CME Providers Research Articles

CME providers’ experiences and practices in Pakistan: a case study

BackgroundPakistan has made numerous attempts to establish and implement a national mandatory CME program which currently do not exist. The purpose of this study is to explore the views of major CME providers in order to identify possible strengths and weaknesses in the current program, and offer evidence-based recommendations to help further enhance the national CME program in Pakistan.MethodsAn exploratory study design using a case study approach through in depth interviews was conducted to examine CME providers’ experiences and perceptions. The study was conducted in Pakistan between August and November 2019 with CME providers from Sindh, Punjab, the North-West Frontier Province, and the Federal Capital Territory. Thirty-six providers recognised by the Pakistan Medical and Dental Council who were involved in providing CME activities at the national level and whose contact information was publicly available on their websites, were selected for the study. Of the 36 providers invited, 22 participated in this study.ResultsThe results generated several organising themes grouped into three major themes: (1) CME current practices, (2) CME past experiences, and (3) Future developments.ConclusionParticipants recommended needs-based educational activities for physicians, a well-structured central regulatory CME body collaborating with existing providers, involving experienced providers for rural CME, accrediting diverse local providers, limiting commercial entities’ role, and implementing CME with proper preparation and a phased approach.

Multistakeholder perspectives on the strengthening and embedding of mandatory continuing medical education in Georgia: a qualitative study

ObjectiveContinuing medical education (CME) is a vital component of health systems. Setting up a CME system is a complex task, requiring involvement of stakeholders including educators, learners, institutions and policy...

Barriers to identifying and obtaining CME: a national survey of physicians, nurse practitioners and physician assistants

BackgroundCPD educators and CME providers would benefit from further insight regarding barriers and supports in obtaining CME, including sources of information about CME. To address this gap, we sought to explore challenges that clinicians encounter as they seek CME, and time and monetary support allotted for CME.MethodsIn August 2018, we surveyed licensed US clinicians (physicians, nurse practitioners, and physician assistants), sampling 100 respondents each of family medicine physicians, internal medicine and hospitalist physicians, medicine specialist physicians, nurse practitioners, and physician assistants (1895 invited, 500 [26.3%] responded). The Internet-based questionnaire addressed barriers to obtaining CME, sources of CME information, and time and monetary support for CME.ResultsThe most often-selected barriers were expense (338/500 [68%]) and travel time (N = 286 [57%]). The source of information about CME activities most commonly selected was online search (N = 348 [70%]). Direct email, professional associations, direct mail, and journals were also each selected by > 50% of respondents. Most respondents reported receiving 1–6 days (N = 301 [60%]) and $1000–$5000 (n = 263 [53%]) per year to use in CME activities. Most (> 70%) also reported no change in time or monetary support over the past 24 months. We found few significant differences in responses across clinician type or age group. In open-ended responses, respondents suggested eight ways to enhance CME: optimize location, reduce cost, publicize effectively, offer more courses and content, allow flexibility, ensure accessibility, make content clinically relevant, and encourage application.ConclusionsClinicians report that expense and travel time are the biggest barriers to CME. Time and money support is limited, and not increasing. Online search and email are the most frequently-used sources of information about CME. Those who organize and market CME should explore options that reduce barriers of time and money, and creatively use online tools to publicize new offerings.

Interprofessional Communities of Practice in Continuing Medical Education for Promoting and Sustaining Practice Change: A Prospective Cohort Study.

