Nancy L. Bennett

Physician internet medical information seeking and on‐line continuing education use patterns

Introduction: Although physician Internet use patterns have been studied, little attention has been paid to how current physician learning and change theories relate to physician Internet information seeking and on‐line learning behaviors. The purpose of this study was to examine physician medical information–seeking behaviors and their relevance to continuing education (CE) providers who design and develop on‐line CE activities. Methods: A survey concerning Internet use and learning was administered by facsimile transmission to a random sample of 2,200 U.S. office‐based physicians of all specialties. Results: Nearly all physicians have access to the Internet, know how to use it, and access it for medical information; the Internets professional importance to physicians currently is in the area of professional development and information seeking to provide better care rather than for patient‐physician communication. A particular patient problem was the most common reason for seeking information. The credibility of the source, quick and 24‐hour access to information, and ease of searching were most important to physicians. Barriers to use included too much information to scan and too little specific information to respond to a defined question. Discussion: The importance of the Internet to physician professional development is growing rapidly. Access to on‐line continuing medical education must be immediate, relevant, credible, and easy to use. A sense of high utility demands content that is focused and well indexed. The roles of the CE provider must be reshaped to include helping physicians seek and construct the kind of knowledge they need to improve patient care.

Continuing Medical Education: A New Vision of the Professional Development of Physicians.

The authors describe their vision of what continuing medical education (CME) should become in the changing health care environment. They first discuss six types of literature (e.g., concerning learning and adult development principles, problem-based/practice-based learning, and other topics) that contribute to ways of thinking about and understanding CME. They then state their view that the Association of American Medical Colleges (AAMC) has made a commitment to helping CME be more effective in the professional development of physicians. In presenting their new vision of CME, the authors describe their interpretation of the nature and values of CME (e.g., optimal CME is highly self-directed; the selection and design of the most relevant CME is based on data from each physicians responsibilities and performance; etc.). They then present seven action steps, suggestions to begin them, and the institutions and organizations they believe should carry them out, and recommend that the AAMC play a major role in supporting activities to carry out these steps. (For example, one action step is the generation and application of new knowledge about how and why physicians learn, select best practices, and change their behaviors). Six core competencies for CME educators are defined. The authors conclude by stating that collaboration among the appropriate academic groups, professional associations, and health care institutions, with leadership from the AAMC, is essential to create the best learning systems for the professional development of physicians.

Family physicians' information seeking behaviors: A survey comparison with other specialties

BackgroundUsing technology to access clinical information has become a critical skill for family physicians. The aims of this study were to assess the way family physicians use the Internet to look for clinical information and how their patterns vary from those of specialists. Further, we sought a better understanding of how family physicians used just-in-time information in clinical practice.MethodsA fax survey was provided with 17 items. The survey instrument, adapted from two previous studies, was sent to community-based physicians. The questions measured frequency of use and importance of the Internet, palm computers, Internet CME, and email for information seeking and CME. Barriers to use were explored. Demographic data was gathered concerning gender, years since medical school graduation, practice location, practice type, and practice specialty.ResultsFamily physicians found the Internet to be useful and important as an information source. They were more likely to search for patient oriented material than were specialists who more often searched literature, journals and corresponded with colleagues. Hand held computers were used by almost half of family physicians.ConclusionFamily physicians consider the Internet important to the practice of medicine, and the majority use it regularly. Their searches differ from colleagues in other specialties with a focus on direct patient care questions. Almost half of family physicians use hand held computers, most often for drug reference.

A controlled trial of the effectiveness of internet continuing medical education

BackgroundThe internet has had a strong impact on how physicians access information and on the development of continuing medical education activities. Evaluation of the effectiveness of these activities has lagged behind their development.MethodsTo determine the effectiveness of a group of 48 internet continuing medical education (CME) activities, case vignette surveys were administered to US physicians immediately following participation, and to a representative control group of non-participant physicians. Responses to case vignettes were analyzed based on evidence presented in the content of CME activities. An effect size for each activity was calculated using Cohens d to determine the amount of difference between the two groups in the likelihood of making evidence-based clinical decisions, expressed as the percentage of non-overlap, between the two groups. Two formats were compared.ResultsIn a sample of 5621 US physicians, of the more than 100,000 physicians who participated in 48 internet CME activities, the average effect size was 0.75, an increased likelihood of 45% that participants were making choices in response to clinical case vignettes based on clinical evidence. This likelihood was higher in interactive case-based activities, 51% (effect size 0.89), than for text-based clinical updates, 40% (effect size 0.63). Effectiveness was also higher among primary care physicians than specialists.ConclusionPhysicians who participated in selected internet CME activities were more likely to make evidence-based clinical choices than non-participants in response to clinical case vignettes. Internet CME activities show promise in offering a searchable, credible, available on-demand, high-impact source of CME for physicians.

The Science of Continuing Medical Education: Terms, Tools, and Gaps: Effectiveness of Continuing Medical Education: American College of Chest Physicians Evidence-Based Educational Guidelines

BACKGROUND By its synthesis of a selected portion of the continuing medical education (CME) literature, the evidence-based practice center (EPC) review discovered several major issues in primary study design and in the systematic review process of CME studies. Through this process, the review speaks to the need for clarity in designing, reporting and synthesizing CME trials and provides an opportunity to advance the research agenda in this field. METHODS The evidence-based guideline (EBG) committee reviewed the methods section of the EPC report and these guidelines in detail, commenting on the search and review process and on the nature of the primary literature and the definitions used within it, comparing these to other published standardized measures. RESULTS Although the EBG committee noted much strength in the EPC review, limitations of the primary literature and the review methodology were identified and defined. These strengths and limitations hold implications for further research in this area. CONCLUSIONS Noting these limitations and in order to move the field forward, the EBG committee proposes a standard nomenclature of terms in common use in CME; a more rigorous process of searching, distilling, and synthesizing the primary literature in this area; and a common format on which to base the development and description of future trials of CME interventions.

