Continuing Medical Education Conference Research Articles

Effectiveness of Continuing Medical Education in Ghana: Preliminary Study

Introduction: The purpose of this study was to evaluate the impact of a Continuing Medical Education (CME) activity on the level of knowledge of Ghanaian physicians. CME is well studied in resource-rich countries, but little is known about the efficacy of CME in Lower- and Middle-income countries.Methods: This cross-sectional study used anonymous semi-structured questionnaires in a self-assessment method of evaluation. Participants of the CME conference organized by the Ghana College of Physicians and Surgeons, dubbed Medical KnowledgeFiesta, were asked to evaluate the utility of the educational content at the conference, and then at three and six-months post-conference. Data was reported anonymously using aggregation and analysed using descriptive statistics.Results: The data indicates a 53% knowledge diffusion rate at three months and 63% at six months post CME. Sixty-six percent and 77% of participants implemented new knowledge within three months and six months post CME, respectively. At three months post CME, 65% of participants indicated CME changed their practice, and this increased to 82% at six months. Changes reportedinclude 57% of participants asking different and/or additional questions during patient assessments three months post CME which increased to 74% at the sixth month survey. Thirty-three percent of participants scheduled more follow up appointments three monthspost CME which increased to 44% six months post CME.Conclusion: In this study, CME improved physician knowledge in Ghana. Within six months following the CME, 82% of respondents reported a change in their medical practice.

Role of conferences and continuing medical education (CME) in post-graduate anaesthesia education.

Role of conferences and continuing medical education (CME) in post-graduate anaesthesia education.

Implementation and Impact Evaluation of a Virtual Orthopaedic Continuing Medical Education Conference in a Low-Resource Country

The Haitian Annual Assembly of Orthopaedic Trauma (HAAOT) is an annual continuing medical education (CME) conference for Haitian orthopedists and trainees converted to a pilot virtual format in 2020 due to the COVID-19 pandemic. We evaluated this virtual format's effectiveness at teaching, facilitating bilingual discussion, and encouraging cross-cultural exchange of experiences - all aimed at improving orthopedic knowledge in a low-resource country like Haiti. Planned collaboratively between North American and Haitian colleagues, the conference involved 4 bilingual weekly Zoom meetings comprised of 4 to 6 prerecorded presentations and live-translated discussion. Pre- and postmeeting knowledge assessments in French (Haitian language of medical instruction) were administered weekly with results compared via 2-sample t-tests. An online postconference survey evaluated attendee satisfaction with the virtual format. Virtual. Weekly attendance involved approximately 50 Haitian orthopedists and trainees, with 20 to 25 completing pre- and postmeeting assessments. Statistically significant increases between pre/post scores were seen during 3 of 4 sessions. Session-wide significant score increases occurred for residents and attending surgeons with <10 years of experience. 85.7% of attendees reported the virtual platform exceeded expectations and 100% indicated likely or extremely likely participation in further virtual events. The pilot virtual HAAOT was extremely well received with high desire for future sessions. Beyond short-term knowledge retention among attendees, nonmeasurable benefits included collaboration between orthopedists and trainees in the United States, Canada, United Kingdom, Haiti, and Burkina Faso. As COVID-19 spurs online learning in high-income nations, the successful low-resource context adjustments and local partnership underlying this model attest that travel restrictions need not impede delivery of virtual CME conferences in lower-income nations. Attendee learning and the decreased cost and travel requirements allude to this platform's sustainability and reproducibility in facilitating future international education and capacity building. Further studies will assess long-term retention of presented material.

Fertility and Reproductive Health in Women Physicians.

