Abstract: Continuingmedicaleducation (CME) is meant to not only improve clinicians ’ knowledge and skills but also lead to better patient care processes and outcomes. The delivery of CME should be able to encourage the health providers to accept new evidence- based practices, and discard or discontinue less effective care. However, continuing use of expensive yet least effective and inappropriate tools and techniques predominates for CME delivery. Hence, the evidence shows a disconnect between evidence-based recommendations and real-world practice – borne out by less than optimal patient outcomes or treatment targets not being met especially in low- to middle-income countries. There is an ethical and professional obligation on CME-providers and decision-makers to safeguard that CME interventions are appraised not only for their quality and effectiveness but also for cost- effectiveness. The process of learning needs to be engaging, convenient, user-friendly and of minimal cost, especially where it is most needed. Today ’ s technology permits these char- acteristics to be integrated, along with further enhancement of the engagement process. We review the literature on the mechanics of CME learning that utilizes today ’ s technology tools and propose a framework for more engaging, ef ﬁ cient and cost-effective approach that implements massive open online courses for CME, adapted for the twenty- ﬁ rst century. Keywords: continuingmedicaleducation, health care, learning management system, massive open online courses, non-communicable diseases
Background: General practitioners (GP) update their knowledge and skills by participating in continuingmedicaleducation (CME) programs either in a traditional or an e-Learning format. GPs ’ beliefs about electronic format of CME have been studied but without an explicit theoretical framework which makes the findings difficult to interpret. In other health disciplines, researchers used theory of planned behavior (TPB) to predict user ’ s behavior. Methods: In this study, an instrument was developed to investigate GPs ’ intention to use e-Learning in CME based on TPB. The goodness of fit of TPB was measured using confirmatory factor analysis and the relationship between latent variables was assessed using structural equation modeling.
Abstract: This article describes five major themes that inform and highlight the transformation of continuingmedicaleducation in the USA. Over the past decade, the Institute of Medicine (IOM) and other national entities have voiced concern over the cost of health care, prevalence of medi- cal errors, fragmentation of care, commercial influence, and competence of health professionals. The recommendations from these entities, as well as the work of other regulatory, professional, academic, and government organizations, have fostered discussion and development of strategies to address these challenges. The five themes in this paper reflect the changing expectations of multiple stakeholders engaged in health care. Each theme is grounded in educational, politico-economic priorities for health care in the USA. The themes include (1) a shift in expectation from simple attendance or a time-based metric (credit) to a measurement that infers competence in performance for successful continuing professional development (CPD); (2) an increased focus on interprofes- sional education to augment profession-specific continuingeducation; (3) the integration of CPD with quality improvement; (4) the expansion of CPD to address population and public health issues; and (5) identification and standardization of continuingeducation (CE) professional competencies. The CE profession plays an essential role in the transformation of the US CPD system for health professionals. Coordination of the five themes described in this paper will foster an improved, effective, and efficient health system that truly meets the needs of patients.
valued by GPs engaged in predominantly rural practice. The benefits of regular contact with a small group of colleagues through attendance at locally-based CME meetings go well beyond the education received. There are clear gains in wellbeing, including relief of stress, boosting of morale, and alleviation of professional isolation. This is of relevance because, aside from benefits for recruitment and retention of rural GPs, there is evidence of a clear link between the wellbeing of doctors and the experiences of their patients. 49 It is proposed that this method of educational delivery should be
Does classroom engagement matter? A meta-analysis of the effectiveness of ContinuingMedicalEducation (CME) found that lectures had no impact on clinician performance or patient outcomes, even though they may increase knowledge short-term . However, interactive teaching had a small effect on professional performance and on occasion, healthcare outcomes, i.e. a positive impact on patient care. It has been suggested that physi- cians get most from CME if their learning is self-directed and derived from true-life clinical settings –difficult to achieve in a lecture-based programme, but more realistic with TBL. Further, evidence suggests that bored learners learn less deeply , and that learners in a positive mood have improved recall  and working memory for words . If we want learners to learn and retain more, increas- ing engagement will help.