Improving the physician-patient cardiovascular risk dialogue to improve statin adherence

BackgroundThe purpose of this study was to evaluate the effectiveness of a patient education program developed to facilitate statin adherence.MethodsA controlled trial was designed to test the effectiveness of a multifaceted patient education program to facilitate statin adherence. The program included a brief, in-office physician counseling kit followed by patient mailings. The primary end point was adherence to filling statin prescriptions during a 120-day period. Patients new to statins enrolled and completed a survey. Data from a national pharmacy claims database were used to track adherence.ResultsPatients new to statin therapy exposed to a patient counseling and education program achieved a 12.4 higher average number of statin prescription fill days and were 10% more likely to fill prescriptions for at least 120 days (p = .01).ConclusionBrief in-office counseling on cardiovascular risk followed by patient education mailings can be effective in increasing adherence. Physicians found a one-minute counseling tool and pocket guidelines useful in counseling patients.

Learning, Testing, and the Evaluation of Learning Environments in Medicine: Global Performance Assessment in Medical Education

Changes in the profession of medicine are creating the demand for a substantive reexamination of current practices in medical education. Many of the major issues in addressing this challenge are structural and political rather than scientific; here we address one critical scientific issue that will be important to (though not by itself adequate for) guiding such changes. The factor we address is the development of a global performance assessment: a standardized mechanism to assess individual skills and abilities that can be used to evaluate alternative educational interventions. We discuss the issues involved in developing such a system, and describe a set of principles for defining desired outcomes and developing assessment tools, including (a) wide clinical scope, (b) direct relationship to actual clinical performance, (c) reliability and repeatability, and (d) non-longitudinal measurement. We discuss the role of simulation, reflective practice, and portfolios of work in developing such a system, and argue that whatever form such metrics take, a system of global performance assessment will develop from close collaboration between clinicians and educators with innovative ways of thinking about performance and expertise.

A standardized approach to assessing physician expectations and perceptions of continuing medical education.

Introduction: Rapidly expanding science and mandates for maintaining credentials place increasing demands on continuing medical education (CME) activities to provide information that is current and relevant to patient care. Quality may be seen as the perceived level of service measured against consumer expectations. Standard tools have not been developed to determine how well CME activities meet consumer expectations. Methods: A widely used approach for evaluating perceptions of service quality in other fields, SERVQUAL, was adapted for CME by eliciting perspectives from physician consumers of CME and CME providers through nominal group techniques. These perspectives were used to develop a CMEQUAL evaluation survey instrument. Feasibility testing was conducted. Data were analyzed and items were tested for internal consistency. Results: CME participants were individuals willing to complete items related to expectations before participation and perceptions after participation in a CME activity. Of the CME activity participants who provided CMEQUAL rating data for the study, 43% rated their overall perceptions of the CME activity below their overall expectations. CME activities most clearly met participant expectations in providing fair and balanced evidence‐based content. Areas of lower priority for participants included opportunities for self‐assessment, solving cases, and interactive learning. Two areas highly valued by participants but not adequately addressed by CME activities were (1) translating trial data to patient seen in practice and (2) addressing barriers to optimal patient management. Discussion: Developing standards for evaluating physician perceptions of the quality of CME activities may assist CME providers in improving the effectiveness of CME activities in meeting physician learning needs.

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

BACKGROUND The Agency for Healthcare Research and Quality (AHRQ) Evidence Report identified and assessed audience characteristics (internal factors) and external factors that influence the effectiveness of continuing medical education (CME) in changing physician behavior. METHODS Thirteen studies examined a series of CME audience characteristics (internal factors), and six studies looked at external factors to reinforce the effects of CME in changing behavior. RESULTS With regard to CME audience characteristics, the 13 studies examined age, gender, practice setting, years in practice, specialty, foreign vs US medical graduate, country of practice, personal motivation, nonmonetary rewards and motivations, learning satisfaction, and knowledge enhancement. With regard to the external characteristics, the six studies looked at the role of regulation, state licensing boards, professional boards, hospital credentialing, external audits, monetary and financial rewards, academic advancement, provision of tools, public demand and expectations, and CME credit. No consistent findings were identified. CONCLUSIONS The AHRQ Evidence Report provides no conclusions about the ways that internal or external factors influence CME effectiveness in changing physician behavior. However, given what is known about how individuals approach learning, it is likely that internal factors play an important role in the design of effective CME. Regulatory and professional organizations are providing new structures, mandates, and recommendations for CME activities that influence the way CME providers design and present activities, supporting a role that is not yet clear for external factors. More research is needed to understand the impact of these factors in enhancing the effectiveness of CME.

The voices of evaluation

&NA; Evaluation in continuing medical education (CME) is a traditional part of planning but is often not approached with the same level of sophistication as other parts of the teaching/learning transaction. An understanding of the models and schema in the literature allows broader and more reasoned thinking about effective evaluation. This article briefly describes and compares several models and schema that are important to adult education and CME. The contributions of qualitative and quantitative evaluation approaches in CME point to the need for the field to create a new model to extend our current thinking.