Background: Our aim was to evaluate trends of childbearing during medical training, evaluate issues of infertility, and measure institutionalized barriers to childbearing among women physicians. Materials and Methods: Attendees of a national women physician's leadership conference (Brave Enough Women Physicians Continuing Medical Education Conference) were surveyed during the conference using Qualtrics© (2019 Qualtrics, Provo, UT), in September 2019. Survey data included demographics, training level, and medical specialty. Data related to reproductive health factors, pregnancy status and history, current number of children, medical history related to pregnancy, breastfeeding history, institutional family planning support, and use of previous fertility treatments were collected. Descriptive analyses were done using IBM SPSS v26.0. Results: Three hundred seventy-seven survey participants were included in the study. 10.6% of respondents reported at least one pregnancy during medical school, versus 78.8% as a practicing physician. Of the participants, 25.8% reported having taken off 1 month or less of clinical duties after giving birth, 39.4% reported that their job prevented breastfeeding for the desired length of time, and 52.2% reported significant workplace limitations to breastfeeding. Of them, 25.5% reported having had fertility issues in the past. Fertility drugs (72.9%) was the most common fertility treatment method used, followed by fertility tracking (54.2%). Demands of training (72.9%) and long work hours (61.5%) were the most cited factors in delaying having children as reported by women physicians. Conclusions: This study reported several barriers related to fertility, family planning, and reproductive health among women physicians. Our results highlight the need for a paradigm shift in fertility awareness and institutional support for childbearing during medical training, postgraduate training programs, and in practice for women in medicine.

Positive association of a women’s continuing medical education conference on career advancement and promotion

ABSTRACT Women physicians are underrepresented in leadership positions across medical specialties. Understanding factors that improve women’s promotion metrics may lead to career and leadership advancement. This study examined if a woman-centered Continuing Medical Education (CME) conference is associated with differences in productivity metrics toward career advancement. The authors conducted a cross-sectional survey study of women physicians attending a national woman-centered CME conference for professional growth, wellness and networking in September 2019. The survey measured promotion metrics achieved in the year prior to the conference and compared them with previous attendees. Of 425 women attendees of the conference, 389 (91.5%) respondents completed the survey. Respondents were divided into two groups for analysis: first time (FT) attendees, and those that attended the conference previously (PV). In the year preceding the survey, PV attendees were more likely to have published a manuscript as first-author or co-author in a peer-reviewed journal (17.5% vs. 9.7%, p = 0.029), given a talk in their area of practice (48.3% vs. 27.9%, p < 0.001) and to have mentored at least one peer (40.8% vs. 27.5%, p = 0.009) and to have asked for a promotion (15.8% vs. 8.6%, p = 0.033) than FT. As compared to first-time conference attendees, women physicians who previously attended a woman-centered CME conference were more likely to achieve career performance metrics including publications and speaking engagements in the preceding year. This study demonstrated a positive association of Women-centered CME conferences in career advancement metrics for women in medicine and suggests further studies on this and other women-centered CME conferences.

Effect of Pause Procedures on Participant Reflection and Commitment-to-Change in Continuing Medical Education

Problem: Conferences are the most common form of continuing medical education (CME), but their effect on clinician practice is inconsistent. Reflection is a critical step in the process of practice change among clinicians and may lead to improved outcomes following conference-based CME. However, reflection requires time to process newly-learned material. Adequate time for reflection may be noticeably absent during many conference presentations. Intervention: The pause procedure is a 90-second ‘pause’ during a 30-minute presentation so learners can review and discuss content. The goal of the pause procedure is to stimulate learners’ active engagement with newly learned material which will, in turn, promote learner reflection. Context: Fifty-six presentations at two hospital medicine CME conferences were assigned to the pause procedure or control. Study outcomes provided by conference participants were validated reflection scores and commitment-to-change (CTC) statements for each presentation. A post-hoc survey of the intervention group was conducted to assess presenters’ experiences with the pause procedure. Impact: A total of 527 conference participants completed presentation evaluations (response rate 72.7%). Presentations incorporating the pause procedure failed to lead higher participant reflection scores (percentage ‘top box’ score; intervention: 39.2% vs. control: 41.7%, p = 0.40) or participant CTC rates (median [IQR]; intervention: 4.64 [3.04, 10.57] vs. control: 8.16 [5.28, 17.12], p = 0.13) than control presentations. However, the majority of presenters (16 out of 17 survey respondents) had never before used the intervention and little active engagement among learners was noted during the pause procedure. Lessons Learned: Adding the pause procedure to CME presentations did not lead to greater reflection or CTC among clinician learners. However, presenters had limited experience with the intervention, which may have reduced their fidelity to the educational principles of the pause procedure. Faculty development may be necessary when planning a new educational intervention that is to be implemented by conference presenters.