Standard knowledge delivery formats for CME may have limited impact on long-term practice change. A community of practice (CoP) is one tool that may enhance competencies and support practice change. This study explores the utility of an interprofessional CoP as an adjunct to a CME program in tobacco addiction treatment (Training Enhancement in Applied Counselling and Health [TEACH] Project) to promote and sustain practice change. A prospective cohort design was utilized to examine the long-term impact of the TEACH CoP on practice change. An online survey was administered to TEACH-trained practitioners to assess perceived feasibility, importance, and confidence related to course competencies, involvement in TEACH CoP activities, engagement in knowledge transfer (KT), and implementation of new programming. Chi-square tests were used to detect differences in KT and program development associated with CoP participation. Course competency scores from immediate postcourse surveys and long-term follow-up surveys were compared. No significant differences in participant characteristics were found between those who did (n = 300) and did not (n = 122) participate in the TEACH CoP. Mean self-perceived competency scores were greater immediately after course than at long-term follow-up; however, self-ratings of competency in pharmacological interventions and motivational interviewing were higher at follow-up. TEACH CoP participation was associated with significantly greater engagement in KT and implementation of new programming after training. The findings from this evaluation suggest the value of interprofessional CoPs offered posttraining as a mechanism to enhance practice. CME providers should consider offering CoPs as a component of training programs to promote and sustain practice change.

Cologne Consensus Conference 2016: assessment in accredited CME/CPD, 16 and 17 September 2016, Cologne, Germany

ABSTRACTParticipants and faculty members from around Europe and North America met in Cologne Germany on 16 and 17 September 2016, for the fifth annual Cologne Consensus Conference under the auspices of the European Cardiology Section Foundation (ECSF) in cooperation with various European and North American professional medical associations, accrediting bodies and CME providers. The conference was preceded by an afternoon workshop, organised by the European Board for Accreditation in Cardiology (EBAC) that allowed participants to observe a range of current e-learning modules in CME and to discuss implications for the accreditation of micro-e-learning. The conference theme was Assessment and the first day’s presentations covered Assessment Methods, Needs Assessment, Assessment of Interprofessional Teams, and Assessment of Providers. The second day’s topics were Assessment of Knowledge, Assessment of Practical Skills, Evaluation methods and the link between Assessment and Licensure. A diverse range of professional expertise among participants from both sides of the Atlantic provided stimulating discussion to make the conference a rewarding experience for all concerned.

A Community-based Collaborative Approach to Improve Breast Cancer Screening in Underserved African American Women

Although African American women in the United States have a lower incidence of breast cancer compared with white women, those younger than 40 years actually have a higher incidence rate; additionally, African American women are more likely to die from breast cancer at every age compared with white women. Racial disparities in breast cancer mortality rates are especially significant in Maryland, which ranks fifth in the nation for breast cancer mortality, and in Baltimore City, which has the second highest annual death rate for African American women in Maryland. To address this disparity in care, Med-IQ, an accredited provider of CME, collaborated with Sisters Network Baltimore Metropolitan, Affiliate Chapter of Sisters Network® Inc., the only national African American breast cancer survivorship organization, to sponsor their community-based educational outreach initiative. The collaborative mission was to engage at-risk African American women, their families, local organizations, healthcare professionals, and clinics, with the goals of increasing awareness, addressing fears that affect timely care and diagnosis, and encouraging women to obtain regular mammograms. Intervention strategies included (1) a "Survivor Stories" video, (2) patient outreach consisting of neighborhood walks and an educational luncheon, and (3) a community outreach utilizing direct mailings to local businesses, community groups, and healthcare professionals. Trusted and well-known community resources were presented as mediums to promote the initiative, yielding achievement of broader and more effective outcomes. As a result of this patient-friendly initiative, two (2) of the women who sought screening were diagnosed with breast cancer and underwent treatment.