1. Pediatric continuingmedicaleducation (CME) providers and departments of pediatrics are encouraged to make training in global health available to pediatricians and trainees. Topics include the global burden of disease; immigrant and refugee health; patient communication through interpreters; social determinants of health; cultural humility; global child health disparities; disaster management; travel and tropical medicine; population health, including strategies for prevention and treatment of common diseases; and ethical considerations, including the ethics of short- term international medical missions and international research. Although some topics are regularly included in courses offered by CME providers, gaps exist, and topics are frequently addressed without a global health framework.
The skills of primary care physicians (PCP) in detect- ing and managing COPD are of great importance for patients . Continuingmedicaleducation (CME), tai- lored to the needs of primary care, may be an important tool to improve guideline adherence and implementa- tion. The effectiveness of CME is largely dependent on how well suited the design and content of the educa- tional programme are to the target group. Effectiveness can be measured by way of three aspects: competence, performance, and patient health status . A decline in effectiveness with regard to these three aspects has been previously shown and it has been deemed adequate at best . However, educational outreach visits appear to improve care , are feasible at primary care settings and are well received by care professionals when heavy workload and time constraints often lead to poor attend- ance at CME sessions outside the workplace (Berggren, E. In manuscript). A didactic educational style involving lectures and textbook instruction instead of hands-on training, have been the norm even in advanced training for physicians. However, in the last few decades, inter- active CMEs have become more common. Today, it is widely accepted that a combined approach involving both interactive and didactic forms of education is more effective than either of these on their own .
BPSD: Behavioural and psychological symptoms of dementia; CMAI: Cohen- Mansfield Agitation Inventory; CME: Continuingmedicaleducation; CRF: Case report form; DSS: Dementia Screening Scale; EPA: Experts for person-centred care for the elderly; EPCentCare: Effect of person-centred care on antipsychotic drug use in nursing homes (acronym of the study); GP: General practitioner; ICCC: Intra-class correlation coefficient; ICER: Incremental cost-effectiveness ratio; ICH-GCP: International Conference on Harmonisation — good clinical practice; PCC: Person-centred care; PRN: Pro re nata ( “ when required ” ); QoL: Quality of life; QoL-AD: Quality of life in Alzheimer ’ s disease.
Strategy: conduct educational meetings with clinicians Five projects additionally conducted educational meetings, targeted to clinicians to teach them about the clinical innovation . IU presented study training programs to the health system senior leadership team, which included clinical and non-clinical administrative personnel, and training programs for the IU School of Medicine Resident and Fellow faculty leaders. IU also held in-person meet- ings (with repeat educational sessions due to provider turn-over), conducted journal clubs, and held a day-long continuingeducation (CE)/continuingmedicaleducation (CME) conference/workshop to educate clinicians about pharmacogenomics and the potential to improve patient outcomes. Mount Sinai described how they joined existing clinician meetings held at the fifteen participating clinic sites/practices to describe APOL1, genomics, and the study and answer provider questions about testing and returning results. UF planned meetings with various levels of stakeholders to ensure understanding and engagement throughout. UM conducted monthly group meetings with clinicians, divisional and departmental grand rounds, ex- ternal lectures, and educational outreach visits with two genetic counselors to facilitate implementation at different sites. The Vanderbilt study team met with providers, pa- thologists, and IT representatives in person on location at I 3 P sites as well as through virtual meetings to educate and facilitate implementation by having a discussion to bring new ideas to the table, learn about new hurdles and try to come up with solutions.
Nine volunteer GIM clinician-educators at an academic health center participated in a 6-month POCUS cur- riculum with a goal of developing core faculty for a resi- dency program. Faculty did not receive protected time from other duties. Figure 1 illustrates the structure and content of the faculty development curriculum, includ- ing elements that were eligible for continuingmedicaleducation (CME) credit. The introductory workshop was required, but all other curricular elements were volun- tary. Subsequent lectures and workshops were scheduled to accommodate as many participants as possible. Before these sessions, participants were asked to review relevant online modules from free open-access medicaleducation resources. Modules were typically 10–15 min in dura- tion. In-person didactics were recorded and posted to an online learning management system for asynchronous
Purpose: Viral hepatitis B and C represent the primary health challenge confronting Asia and Pakistan. With direct-acting antiviral therapy for hepatitis C, patients will be treated by general physicians (GPs) and will need training through continuingmedicaleducation (CME). Blended learning is a combination of didactic teaching with online, self-paced learning, and it has not been evaluated as a CME tool for general physicians. We aimed to compare the change in physician’s knowledge about chronic viral hepatitis following a blended learning educational program. Methods: Participants enrolled in a 6 week blended learning program comprising three mod- ules, each of 2 weeks duration. These were: 1) epidemiology and prevention of viral hepatitis; 2) diagnosis and assessment of hepatitis; and 3) treatment of hepatitis. Activities were primarily web based with some face-to-face interactive sessions. All study material was available on the Teach - Pak website. Discussions, questions, and comments were encouraged. An overall pre- and postintervention knowledge assessment was performed, in addition to individual module assessments.