Characteristics of Effective Continuing Medical Education for Physician Assistants and Nurse Practitioners in Hospital Medicine

The purpose of this study was to describe participant characteristics and effective teaching methods at a national continuing medical education (CME) conference on hospital medicine for physician assistants (PAs) and nurse practitioners (NPs). In this cross-sectional study, participants provided demographic information and teaching effectiveness scores for each presentation. Associations between teaching effectiveness score and presentation characteristics were determined. In total, 163 of 253 participants (64.4%) completed evaluations of 28 presentations. Many of the participants were younger than 50 years (69.0%), had practiced for fewer than 5 years (41.5%), and worked in nonacademic settings (76.7%). Teaching effectiveness scores were significantly associated with the use of clinical cases (perfect scores for 68.8% of presentations with clinical cases vs. 59.8% without; P = .04). Many PAs and NPs at an HM CME conference were early-career clinicians working in nonacademic settings. Presenters at CME conferences in hospital medicine should consider using clinical cases to improve their teaching effectiveness among PA and NP learners.

The analysis of the dynamics of psychiatrists ‘ opinions on continuing medical education

To assess the dynamics of doctors ‘ opinions on continuing medical education (CME) in 2016 and 2018 was conducted an anonymous online survey, which was attended by 52 psychiatrists (in 2016 year, from 14 regions of Russia) and 203 psychiatrists (in 2018 year, from 46 regions of Russia). There is the growth of skeptical views on the feasibility of introducing a new system (in 2016 it was supported by 55,8% of respondents, in 2018 — only by 38,3%). Also in the 2-year term increased the number of difficulties in accessing to attend conferences, increased availability of online modules and has not changed significantly the availability of training in the departments in universities. The most difficult for doctors is to find attending conferences (average score in assessing difficulties 3,6), which requires the search for funds for travel expenses and separation from work, the most convenient — online training (average score in assessing difficulties 3,0). The effectiveness of all three types of educational activities of CME (conferences, online modules and courses in the departments) is estimated at a relative average level (about 3 points on a 5-point scale). The impact of CME on the solution of actual organizational and methodological problems of health care is also rather skeptical.

Strategies to Fill the Gaps in Nutrition Education for Health Professionals through Continuing Medical Education.

Recent studies have documented that diet quality in the US is poor and linked to higher rates of cardiovascular disease (CVD), other non-communicable diseases, and total mortality. As a result, nutrition counseling in clinical practice is an evidence-based strategy endorsed by numerous stakeholders. However, medical nutrition education (MNE) in the US has been inadequate, and physician knowledge, competencies, and practices related to diet counseling have been documented to be insufficient. National scientific meetings and conferences offer opportunities to translate new scientific evidence, guidelines, and competencies to clinicians in attendance and to publicize this evidence widely. This review assessed the adequacy of, and trends in, nutrition education provided at recent major US scientific meetings that offer continuing medical education (CME), with a focus on CVD-related conferences. The authors found no reviews that have assessed the scope and type of nutrition-related educational programming at major conferences. We therefore investigated nutrition-related programming at CVD-related CME conferences in the US from 2013 to 2018. National scientific CVD-related conferences in the USA have offered variable amounts of programming related to practical applications of nutrition science. We did not observe an increase in nutrition-related offerings, despite the increase in diet-related diseases and the growing evidence base for the role of nutrition in the prevention and management of chronic disease. Increasing nutrition-related CME programming at national scientific meetings can lead to greater translation of nutrition evidence to patients by healthcare providers and improved health outcomes in the population.