Case 205

HomeRadiologyVol. 270, No. 1 PreviousNext Diagnosis PleaseFree AccessCase 205Lois S. MacDonald , Gill Rumsby, Snehal LapsiaLois S. MacDonald , Gill Rumsby, Snehal LapsiaAuthor AffiliationsFrom the Department of Radiology, Royal Blackburn Hospital, Haslingden Rd, Blackburn, Lancashire BB2 3HH, England (L.S.M., S.L.); and Department of Clinical Biochemistry, University College London Hospitals, London, England (G.R.).Address correspondence to L.S.M (e-mail: [email protected]).Lois S. MacDonald Gill RumsbySnehal LapsiaPublished Online:Jan 1 2014https://doi.org/10.1148/radiol.13120635MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked InEmail 2014 Diagnosis Please Learning ObjectivesIn submitting a diagnosis for this case, participants demonstrate the ability to■ Recognize normal and abnormal findings as presented in the diagnostic images■ Identify pathologic conditions indicated in the diagnostic images■ Use clinical reasoning skills to generate a list of differential diagnosesAccreditation and Designation StatementThe RSNA is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The RSNA designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.Disclosure StatementThe ACCME requires that the RSNA, as an accredited provider of CME, obtain signed disclosure statements from authors, editors, and reviewers for this case. For this educational activity the authors, editors, and reviewers have indicated that they have no relevant relationships to disclose.Submit Diagnosis Submit the most likely diagnosis to http://rsna.org/dxplease (use only for submission of diagnosis). Select the case from the Active Case List for which you are submitting a diagnosis. Only one case, one name, and one diagnosis per e-mail submission. Multiple diagnoses and multiple submissions will not be considered. Deadline: Midnight U.S. Central Time, March 10, 2014. Answer will appear in the May 2014 issue. Authors wishing to submit cases for Diagnosis Please should first write to the Editor to obtain approval for the case and further information.HistoryAn 80-year-old woman presented to the on-call surgical team with a 2-day history of abdominal distention and vomiting. Clinical examination revealed a distended tympanic abdomen with generalized tenderness but no evidence of peritoneal signs at physical examination. Relevant surgical history included previous intervention for renal stones, cholecystectomy, and cardiovascular and respiratory comorbidities. Abdominal radiography was performed in the emergency department, and computed tomography (CT) was performed based on the radiographic findings (Figs 1–3).Figure 1: Supine abdominal radiograph.Figure 1:Download as PowerPointOpen in Image Viewer Figure 2a: (a–d) Contrast material–enhanced (100 mL iohexol, Omnipaque 350; Nycomed Amersham, Oslo, Norway) axial CT images in the portal venous phase.Figure 2a:Download as PowerPointOpen in Image Viewer Figure 2b: (a–d) Contrast material–enhanced (100 mL iohexol, Omnipaque 350; Nycomed Amersham, Oslo, Norway) axial CT images in the portal venous phase.Figure 2b:Download as PowerPointOpen in Image Viewer Figure 2c: (a–d) Contrast material–enhanced (100 mL iohexol, Omnipaque 350; Nycomed Amersham, Oslo, Norway) axial CT images in the portal venous phase.Figure 2c:Download as PowerPointOpen in Image Viewer Figure 2d: (a–d) Contrast material–enhanced (100 mL iohexol, Omnipaque 350; Nycomed Amersham, Oslo, Norway) axial CT images in the portal venous phase.Figure 2d:Download as PowerPointOpen in Image Viewer Figure 3a: (a, b) Coronal reformatted contrast-enhanced CT images in the portal venous phase.Figure 3a:Download as PowerPointOpen in Image Viewer Figure 3b: (a, b) Coronal reformatted contrast-enhanced CT images in the portal venous phase.Figure 3b:Download as PowerPointOpen in Image Viewer Article HistoryPublished online: Jan 2014Published in print: Jan 2014 FiguresReferencesRelatedDetailsCited ByBritish Journal of Hospital Medicine, Vol. 81, No. 8Recommended Articles Case 282Radiology2020Volume: 295Issue: 3pp. 733-735Case 268Radiology2019Volume: 291Issue: 1pp. 259-260Case 245Radiology2017Volume: 283Issue: 2pp. 609-612Case 269Radiology2019Volume: 291Issue: 2pp. 539-541Case 273Radiology2019Volume: 292Issue: 3pp. 773-775See More RSNA Education Exhibits "Rolling Stones in Flank Pain": Update, Management, and ComplicationsDigital Posters2019Percutaneous Endoscopic Retrieval of Dropped Intraperitoneal Stones: A Minimally Invasive Alternative to Open LaparotomyDigital Posters2018Nephrolithiasis Imaging with DECT in the Current Era: Hope or Hype? 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Case 200

