analyzing the effectiveness of cme-vspence

Analyzing the Effectiveness of Continuing Medical Education

INDEPENDENT MEDICAL EDUCATION

VICTORIA SPENCE

HAMPTON UNIVERSITY SCHOOL OF PHARMACY

PHARM.D. CANDIDATE 2017

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ObjectivesTo understand the value of Independent Medical Education (IME)

and Continuing Medical Education (CME)

To understand the role of Moore's Level Outcomes in CME

To analyze studies reviewing the effectiveness of CME

To consider innovative methods in disseminating education

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Understanding CME and Patient Outcomes

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What is Independent Medical Education?Independent Medical Education (IME) strives to advance

healthcare by offering support to programs that provide medical education to health care providers (HCPs).

These educational activities align with Bristol-Myers Squibb disease states of interest in order to promote lifelong learning.

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1Bristol-Myers Squibb Company Knowledge Management. Independent Medical Education. https://sp.bms.com/sites/wwmcci/Pages/US-Knowledge-Management.aspx. Published 2011. Accessed July 15, 2016.

https://sp.bms.com/sites/wwmcci/Pages/US-Knowledge-Management.aspx

The Importance of Continuing Medical Education

Educating health care providers (HCPs) allows them to implement the most current clinical knowledge in everyday practice, directly improving patient health.

“Continuing Medical Education (CME) is crucial to the prosperity of health care providers—it allows a practitioner to learn and discover viable ways to improve on the patient care they deliver and effectively manage a career in the ever-changing landscape of the medical industry.”

Product promotion material from the supporter may not be utilized in any continuing education programs or activities.

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2Our History. Accreditation council for continuing medical education web site. http://www.accme.org/about-us/our-history. Published 2012. Accessed July 11, 2016. 3Accreditation Council for Continuing Medical Education. Standards for commercial support: Standards to ensure independence in CME activities. http://www.accme.org/requirements/accreditation-requirements-cme-providers/standards-for-commercial-support. Published 2012. Accessed July 15, 2016.

http://www.accme.org/about-us/our-history

http://www.accme.org/requirements/accreditation-requirements-cme-providers/standards-for-commercial-support Published 2012

Moore’s Level OutcomesLevel Outcome Definition

1 Participation The number of providers attending an activity

2 Satisfaction Providers degree to which expectations are met

3a3b

Learning: Declarative Learning: Procedural

Provider’s ability to state what was learnedProvider’s ability to state how to do the learned activity

4 Competence Provider’s ability to show how to perform the learned activity

5 Performance Provider’s implementation of knowledge in the practice setting

6 Patient Health Patients experience an improvement in health status

7 Community Patient population experiences an improvement in health status

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4Moore, D, Green, J., Gallis, H. Achieving Desired Results and Improved Outcomes: Integrating Planning and Assessment Throughout Learning Activities. JCEHP. Published Winter 2009; 29: 1 – 15. Accessed July 12, 2016.

HCP Performance Determines Patient Health Outcomes

Continuing Medical Education supports the notion that the more knowledge a health care provider obtains in their particular concentration, the more likely they will implement this knowledge in everyday practice. Implementing this newfound knowledge advertently leads to an improvement in health status for patients.

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CME activities educate HCPs

HCPs gain knowledge

Patients receive treatment based

on up-to-date information

Patients experience an

improvement in health

Measuring Patient OutcomesProcess Measures: evaluation of provider productivity and

adherence to standards of recommended care

Patient Experience Measures: evaluation of the delivery of care, such as communication

Patient-Reported Outcome Measures (PROM): a report of the status of a patient’s health condition that comes directly from the patient without interpretation from anyone else

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5Hostetter M & Klein S. Using patient reported outcomes to improve health care quality. The Commonwealth Fund: Quality Measures. http://www.commonwealthfund.org/publications/newsletters/quality-matters/2011/december-january-2012/in-focus Published January 2012. Accessed July 15 2016.

6Pace K. Patient-Reported outcomes in performance measures. National Quality Forum. http://www.qualityforum.org/Projects/n-r/Patient-Reported_Outcomes/Patient-Reported_Outcomes.aspx. Published 2012. Accessed July 15, 2016.

http://www.commonwealthfund.org/publications/newsletters/quality-matters/2011/december-january-2012/in-focus

http://www.qualityforum.org/Projects/n-r/Patient-Reported_Outcomes/Patient-Reported_Outcomes.aspx Published December 2012

What Motivates HCPs to Seek CME?

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Patients Forcing Physicians to Seek Knowledge

In a study of 512 patients completing a self-administered mailed study, approximately 53.5% reported internet usage when seeking medical information.

60% of respondents felt the information on the internet was “the same” or “better than” information from their doctors.

58% of respondents sought information on drug side effects or complications of medical therapy.

41% of respondents sought information to obtain second opinions about medical conditions.

60% of the patients who used the internet for medical information indicated they did not share this information with their physicians.

