreditation. "The accreditation system’s direction has at its heart the notion of improvement," says Robert Kristofco, director, Division of CME, University of Alabama School of Medicine in Birmingham. "That may make a difference in getting a lot of people going. There’s still some question about what’s meant by ‘measurement’ in the accreditation system, but it’s a start."

But the real canary in the coal mine might be the Accreditation Council for Graduate Medical Education. This accreditor of graduate medical education programs is beginning to require outcomes measurement for residency training. While the program won’t be implemented in its entirety for several years, once these residents get out into the mainstream of healthcare, they’ll be demanding outcomes research as the norm for CME. "Just like those kids are expecting to use their laptops and PDAs in their practices, they’ll have a whole different expectation for CME," says Harry Gallis, MD, vice president for regional education with Carolinas HealthCare System, and director, Charlotte AHEC, Charlotte, N.C.

Another key factor in the emergence of outcomes measurement is the current push toward practice- and evidence-based medicine, which won’t cohabitate happily with the old "seats in seats" model of CME. "We’re just beginning to see the movement to integrate CME, quality improvement, and evidence-based medicine," says Nancy Davis, PhD, director, CME, with the American Academy of Family Physicians in Leawood, Kan. While some managed-care organizations already are measuring quality improvements in practice, they’re not yet linking it to CME. "If we can take the best of what the managed-care community is doing in quality improvement and link that into educational interventions using evidence-based clinical medicine, that’s going to be the key to really improving outcomes," she says.

How real is the movement toward integrating CME into quality improvement and practice-based medicine? The American Medical Association recently took the word "hours" out of its credit statement, and just earlier this year, AAFP took the word out of its statement as well. "We may not have figured out how it’s going to work yet, but we’re working toward a whole new metric for CME," says Davis. "Doing point-of-care learning, individual-focused activities, and QI projects in practice could add up to thousands of hours, so the old seat-time measurement isn’t going to work anymore."

Adds Kristofco, "The natural evolution of CME is toward looking at how measurable its outcomes are, how effective it can be, and the responsibility each of us has to contribute to the improvement of healthcare."

For more on outcomes, including how to get started, look for the March/April issue of Medical Meetings.