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Case 198

The Challenges and Impact of Evolving Competency-based Medical Education and Practice

In clinical care, much of the emphasis is appropriately focused on evidence-based practice, atient safety, and quality outcomes. However, a closely related evolving dynamic is aimed at ssessing, attaining, and maintaining competence in practice. This evolution has the potential for ajor, even revolutionary, changes in medical education and practice at all levels. Medical education in the United States has undergone a significant transformation over he past several decades, ranging from medical school (undergraduate medical education UME]), to residency training (graduate medical education [GME]), and continuing medical ducation (CME). In some respects, this evolution has occurred in each area independent of he others, but clearly there are overlapping themes, with significant impact on the rofessional activities of both experienced and neophyte physicians. Each of these arenas of education is governed by separate professional accrediting rganizations, ostensibly independent of each other but, again, coordinated in regard to ertain strategies and policies. UME is directed and monitored by the Liaison Committee on edical Education (LCME), which governs U.S. medical school curriculum content and tructure to ensure standards of basic education and training of physicians. GME is ontrolled by the Accreditation Council on Graduate Medical Education (ACGME), which ets institutional standards for organizations that sponsor GME, as well as common program equirements, which govern the structure and function of all ACGME-accredited residency raining programs. In addition, the ACGME is organized into 26 residency review commitees (RRC), which set standards for training in each medical specialty (including physical edicine and rehabilitation [PM&R]), as well as first postgraduate year training programs. he Accreditation Council on Continuing Medical Education (ACCME) in turn sets policies nd accrediting standards for any organization that desires to designate educational activiies for the American Medical Association Physicians’ Recognition Award category 1 CME redits. Each of these organizations periodically surveys its constituents regarding complince with established standards (the LCME surveys medical schools, the ACGME RRCs urvey residency programs, and the ACCME surveys CME providers), with varying cycle urations, depending on the degree of compliance. Another organization with roles in both UME and GME, the Association of American edical Colleges (AAMC), initiated a debate regarding learning objectives for medical tudents, which culminated in the Medical School Objectives Project in 1998, which dentified the following attributes of medical school graduates: altruistic, knowledgeable, killful, and dutiful [1]. More or less concurrently, the ACGME undertook a process to better define and haracterize physician “competence,” and, in 1999, evolved a 4-phase “Outcome Project” 2], with goals for assessing resident performance and instilling specific knowledge, skills, nd attitudes in 6 “core” or “general competencies”:

Sharing Collaborative Designs of Tobacco Cessation Performance Improvement CME Projects

Performance Improvement Continuing Medical Education (PI CME) provides an important opportunity for CME providers to combine educational and quality health care improvement methodologies. Very few CME providers take on the challenges of planning this type of intervention because it is still a new practice and there are limited examples from which to model. This article offers case examples of educational design, results, and lessons learned from 4 tobacco cessation PI CME activities. To share with the CME community different cases of PI CME educational design and results so that CME providers may have examples to draw from and develop more PI CME activities. This is a case report. Four of 9 partners of the Cease Smoking Today (CS2day) initiative developed the 4 tobacco cessation PI CME activities. Each project was designed and implemented using a common planning framework and clinical performance measures but with varying operational and educational design components depending on the strengths and resources of the leading partner. Three projects that are completed show improvements in aggregated practitioner performance and smoking quit rates. One project is currently under way. These cases highlight the value of collaboration, identify influences of operational and educational designs on variation in compliance with performance measures, and lead to a discussion of similarities in barriers, successes, and lessons for future practice.

