Featured in the November/December 2013 Colorado Medicine.
More than 3,000 Colorado physicians participate
Joanne Wojak, Director, Continuing Medical Education
The Colorado Medical Board recently distributed a statewide survey to 19,000 Colorado licensed physicians to learn what types of continuing professional development (CPD) and continuing medical education (CME) activities they participate in and find to be most useful to improving the quality of their practice. More than 3,000 physicians responded.
This survey project was part of the Maintenance of Licensure (MOL) collaborative effort between the medical board, Colorado Medical Society and Colorado Society of Osteopathic Physicians, and was developed with staff from the National Board of Medical Examiners, the Federation of State Medical Boards and the American Board of Medical Specialties.
Of importance to MOL, the data revealed that over the last two years physicians have used mostly live CME and reading the medical literature as methods to improve the quality of their practice. While the respondents felt overall that all types of methods were either “somewhat useful” or “very useful” to improving the quality of their practices, they also reported that live CME and reading the literature offered the least amount of feedback about their performance in an educational setting or in actual practice.
Types of objective feedback methods include:
- Feedback direct from a live evaluator such as during clinical/ procedural simulation;
- Comparison of pre- and post-test results or test scores as found in online CME, case studies, structured clinical examinations or board examinations;
- Detailed information about each item-level response such as why it was correct or not;
- Immediate item-level responses with direction to relevant reference material as found in interactive online activities or self-assessment modules;
- Comparison to peers or benchmarks with PI CME or chart reviews;
- Suggested improvement activities; or
- A detailed report of findings such as from chart reviews or practice audits.
Respondents reported that when they received feedback from activities, it offered insight into their strengths and opportunities.
CME research suggests that if physicians are expected to change their practice as a result of what they learn in a continuing education activity, the activity should include an opportunity to first practice what they learn and receive objective feedback about their performance (JCEHP 2009, Moore et al.). The fact that physicians typically do not receive feedback from live CME conferences is not surprising given that CME design has not yet caught up to CME research; in-person conferences are held external to the practice setting, largely in a lecture format, and rarely offer physicians an opportunity to practice what was learned and receive feedback.
This is important information for the MOL initiative because an MOL framework based on a continuous learning and improving cycle will require physicians to participate in activities that provide feedback through self-assessments and objective assessments, so they can identify opportunities for improvement and choose learning activities accordingly.
Our future projects related to MOL will need to focus on providing clear communication about the requirements and continue to identify appropriate CME/CPD tools for physicians to choose. And, while traditional types of continuing education may still be effective, especially when they offer design characteristics such as interactive components, multiple exposures, and multi-format (AHRQ January 2007), CME providers will need to explore ways to integrate assessments and feedback in their programs or CME if they want to help support physicians with their MOL and/or MOC requirements.
The respondents were also queried about other things such as how much time and money they spend on continuing education. More than half (53.4 percent) revealed they dedicated 10 or more workdays to CME/CPD activities. Forty-one percent said they spend between $1,000 and $3,000 on these activities in a typical two-year period, with 16.2 percent indicating they spend more than $5,000.