Physicians' Dietary Knowledge, Attitudes, and Counseling Practices: The Experience of a Single Health Care Center at Changing the Landscape for Dietary Education.

Morbidity and mortality associated with cardiovascular disease can be significantly modified through lifestyle interventions, yet there is little emphasis on nutrition and lifestyle in medical education. Improving nutrition education for future physicians would likely lead to improved preparedness to counsel patients on lifestyle interventions. An online anonymous survey of medical residents, cardiology fellows, and faculty in Internal Medicine and Cardiology was conducted at New York University Langone Health assessing basic nutritional knowledge, self-reported attitudes and practices. A total of 248 physicians responded (26.7% response rate). Nutrition knowledge was fair, but few (13.5%) felt adequately trained to discuss nutrition with patients. A majority (78.4%) agreed that additional training in nutrition would allow them to provide better clinical care. Based on survey responses, a dedicated continuing medical education (CME) conference was developed to improve knowledge and lifestyle counseling skills of healthcare providers. In postconference evaluations, attendees reported improved knowledge of evidence-based lifestyle interventions. Most noted that they would prescribe a Mediterranean or plant-based diet and would make changes to their practice based on the conference. An annual CME conference on diet and lifestyle can effectively help interested providers overcome barriers to lifestyle change in clinical practice through improved nutrition knowledge.

Continuing Medical Education Speakers with High Evaluation Scores Use more Image-based Slides.

IntroductionAlthough continuing medical education (CME) presentations are common across health professions, it is unknown whether slide design is independently associated with audience evaluations of the speaker. Based on the conceptual framework of Mayer’s theory of multimedia learning, this study aimed to determine whether image use and text density in presentation slides are associated with overall speaker evaluations.MethodsThis retrospective analysis of six sequential CME conferences (two annual emergency medicine conferences over a three-year period) used a mixed linear regression model to assess whether post-conference speaker evaluations were associated with image fraction (percentage of image-based slides per presentation) and text density (number of words per slide).ResultsA total of 105 unique lectures were given by 49 faculty members, and 1,222 evaluations (70.1% response rate) were available for analysis. On average, 47.4% (SD=25.36) of slides had at least one educationally-relevant image (image fraction). Image fraction significantly predicted overall higher evaluation scores [F(1, 100.676)=6.158, p=0.015] in the mixed linear regression model. The mean (SD) text density was 25.61 (8.14) words/slide but was not a significant predictor [F(1, 86.293)=0.55, p=0.815]. Of note, the individual speaker [χ2(1)=2.952, p=0.003] and speaker seniority [F(3, 59.713)=4.083, p=0.011] significantly predicted higher scores.ConclusionThis is the first published study to date assessing the linkage between slide design and CME speaker evaluations by an audience of practicing clinicians. The incorporation of images was associated with higher evaluation scores, in alignment with Mayer’s theory of multimedia learning. Contrary to this theory, however, text density showed no significant association, suggesting that these scores may be multifactorial. Professional development efforts should focus on teaching best practices in both slide design and presentation skills.

Current Literature Summary

Current Literature Summary

The value of prostate cancer support groups: a pilot study of primary physicians’ perspectives

BackgroundIn Canada, prostate cancer (PCa) is the most common male cancer, and prostate cancer support groups (PCSGs) have prevailed for more than 20 years providing support to men with PCa and their families. While the format, focus and benefits of attending PCSGs have been reported little is known about primary physicians’ (PPs) perceptions of these groups. This article describes Canadian primary physicians’ views about face-to-face and web-based PCSGs.MethodsCanadian based primary physicians (n = 140) attending a 2012 Continuing Medical Education Conference participated in a pilot survey questionnaire study. The 56-item questionnaire used in this study included six sets of attitudinal items to measure primary physicians’ beliefs about positive and negative influences of PCSGs, reasons for attending PCSGs, the attributes of effective PCSGs, and the value of face-to-face and web-based PCSGs.ResultsResults showed that PCSGs were positively valued, particularly for information sharing, education and psychosocial support. Poor inclusivity, privacy, and accessibility were identified as potential barriers, and recommendations were made for better marketing and web-based PCSGs to increase engagement with potential attendees.ConclusionsFindings suggest PPs highly valued the role and potential benefits of PCSGs. Information provision and an educational role were perceived as key benefits amid the need to improve local and provincial marketing of PCSGs. The potential for web-based PCSGs to help in the support of PCa patients was also recognized.