Prior to the initiation of the MATCH trial, GH had communicated elements of the STarT Back approach to all clinicians via a one-time video-webcast continuingmedicaleducation (CME) presentation. This optional 45-min presentation briefly described the STarT Back tool and how to access it in the electronic health record (EHR) as well as GH’s new clinical guidelines for low back pain. This initial version of the STarT Back tool was similar but less well-developed than the one used in the intervention. Neither primary care clinicians nor physical therapists received any training or support to implement the STarT Back approach. Not surprisingly, very few clinicians began using the STarT Back tool fol- lowing this minimal and passive CME approach and it is not clear if those who did use it were recommending treatment options appropriate for the patients’ risk level. Funding for the MATCH study provided GH an opportunity to conduct a trial to evaluate full implemen- tation of the STarT Back approach in the form of a mandatory quality improvement (QI) initiative. This manuscript describes the development and implementa- tion of this QI strategy and the protocol for evaluating its effectiveness. The goal of this initiative was to give primary care providers (PCPs) and physical therapists (PTs) the knowledge, tools, and confidence they needed to provide their patients with a broader understanding of their back problem, reassurance that their condition would likely improve, and provide treatment options most likely to be helpful. We hypothesized that this QI intervention would improve patient outcomes by pro- moting the increased use of effective treatment options that address patients’ needs.
The essential purpose of the Faculty Development Programs (FDP) is to empower the competencies of faculties in teaching six core competences suggested by the Accreditation Council for Graduate MedicalEducation (ACGME). 1 FDP can lead to more effective education. It also improves the ability of professors to respond to students ’ educational challenges. 2 The use of e-learning in medicaleducation,which is increasing today and is expected to become more promising in the future, can accelerate the use of adult learning theory and change the role of teachers as content providers in order to facilitate learning, competences training, and assessment. 3,4 Electronic learning (e-learning) responds to learner needs, is ﬂ exible, and allows for individual learning. It also enhances re ﬂ ection thinking and autonomy in learning. 5 Web-based ContinuingMedicalEducation (CME) programs are growing worldwide and have proven to be more effective than traditional ones. 6,7
Acupuncture and moxibustion are more integrated in the Chinese healthcare system than in the national healthcare systems of other countries. Development of acupuncture and moxibustion in China is making progress in this field. For overseas researchers, this commentary offers perspectives on the current status of acupuncture and moxibustion in China and examines relevant opportunities and challenges in healthcare reforms. There has been a steady increase in the number of undergraduates and postgraduates studying acupuncture and moxibustion in Chinese Medicine (CM) universities in China over the past decade. The legislation of CM physicians that was established in 1999 and the launch of continuingmedicaleducation in CM in 2002 have ensured the basic competency of practitioners. The Chinese Government has also shown support for CM development by increasing investment in related fields of research and administration. New challenges have emerged as the healthcare landscape in China has evolved over the past decade. It is important to harness the potential of acupuncture and moxibustion to create a value-driven healthcare system that meets the health needs of a rapidly aging society.
Our study was conducted in a large group model prac- tice with experience using a shared EHR, where all phy- sicians are paid on salary, not on a relative value unit production system. This is an ideal setting for demon- strating how virtual peer-to-peer consultations using a secure electronic messaging system can potentially create bridges between often siloed care settings. Systems changes will be necessary in different healthcare environ- ments for VCs to realistically occur. For example, in sys- tems without integrated EHRs or in academic health centers providing consultation for rural or distant pri- mary care physicians, mechanisms for efficient sharing of medical records (including HIPAA compliance) need to be developed. In systems where consultants are paid on a fee-for-service or production model, incentives would need to be provided for consultants to ‘accept’ virtual consults. However, as EHRs are slowly becoming more common, and data-sharing standards between different EHRs are being developed, we feel that our preliminary findings can inform care integration efforts in different care settings.
