Julie K. Gaines

The Impact of CME on Physician Performance and Patient Health Outcomes: An Updated Synthesis of Systematic Reviews

Introduction: Since 1977, many systematic reviews have asked 2 fundamental questions: (1) Does CME improve physician performance and patient health outcomes? and (2) What are the mechanisms of action that lead to positive changes in these outcomes? The articles purpose is to synthesize the systematic review literature about CME effectiveness published since 2003. Methods: We identified 8 systematic reviews of CME effectiveness published since 2003 in which primary research studies in CME were reviewed and physicians’ performance and/or patient health outcomes were included as outcome measures. Results: Five systematic reviews addressed the question of “Is CME Effective?” using primary studies employing randomized controlled trials (RCTs) or experimental design methods and concluded: (1) CME does improve physician performance and patient health outcomes, and (2) CME has a more reliably positive impact on physician performance than on patient health outcomes. The 8 systematic reviews support previous research showing CME activities that are more interactive, use more methods, involve multiple exposures, are longer, and are focused on outcomes that are considered important by physicians lead to more positive outcomes. Discussion: Future research on CME effectiveness must take account of the wider social, political, and organizational factors that play a role in physician performance and patient health outcomes. We now have 39 systematic reviews that present an evidence‐based approach to designing CME that is more likely to improve physician performance and patient health outcomes. These insights from the scientific study of CME effectiveness should be incorporated in ongoing efforts to reform systems of CME and health care delivery.

Real-time use of the iPad by third-year medical students for clinical decision support and learning: a mixed methods study

Purpose Despite widespread use of mobile technology in medical education, medical students’ use of mobile technology for clinical decision support and learning is not well understood. Three key questions were explored in this extensive mixed methods study: 1) how medical students used mobile technology in the care of patients, 2) the mobile applications (apps) used and 3) how expertise and time spent changed overtime. Methods This year-long (July 2012–June 2013) mixed methods study explored the use of the iPad, using four data collection instruments: 1) beginning and end-of-year questionnaires, 2) iPad usage logs, 3) weekly rounding observations, and 4) weekly medical student interviews. Descriptive statistics were generated for the questionnaires and apps reported in the usage logs. The iPad usage logs, observation logs, and weekly interviews were analyzed via inductive thematic analysis. Results Students predominantly used mobile technology to obtain real-time patient data via the electronic health record (EHR), to access medical knowledge resources for learning, and to inform patient care. The top four apps used were Epocrates®, PDF Expert®, VisualDx®, and Micromedex®. The majority of students indicated that their use (71%) and expertise (75%) using mobile technology grew overtime. Conclusions This mixed methods study provides substantial evidence that medical students used mobile technology for clinical decision support and learning. Integrating its use into the medical students daily workflow was essential for achieving these outcomes. Developing expertise in using mobile technology and various apps was critical for effective and efficient support of real-time clinical decisions.

Medical education scholarship: an introductory guide: AMEE Guide No. 89.

Abstract This AMEE Guide provides an overview of medical education scholarship for early career scholars, based upon a summary of the existing literature and pragmatic advice derived from the experience of its authors. After providing an introduction to the principles of scholarship and describing questions that the Guide addresses, the authors offer a conceptual description of the complementary traditions of teaching and educational discovery, and advocate for the development of educational scholars with both traditions. They then describe the attributes of effective mentor–mentee relationships and how early career scholars can identify potential mentors who can fulfill this role. In the subsequent sections, they describe the appropriate development of scholarly questions and other components of a complete scholarly plan, including how to use conceptual frameworks in guiding such plans. From here, they describe methods that align with both the teaching and discovery traditions and provide concrete examples of each. They then provide guidelines for assessing the impact of scholarship, identify the various opportunities for sharing it, and how to effectively interpret and describe it. Additionally, they provide practical advice on how appropriately to demonstrate the scholarship in a promotional packet, including the principle of reflectivity in scholarship. Finally, they address the principles of applied research ethics for educational scholarship and when to consider soliciting approval for scholarly activities by a human research board.

Adapting an Embedded Model of Librarianship, College by College

Librarians are increasingly moving out of the library and into the wider university setting as patrons spend more time seeking information online and less time visiting the library. The move to embed librarians in colleges, departments, or customer groups has been going on for some time but has recently received more attention as libraries work to find new ways to reach patrons that no longer need to come to the physical library. Few universities have attempted to embed all their librarians. This case study describes how one group of health sciences librarians dispersed its professional staff throughout its campuses and medical centers.

New "starting points" for resources by subject.

The objective of the Starting Points Web page series at The University of Texas Health Science Center at San Antonio (UT HSC) Libraries is to provide specialized information resources in an organized online format. Highlighted resources include databases, journals, UT HSC campus information, funding sources, PubMed® RSS article feeds, and information about professional associations. This paper discusses the development process, planning, challenges, and outcomes of the Starting Points series.

Partnering to Analyze Selection of Resources by Medical Students for Case-Based Small Group Learning: A Collaboration between Librarians and Medical Educators

Abstract Librarians and medical educators analyzed the quality of information resources used by first- and second-year medical students in their case-based small group learning summaries. Librarians provided instruction on using library resources and gave formal feedback to students about appropriate resources for basic science and clinical questions. The team found that students used a high number of clinical and basic science journal articles and textbooks with a number of factors influencing their resource choices. The study demonstrates numerous areas where librarians can play a key role in assisting students to find and assess information to answer clinical questions.