Use of a national continuing medical education meeting to provide simulation-based training in temporary hemodialysis catheter insertion skills: a pre-test post-test study.

BackgroundSimulation-based-mastery-learning (SBML) is an effective method to train nephrology fellows to competently insert temporary, non-tunneled hemodialysis catheters (NTHCs). Previous studies of SBML for NTHC-insertion have been conducted at a local level.ObjectivesDetermine if SBML for NTHC-insertion can be effective when provided at a national continuing medical education (CME) meeting. Describe the correlation of demographic factors, prior experience with NTHC-insertion and procedural self-confidence with simulated performance of the procedure.DesignPre-test – post-test study.Setting2014 Canadian Society of Nephrology annual meeting.ParticipantsNephrology fellows, internal medicine residents and medical students.MeasurementsParticipants were surveyed regarding demographics, prior NTHC-insertion experience, procedural self-confidence and attitudes regarding the training they received. NTHC-insertion skills were assessed using a 28-item checklist.MethodsParticipants underwent a pre-test of their NTHC-insertion skills at the internal jugular site using a realistic patient simulator and ultrasound machine. Participants then had a training session that included a didactic presentation and 2 hours of deliberate practice using the simulator. On the following day, trainees completed a post-test of their NTHC-insertion skills. All participants were required to meet or exceed a minimum passing score (MPS) previously set at 79%. Trainees who did not reach the MPS were required to perform more deliberate practice until the MPS was achieved.ResultsTwenty-two individuals participated in SBML training. None met or exceeded the MPS at baseline with a median checklist score of 20 (IQR, 7.25 to 21). Seventeen of 22 participants (77%) completed post-testing and improved their scores to a median of 27 (IQR, 26 to 28; p < 0.001). All met or exceeded the MPS on their first attempt. There were no significant correlations between demographics, prior experience or procedural self-confidence with pre-test performance.LimitationsSmall sample-size and self-selection of participants. Costs could limit the long-term feasibility of providing this type of training at a CME conference.ConclusionsDespite most participants reporting having previously inserted NTHCs in clinical practice, none met the MPS at baseline; this suggests their prior training may have been inadequate.

Shining Light on the Sunshine Act

Shining Light on the Sunshine Act

Feasibility of scenario-based simulation training versus traditional workshops in continuing medical education: a randomized controlled trial

IntroductionAlthough simulation-based training is increasingly used for medical education, its benefits in continuing medical education (CME) are less established. This study seeks to evaluate the feasibility of incorporating simulation-based training into a CME conference and compare its effectiveness with the traditional workshop in improving knowledge and self-reported confidence.MethodsParticipants (N=27) were group randomized to either a simulation-based workshop or a traditional case-based workshop.ResultsPost-training, knowledge assessment score neither did increase significantly in the traditional group (d=0.13; p=0.76) nor did significantly decrease in the simulation group (d= − 0.44; p=0.19). Self-reported comfort in patient assessment parameters increased in both groups (p<0.05 in all). However, only the simulation group reported an increase in comfort in patient management (d=1.1, p=0.051 for the traditional group and d=1.3; p= 0.0003 for the simulation group). At 1 month, comfort measures in the traditional group increased consistently over time while these measures in the simulation group increased post-workshop but decreased by 1 month, suggesting that some of the effects of training with simulation may be short lived.DiscussionThe use of simulation-based training was not associated with benefits in knowledge acquisition, knowledge retention, or comfort in patient assessment. It was associated with superior outcomes in comfort in patient management, but this benefit may be short-lived. Further studies are required to better define the conditions under which simulation-based training is beneficial.

