The crew that habituates the weekly #CMEChat Twitter hashtag on Wednesday mornings at 11 a.m. Eastern recently took a whack at the age-old question of whether or not CME works. While they did not necessarily come up with any definitive answers, some interesting discussion ensued nonetheless. (The full archive of the chat is available at the CME Advocate blog.)
They began by batting around what their initial responses are when they are asked whether CME works. Initial responses were terse—they just said, “yes,” and “sometimes.” Another qualified his answer: “I say that good CME can work.” Of course, they decided, it depends on what you mean by “works.” And how do you prove that it works?
Measurement is key to the second question, they seemed to agree. As one person said, “Unmeasured means we will never know.” Much better to be able to say, as one person did, “I have proof! We have follow-up data that shows our docs were able to make changes in practice.” While one person thought most providers have evidence that shows their CME’s effectiveness, another said he was “not sure we have moved the needle at all/enough to help folks have faith that this community has significant impact.”
Show Me the Evidence
The evidence you use to demonstrate the efficacy of medical education depends on the goal of the activity, said one chatter. “If the goal was to improve knowledge, and you have data that shows that...[it] works!” But, countered another, “if [one] person learned something but 29 didn't, did it work? if 30 learned something, but forgot it in [four weeks], did it work?” It did “If 30 learned something and forgot it in [four] weeks, but did something with it during the first week,” one person replied.
Another added that if CME is a way to bring awareness of the content to learners, then it should be recognized as effective. The hope then is that that awareness will bring about a change in practice. However, someone replied, “Knowledge is important—but isn't behavior change/improved patient care what we are ultimately looking for?”
“We all recognize the end goal of practice change, but [we have] to start somewhere. Sometimes [we] have to be happy with light-bulb moments,” said one person. But how to build on the light-bulb moment is a key question, as is how to talk about those light-bulb moments more broadly in the medical community.
You have to ground the evidence in the context for it to be meaningful, several agreed. It also needs to be more than a bar chart, said the moderator. “It needs a time component, [and] a planned objective piece.
CME’s Role in the Healthcare System
What is CME’s role in improving the overall quality of the healthcare system? “Even if we cannot (or shouldn't) measure performance and outcomes for every [program], shouldn't we be able to connect the dots” to explain the role of CME, asked the moderator. To which another person promptly countered, “Why shouldn't we measure performance for every program? Seriously.”
To quiet naysayers and definitely prove that CME works, there needs to be hardcore data showing that patient care improved as a direct result of CME, said one CMEChatter. “Not sure ‘connecting the dots’ is enough.” But if you can help hospitals and physician leaders connect the dots from that light-bulb going off to improvements in practice, you can help connect those dots. One example they bandied about was that of Ignaz Semmelwies, MD, who campaigned in the 1800s for the efficacy of hand-washing to reduce mortality rates—“It’s something concrete [that] people can latch onto.” However, there’s still the problem that the majority of CME is still too disconnected from the practice of medicine to be able to routinely measure impact, they said.
So if CME does work, and it does have a role in quality improvement, who should make CME’s case to Congress, the American Medical Association, the Association of American Medical Colleges, or the Institute for Healthcare Improvement? The diplomatic answer was that all stakeholders in the CME continuum should have a role in advocacy, though the leader of the Alliance for Continuing Education in the Health Professions was named as a logical choice for ringleader.
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CME's Future Depends on Being Able to Deliver Value
CME Is Improving Physician Performance to Improve Healthcare