The SARA methodology has effectively been used in resource-limited countries to assess: general health facil- ity readiness , progress towards universal health coverage , maternal and child health services and non-communicable diseases in Bangladesh [33, 34], sur- gical services in Africa , and readiness of Ugandan health services for the management of outpatients with chronic diseases . That said, based on a rigorous internet-based review of literature search, there are no studies that have been conducted to assess the readiness of public health facilities to provide geriatric friendly ser- vices in low- and middle-income countries. In the same line, the WHO building blocks approach enables an as- sessor to evaluate the six critical pillars for health service delivery: leadership and governance, health financing, health service delivery, human resources for health, medical products, logistics and technologies, and health management information systems (HMIS)  (Fig. 1).
The study was sponsored by Chinese Parkinson’s Disease & Movement Disorders Society, Neurology Branch of Chinese Medical Association. From November, 2010 to July, 2011, questionnaires were randomly distributed to doctors attending National Neurological Congress, sev- eral Provincial Conferences or CME courses of PD held in Beijing, Shanghai, Chongqing, Guangzhou, Zheng- zhou, Nanning and Hangzhou, respectively. In this sur- vey, we classified the congress participants into three categories by their specialties and sub-specialties: A movement disorders specialist is a neurologist who has taken additional training in the subspecialty in neurology called movement disorders (as compared to other sub- specialties in neurology) and regularly attends the move- ment disorders clinics; A neurologist who specializes in general neurology rather than movement disorders, is classified as general neurologists; Physicians are the doc- tors who did not work in neurology department, includ- ing general physicians and internal medicine specialists. While family physicians were not included in this survey.
Much disability results: the estimated productivity losses to headache in Russia account for 1.75% of gross domestic product (GDP) . Clearly these statistics signal very substantial and unmet health-care needs of people with headache in Russia. While the health-care needs of people with headache are to a large extent unmet in all countries of the world , in Russia there are particular reasons for this beyond the high prevalence of these disorders. The prevailing view among the majority of Russian primary- care physicians (PCPs), and many neurologists, is that headache signals an organic brain lesion [12,13]. In conse- quence, almost all patients who complain of headache are referred, mostly unnecessarily, for investigations and/or neurological consultations  – a practice reinforced by official “standards” [15,16]. This is obviously wasteful  but, worse, the non-specific and clinically unimportant changes often found on investigations are interpreted as evidence of organic brain lesions. Patients then receive er- roneous and sometimes arcane diagnoses such as “dyscir- culatory encephalopathy” or “autonomic dysfunction with headache paroxysms” [12,13]. These unhelpful practices are reinforced by the system of obligatory medical insur- ance, whereby such diagnoses provide not only the right to extended sickness benefit for the patient but also enhanced reimbursements to the treating institution. Furthermore, these erroneous diagnoses lead to treatment not with medi- cations effective for migraine or TTH but with inappropri- ate vasoactive, nootropic or venotonic agents .
At present, China encounters such healthcare problems as GPs’ insufficiency [4, 5], under-qualified personnel [6 – 11], uneven distribution [12, 13], and serious brain drain [14 – 16]. Thus the field studies and policy strategies focusing on in GPs’ human resource equity are of great importance to ensuring the quantity and quality of GPs in China. In March, 2010, the National Development and Reform Commission (NDRC), the National Health and Family Planning Commission (NHFPC), the State Commission Office of Public Sectors Reform (SCOPSR), the Ministry of Education (ME), the Ministry of Finance (MF), the Ministry of Human Resources and Social Security (MHRSS) jointly issued the Construction Planning of GP-Focused Primary Health Care Teams, which consisted of three major tasks of culti- vation, employment and management to have built a com- munity of 300,000 across the country by 2020 to address the requirements of primary health care . Hereinto, an emphasis was placed on the establishment of ability-and- performance-oriented and social-recognition-focused mechanism of qualification evaluation targeted at the pri- mary care personnel, because such an endeavor would help reduce inequity of health workforce in the provision of primary health care.