Motivating Learning and Assessing Outcomes in Continuing Medical Education Using a Personal Learning Plan

Although there is increasing focus on provider behavior change as an outcome of continuing medical education (CME), it has long been known that an increase in knowledge alone is rarely sufficient to induce such change. The Personal Learning Plan (PLP), designed to motivate and assess CME learning, was partly derived from SMART goals (specific, measurable, attainable, realistic, and timely), a concept well supported as a strategy to promote behavior change. The goal of this study was to explore the relationship between SMART goals developed after attending a CME conference and subsequent provider behavior change, using the PLP as a tool. PLPs were used as the outcome measure for Dartmouth-Hitchcock Continuing Medical Education conferences conducted during the fall of 2010. Three months later, participants were asked how close they were to completing their goals. All participants' goals were analyzed according to SMART criteria. Of the 841 participants attending conferences in fall 2010, 347 completed a PLP. An independent t-test found that among the 125 participants who completed the follow-up survey, those who indicated that they had completed their goal or were "very close" or "extremely close" to completing their goal wrote SMARTer goals than those who reported being "not at all close" to "moderately close" to completing their goal (t = 2.48, df = 123, p = 0.015). Our results corroborate previous research that has found "use of specific strategies to implement research-based recommendations seems to be necessary to ensure that practices change." Future directions include both a study of use of a PLP compared to a simple intent to change document and work on helping participants to write SMARTer goals.

Meeting Highlights on Psychiatric Clinical Challenges and Advancing the Science of Treatment: The 3 rd Annual Chair Summit

Health care providers encounter many patients who have a typical, bread-and-butter symptom presentation and illness course, and for whom developing a treatment plan is relatively straightforward. However, some patients have cases that are challenging because 1) their illnesses are atypical, severe, or treatment-refractory in nature; 2) their conditions are less frequently encountered in the clinical setting; or 3) optimal treatment has not yet been well-studied and clearly defined. In the neurosciences, such challenges often seem to be the rule more than the exception. Continuing medical education (CME) can help clinicians address these challenges and promote clinical competence regarding innovations in neuroscience technologies. In August 2010, psychiatry and neurology health care providers participated in a comprehensive neuroscience CME conference— The 3 rd Annual Chair Summit, The Master Class for Neuroscience Professional Development— that featured faculty chairpersons of psychiatry and neurology departments. This 4 th article of 5 in a CME-certified companion series presents meeting highlights on managing the complexities of neuropsychiatric care and on scientific advances, especially technology-based innovations. Specifically, clinical topics focus on recognizing attention deficit hyperactivity disorder that persists into adulthood; differential diagnosis of rage and aggression; treating borderline personality disorder; preventing suicide; and implementing care strategies for physician addiction. Rounding out this attention to difficult cases, technology highlights pertained to advanced diagnostic innovations in functional magnetic resonance imaging and to brain stimulation treatment strategies (ie, electroconvulsive therapy, deep brain stimulation, repetitive transcranial magnetic stimulation, and vagus nerve stimulation). This article contains several patient cases and summary points connecting research to clinical practice.

Adapting to Decreased Industry Support of CME: Lifelong Education in an "Industry-Lite" World

