How effective is CME at changing physician behavior? This question has taken on new urgency with the Accreditation Council for CME's updated accreditation criteria, which tasks providers with “addressing issues that prevent [physicians] from implementing what our activities teach them to do” (criterion 19). When physicians say their behavior will change as a result of education, how many of us go back to see if they made those changes or, even more important, to learn why the changes were not made?
One of the physician-reported barriers to implementation is that stand-alone activities do not provide them with adequate information to warrant behavior change — especially when an activity introduces novel treatment and management strategies.
Furthermore, while there are data to support the use of just about every format, method, and media selection used in CME activities today, they are not equally effective for all audiences. When asked, physicians will indicate a preference for live education, but their choices for enduring materials are diverse, depending on subject matter.
How can providers develop the right intervention, at the best time, for the appropriate audience, in the optimal setting? One approach is to seek funding for a series of linked activities or an initiative using a variety of formats and covering complementary topics. On evaluation forms, in addition to asking participants about what topics they're interested in, inquire about their learning-style preferences. Ask them how they want to learn about particular topics and what kind of follow-up activities they prefer. This way, you can offer physicians a choice of formats and topics — customized CME.
The success of initiatives will also depend on your ability to get participants to make the connection between activities. Here are some suggestions:
Remind physicians about each previous activity in subsequent interventions and make them aware of future activities.
Incorporate patient resource materials or clinician diagnostic tools to enhance each activity, to increase physician awareness, and to provide motivation for them to change their practice behavior.
Schedule linked activities fairly closely together in time to maintain participants' interest.
To reinforce learning, activities in a series should be designed with an appropriate difficulty level and should address subject matter in a manner that enhances retention. For instance, consider a series of on-demand activities as a follow-up. Highlight the information that physicians need to have reinforced. Integrate methods such as case vignettes to engage your audience.
Here are follow-up strategies you can use to determine whether the activity was effective.
Convene small focus groups of participants or provide a detailed survey two months afterwards.
Ask participants clinical questions to ascertain whether or not they have retained the new information.
If you discover that there has been a significant decrease in participants' knowledge retention, find out the reasons why.
Although environmental and/or economic factors are obstacles beyond providers' control, we can adapt our CME to reflect physicians' learning preferences, so that we develop activities that make a lasting difference in physician practice.
Ann C. Lichti, assistant CME director, Veritas Institute for Medical Education Inc., in Hasbrouck Heights, N.J., has four years' CE experience. Reach her at email@example.com. Harold I. Magazine, PhD, president, Veritas Institute for Medical Education Inc., has 18 years of combined experience in academic research, publications, and medical education. Contact him at firstname.lastname@example.org. The opinions expressed are those of the authors and do not constitute the views of Veritas Institute for Medical Education Inc.