Online CME Participation by Gastroenterologists Improves Management of Exocrine Pancreatic Insufficiency

Abstract

Introduction: Management of exocrine pancreatic insufficiency (EPI) can be challenging for gastroenterologists. This study assessed the effect of online continuing medical education (CME) on clinical decision-making among participating gastroenterologists compared to non-participating matched peers. Methods: The American Gastroenterological Association Institute and Medscape, LLC identified performance gaps in management of EPI. An enduring online video-based CME expert roundtable discussion was hosted on Medscape from February 28th, 2013. Clinical case vignettes with assessment questions were administered to CME participants following the CME activity and final data for outcomes was collected by May 30th, 2013. A control group of non-participants that matched the participants' characteristics (e.g., specialty, number of EPI patients treated) was randomly selected and administered the same set of questions. The difference in responses to survey questions between the two groups were analyzed using chi-square tests (P < .05), and educational effect size was calculated using Cohen's d formula, which represented the degree of nonoverlap in answers between the CME participants and non-participants. Results: Gastroenterologist CME participants (n=100) were 37.2% more likely to make evidence-based practice choices than non-participants (n=100) (moderate educational effect size of d=0.58) in the following areas: - 28% more participants ordered a fecal elastase test to confirm EPI (75% participants vs 47% non-participants, P<0.001). - 12% more participants ruled out small bowel bacteria overgrowth in poor responders to enzyme replacement therapy (90% participants vs 78% non-participants, P=.02). - 16% more participants ordered a Vitamin D level for a patient with a history of diarrhea due to EPI (93% participants vs 77% non-participants, P=.002). - 12% more participants accurately counselled patients beginning EPI therapy (88% participants vs 76% non-participants, P=.03). - Most participants (88%) and non-participants (90%) recognized that efficacy of pancreatic enzyme supplementation is influenced by timing of consumption. Conclusion: CME participation in an online video roundtable discussion impacted clinical decisionmaking in gastroenterologists treating EPI, which may translate to improved outcomes in patients. Future education should focus on testing to confirm EPI and patient-clinician communication on treatment adherence and disease management.