The continuing medical education (CME) enterprise in academic medicine is changing rapidly because of a number of important factors: the change in CME doctrine promulgated by the Accreditation Council for Continuing Medical Education (ACCME) (1), the refinement of the criteria for maintenance of certification (MOC) by the American Board of Medical Specialties (ABMS) (2), and alterations in patterns of commercial sponsorship for educational events by pharmaceutical and device industries. This article focuses on how alterations in the patterns of commercial support for educational events at academic medical centers and universities are changing the CME opportunities for faculty and trainees associated with academic departments of psychiatry. Historically, commercial funding has subsidized and supported considerable CME activity in academic medical centers. A 2006 survey (3) indicated that 49% of CME course costs at academic centers were funded by industry. Commercial sponsorship of CME has taken several forms. Commercial companies, either directly or through their educational intermediaries, have sponsored Grand Rounds speakers in academic departments, either as members of speakers’ bureaus or via individual grants. These companies have also helped underwrite the costs of CME conferences sponsored by academic departments through their universities. Also, commercial companies have sponsored journal clubs and dinner meetings with speakers for practitioners in the community, often at reasonably attractive restaurants, as well as travel funds for faculty, residents, and fellows to attend national and international meetings. Through “medical education and communication companies,” which have frequently partnered with academic departments of psychiatry, industry has sponsored educational activities with online options, teleconferences, and videoconferences and the development and production of CME events in conjunction with professional-association meetings. Traditionally, these offerings feature top names and excellent media production, and they draw large audiences. Thus, increased levels of commercial support have helped proliferate different approaches for physicians to receive free CME. At times, these presentations may become vehicles for commercial entities to “educate” practitioners in a manner that is conducive to acceptance of a product or a specific class of agents for treatment interventions. In 2008, pharmaceutical and medical-device companies funded half of the $3 billion CME industry, and much of this money was directed to for-profit medical-communication companies that organize CME programs and symposia (4). Well-warranted concerns about ethics issues and the educational implications of marketing biases and academic leaders’ industry ties (5), raised by public scrutiny, Congressional investigations, and leaders in the medical profession, have led pharmaceutical and device companies to revise their funding patterns and practices. The overall effect has been a severe curtailment of industry funding of CME activities. Academic departments and organizations that relied on commercial largess have been increasingly deprived of the funds previously available for CME activities. According to industry sources, many providers now Received December 20, 2009; revised March 7, 2010; accepted March 8, 2010. Dr. Yager is affiliated with the Department of Psychiatry at the University of Colorado, Denver. Dr. Silverman is affiliated with the Department of Psychiatry at Virginia Commonwealth University in Richmond, VA. Dr. Rapaport is at the Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, and the Department of Psychiatry and Bio-Behavioral Sciences, University of California, Los Angeles. Address correspondence to Joel Yager, Department of Psychiatry, University of Colorado, 13001 E 17th Pl, A011-04, Aurora, CO 80045; jyager@unm.edu (e-mail). Copyright © 2011 Academic Psychiatry

Impact on Clinical Behavior of Face-to-Face Continuing Medical Education Blended with Online Spaced Education: A Randomized Controlled Trial

Spaced education (SE) is a novel, evidence-based form of online learning. We investigated whether an SE program following a face-to-face continuing medical education (CME) course could enhance the course's impact on providers' clinical behaviors. This randomized controlled trial was conducted from March 2009 to April 2010, immediately following the Current Clinical Issues in Primary Care (Pri-Med) CME conference in Houston, Texas. Enrolled providers were randomized to receive the SE program immediately after the live CME event or 18 weeks later (wait-list controls). The SE program consisted of 40 validated questions and explanations covering 4 clinical topics. The repetition intervals were adapted to each provider based on his or her performance (8- and 16-day intervals for incorrect and correct answers, respectively). Questions were retired when answered correctly twice in a row. At week 18, a behavior change survey instrument was administered simultaneously to providers in both cohorts. Seventy-four percent of participants (181/246) completed the SE program. Of these, 97% (176/181) submitted the behavior change survey. Across all 4 clinical topics, providers who received SE reported significantly greater change in their global clinical behaviors as a result of the CME program (p-values .013 to < .001; effect size 0.7). Ninety-seven percent (175/179) requested to participate in future SE supplements to live CME courses. Eighty-six percent (156/179) agreed or strongly agreed that the SE program enhanced the impact of the live CME conference. Online spaced education following a live CME course can significantly increase the impact of a face-to-face course on providers' self-reported global clinical behaviors.