When it comes to boosting performance in an area of your practice, don't undertake just one activity, such as a CME course, and expect a measurably meaningful, sustainable improvement. Instead, combine several activities for a prolonged period to bring about the change you want. So says the study "Impact of Educational Interventions on Physician Performance and Patient Outcomes," which was published recently in CE Measure, the journal of outcomes measurement in continuing health care education.
AAFP Study: Multiple Efforts Lead to Sustainable Practice Improvements
By Paula Haas
4/16/2008
Study authors are AAFP CME Division Director Mindi McKenna, Ph.D., M.B.A.; Susan Richart, M.B.A., C.P.H.Q., manager of AAFP's METRIC (Measuring, Evaluating and Translating Research Into Care) program; and Susan Tyler, M.Ed., the Academy's CME accreditation manager.
Surveying the Field
The authors reviewed 258 articles, including 96 evidence-based studies, to investigate challenges associated with the design, delivery and use of educational and noneducational interventions to improve practice performance and patient outcomes in a measurable way.
According to their research, "the most effective way to make sustainable changes is through the use of needs-driven and self-directed CME," explained McKenna in an interview with AAFP News Now. "Find something you need to excel at. For example, if you care for many patients with a condition such as diabetes, or if you frequently perform a certain procedure, pick that area for improvement. Then, look for changes in the science that you should incorporate into your practice and seek out multiple educational opportunities that will help you make those changes."
Factor your personal style into the equation, McKenna added. "Some people are auditory learners, others visual. Some prefer small sips of information, others large swallows. Some want self-study information to come to them regularly, while others want to get away for several days to learn about the needed changes. Figure out activities that work for you."
The study found that performance might be enhanced by ongoing inservice education, support from a medical director or a peer mentor, or follow-up coaching to reinforce improvements. It also found that interactive activities seem to be more effective than traditional passive learning and that decision support tools and point-of-care reminder systems have been shown to contribute to improvements.
On the other hand, barriers to success include lack of administrative support, difficulty achieving consensus for change within the care team, lack of time and reimbursement, and workload pressures.
According to their research, "the most effective way to make sustainable changes is through the use of needs-driven and self-directed CME," explained McKenna in an interview with AAFP News Now. "Find something you need to excel at. For example, if you care for many patients with a condition such as diabetes, or if you frequently perform a certain procedure, pick that area for improvement. Then, look for changes in the science that you should incorporate into your practice and seek out multiple educational opportunities that will help you make those changes."
Factor your personal style into the equation, McKenna added. "Some people are auditory learners, others visual. Some prefer small sips of information, others large swallows. Some want self-study information to come to them regularly, while others want to get away for several days to learn about the needed changes. Figure out activities that work for you."
The study found that performance might be enhanced by ongoing inservice education, support from a medical director or a peer mentor, or follow-up coaching to reinforce improvements. It also found that interactive activities seem to be more effective than traditional passive learning and that decision support tools and point-of-care reminder systems have been shown to contribute to improvements.
On the other hand, barriers to success include lack of administrative support, difficulty achieving consensus for change within the care team, lack of time and reimbursement, and workload pressures.
Assessing PI CME Offerings
After reviewing the 258 articles, the study authors then assessed four performance-improvement, or PI, CME programs designed for use by primary care physicians, including AAFP's METRIC program. The other PI CME programs assessed were developed by the American Academy of Pediatrics, the American Board of Family Medicine and the American Board of Internal Medicine. All four programs share a common purpose: They were created to help physicians in each of these specialties fulfill the performance-in-practice requirement for board certification mandated by the American Board of Medical Specialties.
Such programs, which involve baseline assessment, education, application of learning and subsequent reassessment, "show potential for positively affecting practice performance and patient outcomes," the authors wrote. They found that some, but not all, of the factors shown to increase the impact of educational interventions have been incorporated into the four PI CME programs.
Richart noted that additional research, including studies the AAFP's National Research Network will be conducting to assess the effectiveness of the Academy's METRIC modules and Practice Enhancement Forum programs in improving practice performance, would provide more information on ways to make PI CME programs even better.
Such programs, which involve baseline assessment, education, application of learning and subsequent reassessment, "show potential for positively affecting practice performance and patient outcomes," the authors wrote. They found that some, but not all, of the factors shown to increase the impact of educational interventions have been incorporated into the four PI CME programs.
Richart noted that additional research, including studies the AAFP's National Research Network will be conducting to assess the effectiveness of the Academy's METRIC modules and Practice Enhancement Forum programs in improving practice performance, would provide more information on ways to make PI CME programs even better.
Encouraging Members
"We hope that members are encouraged by the fact that we're studying what works and enhancing AAFP CME accordingly," McKenna said. "Members are so resource- and time-constrained that we want to make sure they get the maximum value for the dollars they invest in CME and practice improvement programs."
McKenna also said she's eager to see physicians embrace the idea of being in the driver's seat of their own professional development. "They shouldn't see it as one more thing they have to do, but as a way of connecting the many things they already have to do -- such as CME credits to maintain their license and professional standing, and PI activities to maintain their board certification."
McKenna also said she's eager to see physicians embrace the idea of being in the driver's seat of their own professional development. "They shouldn't see it as one more thing they have to do, but as a way of connecting the many things they already have to do -- such as CME credits to maintain their license and professional standing, and PI activities to maintain their board certification."
