Creating a new paradigm for CME: Seizing opportunities within the health care revolution

Moore, Donald E.; Green, Joseph S.; Jay, Stephen J.; Leist, James C.; Maitland, Frances M.

doi:10.1002/chp.4750140102

Cited by 59 publications

(23 citation statements)

References 59 publications

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“…Finally, designers of continuing medical education programs should consider innovative ways to positively reinforce change that leads to better health care for patients and communities. 25,26 Although it is disappointing that we did not find large increases in breast cancer screening as a result of the intervention, we believe there are reasons to be encouraged about this type of intervention in the future. We are very encouraged by our finding that community primary care physicians, medical schools, and professional societies can work together to improve the quality of health care.…”

Section: Discussionmentioning

confidence: 89%

“…25,26 Although some volunteer practices may be enthusiastic enough to make substantial changes with assistance, change for many medical practices, like change for individuals, comes slowly and with difficulty. Providing the type of assistance practices really need may take considerable time as practices work through the process of change; it may take discussions of attitudes and knowledge of populations and systems as opposed to only technical medical matters; it may take finding ways for networks of practices to support one another as they change; it may take assistance in using computers in ways other than for billing; 27,28 it may take helping practices learn the basics of continuous quality improvement; and it may take identifying and supporting leaders within practices.…”

Section: Discussionmentioning

confidence: 99%

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Using an office system intervention to increase breast cancer screening

et al. 1998

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OBJECTIVE:To evaluate an innovative approach to continuing medical education, an outreach intervention designed to improve performance rates of breast cancer screening through implementation of office systems in community primary care practices. DESIGN:Randomized, controlled trial with primary care practices assigned to either the intervention group or control group, with the practice as the unit of analysis. SETTING:Twenty mostly rural counties in North Carolina. PARTICIPANTS:Physicians and staff of 62 randomly selected family medicine and general internal medicine practices, primarily fee-for-service, half group practices and half solo practitioners. INTERVENTION:Physician investigators and facilitators met with practice physicians and staff over a period of 12 to 18 months to provide feedback on breast cancer screening performance, and to assist these primary care practices in developing office systems tailored to increase breast cancer screening. MEASUREMENTS AND MAIN RESULTS:Physician questionnaires were obtained at baseline and follow-up to assess the presence of five indicators of an office system. Three of the five indicators of office systems increased significantly more in intervention practices than in control practices, but the mean number of indicators in intervention practices at followup was only 2.8 out of 5. Cross-sectional reviews of randomly chosen medical records of eligible women patients aged 50 years and over were done at baseline ( n ‫؍‬ 2,887) and followup ( n ‫؍‬ 2,874) to determine whether clinical breast examinations and mammography, were performed. Results for mammography were recorded in two ways, mention of the test in the visit note and actual report of the test in the medical record. These reviews showed an increase from 39% to 51% in mention of mammography in intervention practices, compared with an increase from 41% to 44% in control practices ( p ‫؍‬ .01). There was no significant difference, however, between the two groups in change in mammograms reported (intervention group increased from 28% to 32.7%; control group increased from 30.6% to 34.0%, p ‫؍‬ .56). There was a nonsignificant trend ( p ‫؍‬ .06) toward a greater increase in performance of clinical breast examination in intervention versus control practices. CONCLUSIONS:A moderately intensive outreach intervention to increase rates of breast cancer screening through the development of office systems was modestly successful in increasing indicators of office systems and in documenting mention of mammography, but had little impact on actual performance of breast cancer screening. At follow-up, few practices had a complete office system for breast cancer screening. Outreach approaches to assist primary care practices implement office systems are promising but need further development.KEY WORDS: breast cancer screening; office systems; continuing medical education; clinical breast examination; mammography. J GEN INTERN MED 1998;13:507-514. D espite much attention over the past 10 years, rates of breast cancer screening (t...

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Using an office system intervention to increase breast cancer screening

et al. 1998

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“…We need not to reform but to transform medical education, including continuing education. 14,15 We need a new mind-set. 16 A failure to meet the challenge and a lack of a response to the technological and educational trends will alienate the future generation of physicians and the public who have come to expect such an approach.…”

Section: International Virtual Medical Schoolmentioning

confidence: 99%

A new vision for distance learning and continuing medical education

Harden

2005

Journal of Continuing Education in the Health Professions

107

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Increasing demands on continuing medical education (CME) are taking place at a time of significant developments in educational thinking and new learning technologies. Such developments allow today's CME providers to better meet the CRISIS criteria for effective continuing education: convenience, relevance, individualization, self-assessment, independent learning, and a systematic approach. The International Virtual Medical School (IVIMEDS) provides a case study that illustrates how rapid growth of the Internet and e-learning can alter undergraduate education and has the potential to alter the nature of CME. Key components are a bank of reusable learning objects, a virtual practice with virtual patients, a learning-outcomes framework, and self-assessment instruments. Learning is facilitated by a curriculum map, guided-learning resources, "ask-the-expert" opportunities, and collaborative or peer-to-peer learning. The educational philosophy is "just-for-you" learning (learning customized to the content, educational strategy, and distribution needs of the individual physician) and "just-in-time" learning (learning resources available to physicians when they are required). Implications of the new learning technologies are profound. E-learning provides a bridge between the cutting edge of education and training and outdated procedures embedded in institutions and professional organizations. There are important implications, too, for globalization in medical education, for multiprofessional education, and for the continuum of education from undergraduate to postgraduate and continuing education.

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“…Walsh proposed five levels for judging the value of CME: the number of participants; the degree of their satisfaction; the extent to which participants achieve activity objectives or measured increase in competence related to objectives; the degree of translation of new competence into performance of their duties; and the extent to which performance contributes to desired outcomes. 39,40 Further efforts should be made toward capitalizing upon levels four and five. Moore's outcome framework -which outlines seven levels of learner outcomes as participation, satisfaction, learning, competence, performance, patient health, and community health -provides an additional source of measuring the impact of CE programming.…”

Section: Implications For Ce Providers and The Academymentioning

confidence: 99%