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7Diaz J et al. Patients' Use of the Internet for Medical Information. JGIM. 2002 Mar; 17(3): 180–185. doi: 10.1046/j.1525-1497.2002.10603.x

Implications for HCPsParticipating in continuing education activities is essential for

maintaining licensure, meeting the demands of patient inquiry, and lifelong learning.

Patients are now actively seeking medical knowledge and becoming more involved in the healthcare decision-making process.

In response to an increase in accessible information, HCP must stay well-informed on new data to proficiently communicate with patients.

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Effectiveness of CME

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The Impact of CME On Physician Performance and Patient Health Outcomes

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8Cervero, R. M. and Gaines, J. K. (2015), The Impact of CME on Physician Performance and Patient Health Outcomes: An Updated Synthesis of Systematic Reviews. J. Contin. Educ. Health Prof., 35: 131–138. doi: 10.1002/chp.2129

Study ObjectivesTo systematically review literature identifying if continuing medical

education improves physician performance and patient outcomes

To view the mechanisms of action that lead to positive patient outcomes

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Study Design: MethodsA review of various databases (MEDLINE, CINAHL, Academic Search Complete, and Education Research Complete) led to a compiled report of 8 articles that further reviewed the effectiveness of continuing medical education and corresponding patient health outcomes.

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Study Design: Inclusion CriteriaPrimary research studies in CME

Randomized controlled trials or quasi-experimented designs

Outcome measures consisted of physician performance and/or patient outcomes

Studies published after 2003

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ResultsStudy # of

StudiesGreatest Impact

Lowest Impact

Recommendation

Bloom BS. Effects of continuing medical education on improving physician clinical care and patient health. IJTAHC. 2005; 21(3):380-385.

26 Interactive Methods

Didactic Presentations & Printed Materials

"Relying on effective education techniques alone is insufficient [because] no single approach works best under all circumstances."

Davis D et al. Continuing medical education effect on practice performance. Chest.2009; 135

105 Live Media Print Materials

"Multiple exposure to CME is more effective than single exposure.”

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Results

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Study # of Studies

Greatest Impact

Lowest Impact

Recommendation

Forsetlund L et al. Continuing education meetings and workshops. Cochrane Database Syst Rev. 2009(2):CD003030

81 Interactive Methods

Didactic Presentations

"Further research should focus on direct comparisons of different types of [effective] education.”

Galbraith R et al. Continuing medical education effect on clinical outcomes. Chest. 2009;135(3 Suppl): 49S-55S.

37 Multimedia Print Materials

"Future research should articulate the casual linkages among CME physician performance, and clinical outcomes."


Results

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Study # of Studies

Greatest Impact

Lowest Impact

Recommendation

Mansouri M et al. A meta-analysis of continuing medical education effectiveness. J Contin Educ Health Prof. 2007;27(1):6-15.

31 Interactive Methods & Small Group/ Single Discipline

Conferences "The effect size of CME on physician knowledge is a medium one; however, the effect size is small for physician performance and patient outcomes."

Marinopoulos et al. Effectiveness of continuing education. Evid Rep Technol Assess (Full Rep). 2007(149):1-69.

136 Multimedia & Interactive Methods

Print Materials or Didactic Presentations

"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."


Results

Live Media12%

Interactive Methods50%

Multimedia25%

Small Group/Single Concentration

13%

Most Impactful CME

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Results

Didactic Presentations33%

Print Materials45%

Single Form of Media11%

Conferences11%

Least Impactful CME

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Discussion

CME demonstrates a weak link between physician performance and patient health outcomes.

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.

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StrengthsThe systematic review demonstrates the majority of studies (63%)

successfully address the question of whether CME is effective.

The studies cohesively agree further research is needed to determine the mechanisms by which CME improves patient health outcomes.

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LimitationsThe systematic reviews on CME effectiveness do not describe how

and when various types of CME will be effective.

CME impacts physician performance more positively than patient health outcomes.

There is the evident concern that continuing education may be negatively impacted by external factors (social, political, economic) of the institutions and providers that support them.

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Lessons for PracticeCME leads to greater improvement in physician performance and

patient outcomes if it is more interactive, uses more methods, involves multiple exposures, is longer, and is focused on outcomes that are considered important by physicians.

These strategies should be incorporated into instructional design models for planning CME in order to generate the desired impact of improved patient health outcomes.

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Tweeting the Meeting

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9Attai D, et al. Tweeting the meeting: twitter use at the American society of breast surgeons annual meeting 2013-2016. Published 27 April 2016. Accessed 13 July 2016. doi:10.3109/09540261.2014.1000270

Study ObjectivesTo analyze the usage of Twitter during The American Society of

Breast Surgeons (ASBrS) Annual Meetings from 2013 to 2016.

To determine if the implementation of Twitter would increase dissemination of effective medical content and encourage active participation in medical content.

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Study Design: MethodsA healthcare social media analytics platform, Symplur Signals was

used to register the Twitter hashtag #ASBrS to determine conference activity at the annual meetings.

The database generated information on total tweets, number of users, tweets per user, and impressions (tweets x number of followers).

