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Effectiveness of Continuing Medical Education
Evidence Reports/Technology Assessments, No. 149
Investigators: Spyridon S Marinopoulos, MD, MBA, Todd Dorman, MD, Neda Ratanawongsa, MD, Lisa M Wilson, ScM, Bimal H Ashar, MD, Jeffrey L Magaziner, MD, Redonda G Miller, MD, MBA, Patricia A Thomas, MD, Gregory P Prokopowicz, MD, Rehan Qayyum, MD, and Eric B Bass, MD, MPH.
Structured Abstract
Objective:
Despite the broad range of continuing medical education (CME) offerings aimed at educating practicing physicians through the provision of up-to-date clinical information, physicians commonly overuse, under-use, and misuse therapeutic and diagnostic interventions. It has been suggested that the ineffective nature of CME either accounts for the discrepancy between evidence and practice or at a minimum contributes to this gap. Understanding what CME tools and techniques are most effective in disseminating and retaining medical knowledge is critical to improving CME and thus diminishing the gap between evidence and practice. The purpose of this review was to comprehensively and systematically synthesize evidence regarding the effectiveness of CME and differing instructional designs in terms of knowledge, attitudes, skills, practice behavior, and clinical practice outcomes.
Methods:
We formulated specific questions with input from external experts and representatives of the Agency for Healthcare Research and Quality (AHRQ) and the American College of Chest Physicians (ACCP) which nominated this topic. We systematically searched the literature using specific eligibility criteria, hand searching of selected journals, and electronic databases including: MEDLINE®, EMBASE®, the Cochrane Database of Systematic Reviews, The Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Abstracts of Reviews of Effects (DARE), PsycINFO, and the Educational Resource Information Center (ERIC®). Two independent reviewers conducted title scans, abstract reviews, and then full article reviews to identify eligible articles. Each eligible article underwent double review for data abstraction and assessment of study quality.
Results:
Of the 68,000 citations identified by literature searching, 136 articles and 9 systematic reviews ultimately met our eligibility criteria. The overall quality of the literature was low and consequently firm conclusions were not possible. Despite this, the literature overall supported the concept that CME was effective, at least to some degree, in achieving and maintaining the objectives studied, including knowledge (22 of 28 studies), attitudes (22 of 26), skills (12 of 15), practice behavior (61 of 105), and clinical practice outcomes (14 of 33). Common themes included that live media was more effective than print, multimedia was more effective than single media interventions, and multiple exposures were more effective than a single exposure. The number of articles that addressed internal and/or external characteristics of CME activities was too small and the studies too heterogeneous to determine if any of these are crucial for CME success. Evidence was limited on the reliability and validity of the tools that have been used to assess CME effectiveness. Based on previous reviews, the evidence indicates that simulation methods in medical education are effective in the dissemination of psychomotor and procedural skills.
Conclusion:
Despite the low quality of the evidence, CME appears to be effective at the acquisition and retention of knowledge, attitudes, skills, behaviors and clinical outcomes. More research is needed to determine with any degree of certainty which types of media, techniques, and exposure volumes as well as what internal and external audience characteristics are associated with improvements in outcomes.
Contents
- Preface
- Acknowledgments
- Executive Summary
- 1. Introduction
- 2. Methods
- 3. Results
- Results of Review of Primary Literature
- Results of Review of Systematic Reviews
- Summary of Study Characteristics and Evaluation Methods
- Summary of Study Participants and Study Setting
- Summary of CME Activity Characteristics
- Study Quality of Primary Literature
- Quality of the Systematic Reviews
- Reporting of Adult Learning Principles
- Key Question 1: Is there evidence that particular methods of delivering CME are more effective in: a) imparting knowledge to physicians, b) changing physician attitudes, c) acquiring skills, d) changing physician practice behavior, or e) changing clinical practice outcomes?
- Key Question 2: Do changes in knowledge, attitudes, skills, practice behavior, or clinical practice outcomes produced by CME persist over time (greater than or equal to 30 days)?
- Key Question 3: What is the evidence from systematic reviews about the effectiveness of simulation methods in medical education outside of CME?
- Key Question 4: Which characteristics of the audience by themselves or in combination with other characteristics influence the effectiveness of certain educational techniques?
- Key Question 5: Which external factors by themselves or in combination with other factors reinforce the effects of CME in changing behavior?
- Key Question 6: What is the reported validity and reliability of the methods that have been used for measuring the effects of CME in terms of a) imparting knowledge, b) changing attitudes, c) acquiring skills, d) changing practice behavior, or e) changing clinical practice outcomes?
- 4. Discussion
- List of Acronyms/Abbreviations
- Appendixes
- References
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-02-0018. Prepared by: The Johns Hopkins University, Evidence-based Practice Center, Baltimore, MD.
Suggested citation:
Marinopoulos SS, Dorman T, Ratanawongsa N, Wilson LM, Ashar BH, Magaziner JL, Miller RG, Thomas PA, Prokopowicz GP, Qayyum R, Bass EB. Effectiveness of Continuing Medical Education. Evidence Report/Technology Assessment No. 149 (Prepared by the Johns Hopkins Evidence-based Practice Center, under Contract No. 290-02-0018.) AHRQ Publication No. 07-E006. Rockville, MD: Agency for Healthcare Research and Quality January 2007.
This report is based on research conducted by the Johns Hopkins University Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0018). The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.
This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in this report.
- 1
540 Gaither Road, Rockville, MD 20850. www
.ahrq.gov
- Continuing medical education effect on physician knowledge: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.[Chest. 2009]Continuing medical education effect on physician knowledge: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.Bordage G, Carlin B, Mazmanian PE, American College of Chest Physicians Health and Science Policy Committee. Chest. 2009 Mar; 135(3 Suppl):29S-36S.
- Review Continuing medical education effect on physician knowledge application and psychomotor skills: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.[Chest. 2009]Review Continuing medical education effect on physician knowledge application and psychomotor skills: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.O'Neil KM, Addrizzo-Harris DJ, American College of Chest Physicians Health and Science Policy Committee. Chest. 2009 Mar; 135(3 Suppl):37S-41S.
- Review Continuing medical education effect on practice performance: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.[Chest. 2009]Review Continuing medical education effect on practice performance: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.Davis D, Galbraith R, American College of Chest Physicians Health and Science Policy Committee. Chest. 2009 Mar; 135(3 Suppl):42S-48S.
- Review The role of audience characteristics and external factors in continuing medical education and physician change: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.[Chest. 2009]Review The role of audience characteristics and external factors in continuing medical education and physician change: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.Lowe MM, Bennett N, Aparicio A, American College of Chest Physicians Health and Science Policy Committee. Chest. 2009 Mar; 135(3 Suppl):56S-61S.
- Review Lessons for continuing medical education from simulation research in undergraduate and graduate medical education: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.[Chest. 2009]Review Lessons for continuing medical education from simulation research in undergraduate and graduate medical education: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.McGaghie WC, Siddall VJ, Mazmanian PE, Myers J, American College of Chest Physicians Health and Science Policy Committee. Chest. 2009 Mar; 135(3 Suppl):62S-68S.
- Effectiveness of Continuing Medical EducationEffectiveness of Continuing Medical Education
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