2. Outcomes-Based CME National CPD Accreditation Meeting Dave Davis, MD Senior Director, Continuing Education & Performance Improvement

3. Thinking that lectures will change outcomes? Just plain dumb….

4. Outline You first: -Your objectives -Your challenges Me next: -One useful model of CME/CPD -Several Problems in CME & Ten minutes of research findings All of us…..Overcoming the problems: the first annual Canadian CPD Outcomes exercise Wrap-up

5. a useful model: a useful model: Nowlen’s Models of Continuing Education

6. CME problem #1: the perception thing

7. CME Problem 2: confusing dissemination with implementation Diffusion: distribution of information and the practitioners’ natural unaided adoption of policies and practices Dissemination: communication of information to clinicians to improve their skills Implementation: putting a guideline in place, involves effective communication, overcomes barriers by administrative and educational techniques (after Lomas)...

8. Problem #3: not paying attention to the research, especially mine Physicians and others not self-aware: objective needs assessment, performance feedback important Knowledge necessary but not sufficient for change; didactics lousy at changing performance What works? Interactivity; sequencing; predisposing, enabling and reinforcing strategies ‘ CME’ > conferences; = practice-based tools (reminders, audit-feedback, protocols & training) Docs pass through stages of learning: awareness, agreement, adoption to adherence ………… Cochrane reviews, AHRQ/EB reviews, others

9. Effective CME: what do the studies of CE say? The effect of interventions on performance and health care outcomes JAMA 1995;274:700-705 +PP refers the number of studies that showed positive effects Interv# refers to the number of studies with the particular interventions

10. Does formal CME work?: graphic representation of effect of variables (JAMA 1999; 282:867-874 ) Interv# refers to the number of studies with the particular interventions +PP refers the number of studies that showed positive effects

11. Another problem: no, or only self-assessment – e.g. regular rounds Teenage kids Golf game this aft… Diabetic ketoacidosis? patient on 5A Charts overdue Pre- eclampsia patient in ER

12. Applying the Research… Adapted from Straus et al, EBM 2005 Systematic reviews Studies Self/educational experiences Implementation tools

13. objective assessments, e.g., quality rounds… How could we do better? What’s the role of other team members in making this better? Our department's performance in XX management What’s the evidence? How do we compare with…?

14. NO, okay maybe a few, targeted didactic lectures

15. Putting it together: Pathman, PROCEED and a CME-based implementation planning guide Davis et al, BMJ, 2003 Methods/ Stages AwarenessAgreementAdoptionAdherence Predisposing Enabling Reinforcing

16. Warning: interaction ahead What’s the clinical problem? How do you KNOW it’s a problem? Evidence, Data What are the barriers to fixing it? How WOULD you fix it? - Awareness –Agreement –Adoption –Adherence –Accountability What Stakeholders will you need ‘at the table’ How will you know when it’s fixed? What metrics would you use? Other thoughts, ideas

17. More information More information: E-mail Web ddavis@aamc.org www.aamc.org/initiatives/cei www.mededportal.org