Before thinking about the specific design of any single CME activity, we have to ensure that all continuing medical education activity meets the ACCME's standards for integrity and independence: that education is fair and balanced and any clinical content presented supports safe, effective patient care.
Before any other decisions about structure and design are made, please ask yourself these questions:
- Are recommendations for patient care based on current science, evidence, and clinical reasoning, while giving a fair and balanced view of diagnostic and therapeutic options
- Does all scientific research referred to, reported, or used in this educational activity in support or justification of a patient care recommendation conform to the generally accepted standards of experimental design, data collection, analysis, and interpretation?
- Are new and evolving topics for which there is a lower (or absent) evidence base, clearly identified as such within the education and individual presentations?
- Does the educational activity avoid advocating for, or promoting, practices that are not, or not yet, adequately based on current science, evidence, and clinical reasoning?
- Does the activity exclude any advocacy for, or promotion of, unscientific approaches to diagnosis or therapy, or recommendations, treatment, or manners of practicing healthcare that are determined to have risks or dangers that outweigh the benefits or are known to be ineffective in the treatment of patients?
Learner-Centered Design
Learner-centered design is intended to do just that - place the student at the center of the learning experience, as opposed to the instructor or presenter. Where possible, this includes engaging learners so that they interact with the content, one another, and the presenter. The key to doing that is to focus on the intended outcomes of the activity and separating content into what's critical (what you would like to impart an enduring understanding of), what's important to know and do, and what's worth being familiar with. When employed effectively, this provides opportunities for learners to reflect on and demonstrate their learning, encourage dialogue, and generate questions that can be the basis for additional educational activities.
Premises:
- Physicians learn from their own experience
- Physicians learn through their interactions with other Physicians
- Helping physicians become comfortable with the role of learner is very important
- An important approach to enhancing physician learning is to develop communities of interaction
- When physicians can engage in practice research that provides real, tangible results that directly impact their experience, it fosters the growth of learning communities
(Adapted from How People Learn, Bransford, Brown & Cocking Chapter 8)
There's always a little resistance to change, the physician community is no exception. And as very busy (and often over-extended) professionals, "it ain't broke so don't fix it" is a reasonable response to proposed new methods. However, we at CME would humbly argue that CME has been demonstrated to be effective in multiple environment [Davis & Galbraith, 2009; Cervero & Gaines, 2015], and that format does have an impact on effectiveness [Marinopoulos et al.].
It's fair to say that the evidence is mixed; but we can also say that about evidence to support all other education activities from elementary school to the professional level (pre-school studies show much more robust results, so it appears a lot of things get in the way along the typical learning path).
Backward Design
Wiggins and McTighe identify "twin sins" of traditional design: engaging learners without specific purpose; attempting to cover all material related to a topic without considering its value2. The missing element is intellectual goals - what do we want the audience to learn? Are there any big ideas guiding the instruction, and is there a plan to ensure that participants learn those big ideas?
Unlike killing werewolves, there's silver bullet to ensuring that people understand what you want them to understand, but this approach is useful in that it provides a systematic and purposeful way to look at an activity, lecture, or session, to determine if it meets the goals of the learner.
In this model we first consider the goal of the presentation: what do we want the participant to know or achieve? Secondly, how will we know that the participant has achieved the desired result? And then we plan the learning experience that we believe will facilitate achievement of the desired result.
The learning experience might be based on:
- Enabling knowledge: facts, concepts, principles; and/or
- Skills: processes, procedures, strategies
So we're selecting teaching method, topic sequence, foundational and resource materials only after we identify desired results and how those results could be assessed. If you'd like more details, there's additional information in the section presentation design principles.
References
Cervero, Ronald M., Gaines, Julie K. (2014) Effectiveness of Continuing Medical Education: Updated Synthesis of Systematic Reviews
Bloom, B.S. (2005). Effects of continuing medical education on improving physician clinical care and patient heath. International Journal of Technology Assessment in Health Care, 21(3), 380-385.
Davis, D.A., & Galbraith, R. (2009). Continuing medical education effect on practice performance: Effectiveness of continuing medical education: American College of Chest Physicians evidence-based educational guidelines. Chest, 135 (Suppl 3): 42S – 48S
Forsetlund, L., Bjorndal, A., Rashidian, A., Jamtvedt, G., Obrien, M.A., Wolf, F., Davis, D., Odgaard-Jensen, J., & Oxman, A.D. (2009). Continuing education meetings and workshops: Effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews (2): CD003030.
Mansouri, M., & Lockyer, J. (2007). A meta-analysis of continuing medical education effectiveness. The Journal of Continuing Education in the Health Professions, 27, 6-15.
Marinopoulos, S.S., Dorman, T., Ratanawongsa, N., Wilson, L.M., Ashar, B.H., Magaziner, J.L., Miller, R.G., Thomas, P.A., Prokopowicz, G.P., Qayyum, R., & Bass, E.B. (2007). Effectiveness of continuing medical education. Evidence report/technology assessment no. 149. Rockville, MD: Agency for Healthcare Research and Quality.
Mazmanian P.E., Davis D.A., & Galbraith R. (2009). Continuing medical education effect on clinical outcomes: effectiveness of continuing medical education: American College of Chest Physicians evidence-based educational guidelines. Chest, 135 (Suppl 3): 49S-55S.