Factors Contributing to Successful Interorganizational Collaboration: The Case of CS2day

Continuing medical education's transition from an emphasis on dissemination to changing clinical practice has made it increasingly necessary for CME providers to develop effective interorganizational collaborations. Although interorganizational collaboration has become commonplace in most sectors of government, business, and academia, our review of the literature and experience as practitioners and researchers suggest that the practice is less widespread in the CME field. The absence of a rich scholarly literature on establishing and maintaining interorganizational collaborations to provide continuing education to health professionals means there is little information about how guidelines and principles for effective collaboration developed in other fields might apply to continuing professional development in health care and few models of successful collaboration. The purpose of this article is to address this gap by describing a successful interorganizational CME collaboration-Cease Smoking Today (CS2day)-and summarizing what was learned from the experience, extending our knowledge by exploring and illustrating points of connection between our experience and the existing literature on successful interorganizational collaboration. In this article, we describe the collaboration and the clinical need it was organized to address, and review the evidence that led us to conclude the collaboration was successful. We then discuss, in the context of the literature on effective interorganizational collaboration, several factors we believe were major contributors to success. The CS2day collaboration provides an example of how guidelines for collaboration developed in various contexts apply to continuing medical education and a case example providing insight into the pathways that lead to a collaboration's success.

Enhancing Practice Improvement by Facilitating Practitioner Interactivity: New Roles for Providers of Continuing Medical Education

Research into networking and interactivity among practitioners is providing new information that has the potential to enhance the effectiveness of practice improvement initiatives. This commentary reviews the evidence that practitioner interactivity can facilitate emergent learning and behavior change that lead to practice improvements. Insights from learning theories provide a framework for understanding emergent learning as the product of interactions between individuals in trusted relationships, such as occurs in communities of practice. This framework helps explain why some groups respond more favorably to improvement initiatives than others. Failure to take advantage of practitioner interactivity may explain in part the disappointingly low mean rates of practice improvement reported in studies of the effectiveness of practice improvement projects. Examples of improvement models in primary care settings that explicitly use relationship building and facilitation techniques to enhance practitioner interactivity are provided. Ingredients of a curriculum to teach relationship building in communities of practice and facilitation skills to enhance learning in small group education sessions are explored. Sufficient evidence exists to support the roles of relationships and interactivity in practice improvement initiatives such that we recommend the development of training programs to teach these skills to CME providers.

Conflicts of interest concerning the use of implants in the operating room

ordance with ACCME regulations, the American College of ns, as the accredited provider of this journal CME, must that anyone in a position to control the content of the tional activity has disclosed all relevant financial relationships ny commercial interest. The editor and author(s) of this article were required to complete disclosures and any reported conflicts have been managed to our satisfaction. However, if you perceive a bias within the article, please advise us of the circumstances on the evaluation form.

Withdrawal of care in a potentially curable patient

ordance with ACCME regulations, the American College of ns, as the accredited provider of this journal CME, must that anyone in a position to control the content of the tional activity has disclosed all relevant financial relationships ny commercial interest. The editor and author(s) of this article were required to complete disclosures and any reported conflicts have been managed to our satisfaction. However, if you perceive a bias within the article, please advise us of the circumstances on the evaluation form.

CME: From hard reality to virtual reality

With the launch of new guidelines for the accreditation of e-learning materials by European Accreditation Council for Continuing Medical Education (EACCME) expected in April 2009, the landscape of CME activities in Europe is set to change. Traditional formats such as meetings and workshops are expected to make way for more digital and interactive approaches to medical education. Some formats, including online training programmes and CD-Roms, have been in mainstream use for several years but a plethora of new digital delivery channels are emerging. Whilst CME providers battle to adopt increasingly novel and exciting formats for medical education, the risk is that the learners and their needs will be forgotten in the stampede. How doctors embrace the digital revolution – now and in the future – will shape the technologies utilised for medical e-learning. Different learning styles will require varied formats and individualised learning, giving doctors the flexibility to learn effectively when, where and how ...