Users were further categorized by physician, patient/caregiver advocate, or industry. The list of physician tweeters was cross-referenced with annual membership rosters and attendance records.

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Results

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887

6207

NUMBER OF TWEETS

2013 2016

107

589

NUMBER OF TWITTER USERS

2013 2016


Results

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3,500,000

20,500,000

IMPRESSIONS

2013 2016

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167

PHYSICIAN TWEETERS

2013 2016


Study Design: MethodsTwitter content was classified into the following categories:

Scientific: the content was related to a specific topic being discussed in a meeting session or was a discussion or commentary between users related to scientific meeting content

Social: the content contained general meeting or venue impressions, jokes, or other obvious social content

Administrative: content was used to alert attendees of particular meeting sessions

Industry Promotion: content was from vendors advertising their booth, product, or vendor-sponsored symposia

Irrelevant/Spam: content that was completely unrelated to the meeting content

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Results

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Scientific75%

Social18%

Administrative6%

Promotional2% Irrelevant

1%

Content Dissemination


DiscussionUsing Twitter during professional meetings offers an opportunity

to share information without requiring a significant financial investment.

Twitter can increase rapid exposure of important information during medical conferences and other educational activities.

The implementation of Twitter can promote active participation in disseminating medical information.

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StrengthsTwitter social media use at The American Society of Breast

Surgeons annual meeting showed a substantial increase during the time period evaluated.

The use of Twitter during professional meetings is a tremendous opportunity to share information.

The authors feel that medical conference organizers should encourage Twitter participation and should educate attendees on the proper use of Twitter.

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Limitations“Tweet Moderators” were used during sessions and shared the

stage with presenters. Questions were taken via twitter and displayed alongside presenters’ slides. This proved to be a distraction and was discontinued in 2016.

The dissemination of erroneous information, via Twitter, may have possessed a negative impact by compromising the publication of research findings.

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Lessons for PracticeActively engaging HCPs can lead to increased dissemination of

knowledge.

Twitter can be used in online communication of various topics, enhance patient education and support, and has potential to recruit participants in clinical trials.

The use of Twitter is a tremendous opportunity to share information and does not require a significant investment in dollars or organization resources.

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Implementing New Techniques

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Innovative ApplicationsUtilizing mobile apps for continuing education is a dynamic way to offer educational materials.

94% of HCPs use mobile applications to access medical information.

91% of HCPs are interested in using mobile apps to access electronic health records (EHR).

Mobile applications are beneficial tools for practitioners in rural communities.

Implementing mobile apps can serve as a more inexpensive method in obtaining CME credit.

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10Vitera Healthcare Solutions Study Indicates That the Majority of Healthcare Professionals Are Interested in a Mobile EHR Solution. Greenway Health. http://www.greenwayhealth.com/press-releases/vitera-news-archive/vitera-healthcare-solutions-study-indicates-majority-healthcare-professionals-interested-mobile-ehr-solution/ Published August 14, 2012. Accessed July 17 2016.

http://www.greenwayhealth.com/press-releases/vitera-news-archive/vitera-healthcare-solutions-study-indicates-majority-healthcare-professionals-interested-mobile-ehr-solution/

EpocratesClinical information app that offers 0.25 to 1.5 continuing educational

credit to a wide variety of HCPs (nurses, physicians, etc).

In-house clinicians offer content, causing the app to be utilized as a decision support tool.

The app currently offers education to one million HCPs in which 30% access content at least three times daily.

The app can be utilized free of charge.

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11Watson Z. Mobile Apps: The New Source for CME. UBM Medica. http://www.physicianspractice.com/blog/mobile-apps-new-source-cmePublished October 24, 2014. Accessed July 18, 2016.

http://www.physicianspractice.com/blog/mobile-apps-new-source-cme

QuantiaMDThis application focuses on the community aspect of medicine,

promoting open dialogue and debate amongst physicians.

Various learning methods include listening to lectures from other physicians, listening to recorded case studies from peers, voting on proper diagnoses and decisions, monthly case challenges, and quizzes.

The app can be utilized free of charge.

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QstreamThis application specifically emphasizes memory retention –a vital

concept that can lead to increased implementation in everyday practice.

Performance-based personalized quizzes, three to five minute quizzes on clinical scenarios, score and leader boards to encourage positive competition, and integrated blogs are offered to promote continuing education.

The application is offered in 17 languages, catering towards the shift of educating HCPs on global scale.

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Construction of CME

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RecommendationsIt is essential that more research is

conducted to determine the most effective CME methods that lead to improved patient health outcomes.

In order to enhance patient health outcomes, innovative methods must be used to actively engage HCPs.

Combining traditional CME with innovative techniques can lead to successfully reaching Moore’s higher level outcomes.

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Recommended CME Construction

Didactic Presentation/Print Materials

Online Assessment with Case Studies

Procedural Demonstration of Knowledge

Weekly Qstream activities

Annual CME Competitions based upon newfound knowledge

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QUESTIONS

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analyzing the effectiveness of cme-vspence

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