Redesigning Continuing Education in the Health Professions (2010) / Chapter Skim
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2 Scientific Foundations of Continuing Education
2 Scientific Foundations of Continuing Education
Pages 29-54
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From page 29... ...
. To support this objective, states in the 1970s began to mandate that health professionals receive continuing education (CE)
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From page 30... ...
As discussed in Chapter 1, the IOM report Health Professions Education: A Bridge to Quality (2003) details five core competencies deemed necessary for all health professionals: patient-centered care, interdisciplinary team-based care, evidence-based practice, quality improvement strategies, and the use of health informatics.
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account for 44.1 percent of total reported activities conducted by providers accredited by the Accreditation Council for Continuing Medical Education (ACCME) and 88.1 percent of total activities presented by providers accredited by state medical societies (ACCME, 2008)
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275,00 0 32 250,0 00 225,000 Hours of Instruction by ACCME 200,0 00 Accredited Providers 175,00 0 Hours of Instruction by State Medical Societ y-Accredited 150,0 00 Providers Hours 125,00 0 10 0,0 00 75,0 00 50,0 00 25,00 0 0 CME Other (Live) Writing Review Journal Internet Internet Internet Courses Learning Enduring Teaching Materials Test Item Regularly (Enduring Materials)
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From page 33... ...
Data on the use of these approaches are not always available. For example, the rate at which health professionals participate in self-directed learning is not available from CE providers or accreditors because in most health professions, CE credits -- the metric for CE activities -- cannot currently be earned for participation in self-directed learning.
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From page 34... ...
Academic detailing Outreach in which health professionals are visited by another knowledgeable professional to discuss practice issues Simulation The act of imitating a situation or a process through something analogous. Examples include using an actor to play a patient, a computerized mannequin to imitate the behavior of a patient, a computer program to imitate a case scenario, and an animation to mimic the spread of an infectious disease in a population Reminders Paper or computer-generated prompts about issues of prevention, diagnosis, or management delivered at the time of care and point-of-care Protocols and A set of rules generated by piecing together guidelines research-based evidence in the medical literature, representing the optimal approaches to managing a medical disease Audit/feedback Health care performance is measured and the results are presented to the professional Multifaceted methods Comprehensive programs designed to improve health professional performance or health care outcomes using a variety of methods Educational materials Publications or mailings of written recommendations for clinical care, including guidelines and educational computer programs Opinion leaders Individuals recognized by their own community as clinical experts with well-developed interpersonal skills Patient-mediated Techniques that increase the education of patients strategies and health consumers (e.g., health promotion media campaigns, directed prompts)
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From page 35... ...
The science of measuring outcomes is advancing beyond measuring procedural knowledge as researchers have come to focus on linking CE to patient care and population health (Miller, 1990; Moore et al., 2009; Tian et al., 2007)
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(2009) Description Participation The number of health professionals who participated in the CME activity Satisfaction The degree to which the expectations of the participants about the setting and delivery of the CME activity were met Knows Learning: Declarative The degree to which participants knowledge are able to state what the CE activity intended them to know Knows how Learning: Procedural The degree to which participants knowledge are able to state how to do what the CE activity intended them to know how to do Shows how Competence The degree to which participants show in an educational setting how to do what the CE activity intended them to be able to do Does Performance The degree to which participants do in their practices what the CE activity intended them to be able to do Patient health The degree to which the health status of patients improves due to changes in the practice behavior of participants Community health The degree to which the health status of a community of patients changes due to changes in the practice behavior of participants SOURCE: Adapted from Moore et al., 2009.
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From page 37... ...
. In the absence of data on patient outcomes, health professionals' self-reported knowledge gains and behavior change resulting from participation in a CE activity may provide insight into learning.
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. Studies from a variety of health professions were included.
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From page 39... ...
Fourteen studies used the prescribing process to determine changes in prescription trends that may have resulted from a health professional's participation in a CE activity. Overall Effectiveness of CE Although CE research is fragmented and may focus too heavily on learning outside of clinical settings, there is evidence that CE works, in some cases, to improve clinical practice and patient outcomes.
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From page 40... ...
Methods that included multiple expo sures to activities tend to produce more positive results than onetime methods, a finding aligned with previous studies indicating that health professionals are more likely to apply what they have learned in practice if they participate in multiple learning activities on a single topic (Davis and Galbraith, 2009; Davis et al., 1992, 1995; Mansouri and Lockyer, 2007; Marinopoulos et al., 2007; Mazmanian et al., 2009)
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From page 41... ...
The design of CE activities should be guided by theoretical insights into how learning occurs and what makes the application of new knowledge more likely. Insights can be drawn from the literature of several academic disciplines, including adult education, sociology, psychology, knowledge translation, organizational change, engineering, and systems learning (Bennett et al., 2000)
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. This approach to learning, in which health professionals continually engage in learning for their own personal goals, is in contrast to simply participating in formal CE for the purposes of receiving credit (King and Kitchener, 1994)
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. Learning experiences are construed by health professionals in light of previous experiences and influences from other professionals and with regard to wider social processes.
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. Self-directed learning offers opportunities for health professionals to assess their previous experiences and existing knowledge and then set learning goals, locate resources, decide on which learning methods to use, and evaluate processes (Brookfield, 1995)
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. Teachable moments, which are also referred to as clinical questions, are essential to health professionals' learning (Moore and Pennington, 2003)
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The committee determined that effective CE activities have the following features: • ncorporate needs assessments to ensure that the activity is I controlled by and meets the needs of health professionals; • e interactive (e.g., group reflection, opportunities to practice B behaviors) ; • mploy ongoing feedback to engage health professionals in E the learning process; • se multiple methods of learning and provide adequate time U to digest and incorporate knowledge; and • Simulate the clinical setting.
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From page 47... ...
There also is evidence that health professionals often need multiple learning opportunities and multiple methods of edu cation, such as practicing self-reflection in the workplace, reading journal articles that report new clinical evidence, and participating in formal CE lectures, if they are to most effectively change their performance and, in turn, improve patient outcomes. The evidence is also strong, however, that continuing education is too often disconnected from theories of how adults learn and from the actual delivery of patient care.
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From page 48... ...
CE providers have little evidence base for adopting proven and innovative methods of CE, and health professionals do not have a dependable basis for choosing one CE method over another. • efine CE outcome measures.
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1977. The evaluation of continuing medical education: A literature review.
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1999. Impact of formal continuing medical education: Do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes?
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Journal of Continuing Education in the Health Professions 22(4)
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In Continuing education in the health professions: Improing healthcare through lifelong learning. Edited by M
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1997. Effectiveness of commitment contracts in facilitating change in continuing medical education intervention.
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2007. A systematic review of evalu ation in formal continuing medical education.
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