Measuring Continuing Medical Education Outcomes: A Pilot Study of Effect Size of Three CME Interventions at an SGIM Annual Meeting

The ACCME is phasing in new criteria for accreditation from 2008 to 2012. These criteria require CME providers to assess the impact of their interventions. To assess the feasibility of measuring outcomes at a national meeting, the SGIM evaluation committee conducted a pilot assessment of two workshops and one precourse. Session coordinators prepared a five-item questionnaire to assess the knowledge and confidence of participants. The questionnaire was administered pre, immediately post, and 9 months after the educational sessions. Changes in performance were calculated as a standardized difference, or effect size. All three sessions demonstrated initial knowledge acquisition with effect sizes ranging from 0.39 (small) to 0.99 (large) immediately after the sessions. One session demonstrated sustainment of knowledge over the subsequent 9 months while the other two demonstrated decay. Confidence levels decreased following one of the sessions with an effect size of -0.72 (modest effect). Effect size measurement of sessions provides quantitative information about their impact on learning and is one way to achieve ACCME compliance. The method, however, poses methodological and logistical challenges that raise questions about the feasibility of tracking learning and retention following a national meeting.

Industry strongly supports continuing medical education.

1. Wazana A. Physicians and the pharmaceutical industry. JAMA. 2000;283:373380. 2. Vergano D. Who’s teaching the doctors? USA Today. March 9, 2000;D:1. 3. Ross JS, Lurie P, Wolfe SM. Medical Education Services Suppliers: A Threat to Physician Education. Washington, DC: Public Citizen’s Health Research Group; July 19, 2000. (This is based on a survey in Medical Marketing & Media. 2000; 24:40-80.) 4. Drug-company influence on medical education in USA. Lancet. 2000;356: 781. 5. American Medical Association. The Physicians Recognition Award Information Booklet for CME Providers: Version 3.0. Chicago, Ill: AMA. 6. Accreditation Council on Continuing Medical Education. Essential, guidelines and standards. In: Standards for Comercial Support of Continuing Medical Education. March 20, 1992: 18-22. 7. Council on Ethical and Judicial Affairs, American Medical Association. Ethical opinion 8.011. In: Code of Medical Ethics, Current Opinions With Annotations. Chicago, Ill: Council on Ethical and Judicial Affairs, American Medical Association; 2000. 8. Tenery RM Jr. Interactions between physicians and the health care technology industry. JAMA. 2000;283:391-393. 9. Pellegrino E, Relman A. Professional medical associations: ethical and practical guidelines. JAMA. 1999;282:984-986. 10. Martin JB, Kasper DL. In whose best interest? breaching the academicindustrial wall. N Engl J Med. 2000;343:1646-1649.

Promising Innovations Loom on the e-healthcare Landscape

Promising Innovations Loom on the e-healthcare Landscape

Designing effective on-line continuing medical education

The Internet, and new information and communication technologies available through the Internet, provides medical educators with an opportunity to develop unique on-line learning environments with real potential to improve physicians' knowledge and effect change in their clinical practice. There are approximately 100 websites offering on-line CME courses in the USA alone. However, few of these CME courses appear to be based on sound educational principles or CME research and may have little chance of achieving the broader goals of CME. The majority of these courses closely resemble their traditional counterparts (e.g. paper-based books are now electronic books) and appear to be mere substitutions for old-technology CME resources. Whilst some CME providers add unique features of the Internet to enrich their websites, they do not employ strategies to optimize the learning opportunities afforded by this new technology. The adoption of adult learning principles, reflective practice and problem-based approaches can be used as a foundation for sound CME course design. In addition, knowledge of Internet technology and the learning opportunities it affords, together with strategies to maintain participation and new assessment paradigms, are all needed for developing online CME. We argue for an evidence-based and strategic approach to the development of on-line CME courses designed to enhance physician learning and facilitate change in clinical behaviour.