Evidence Based CME Credit

Transcription

1 Evidence Based CME Credit Mindi K. McKenna, PhD, MBA CME Division Director American Academy of Family Physicians

2 SUMMIT LEARNING OBJECTIVES Describe how CME has evolved from expert opinion to evidence-based medicine. Identify impending changes in how CME credit is likely to be awarded in the future. Recognize how to ensure that CME programming is independent, regardless of the funding source. Describe how Maintenance of Certification and Maintenance of Licensure will demand specific processes and outcomes for CME in the future. Define advantages and disadvantages of providing continuing education for physicians without CME credit. Summarize accreditation expectations for CME providers.

3 Conjoint Committee 2005 Dashboard 4.1 Design and deliver CME based on current and emerging best evidence, physician expertise and patient values. (CME is NOT just about offering activities, it is about facilitating continuous measurement and improvement of performance in practice)

4 SESSION OBJECTIVES Following this session, participants should better understand: How the nation s 3 CME credit systems are evolving to assure that CME activities are evidence-based: Content is based upon best-available evidence Activities are developed via EB educational design Learners are informed about the sources and levels of evidence for the CME Implications for CME providers and learners

5 EVIDENCE: scientific, factual, objective, measurable, empirical, externally validated (ev -i-dens) n. 1. That which is helpful in forming a conclusion or judgment for and against a hypothesis. 2. Indicative; an outward sign. 3. Clearly indicated, exemplified or proven.

6 BASED: derived from, designed or built upon (bāst) adj. Having as its basis: paper-based In or at a specified source: Chicago-based

7 CONTINUING: Ongoing, iterative, unending (ken-t in-yoo-ng) v. 1. To remain, last, persist, exist, over a prolonged period. 2. To carry on or resume after an interruption. 3. To extend.

8 MEDICAL: clinical practice, patient care (med i-kel) adj. 1. Of or relating to the study or practice of medicine. 2. Requiring treatment by medicine.

9 EDUCATION: teaching, learning and improvement, continuing professional development (ej e-ka-jen) n. 1. The act or process of educating or being educated. 2. Knowledge or skill developed by learning. 3. A program of instruction. 4. The pedagogy of teaching and learning. 5. An instructive or enlightening experience.

10 Evidence-Based Medicine the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research." Sackett D. Evidence-Based Medicine Working Group Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine JAMA 1992;268(17):

11 The nation s 3 credit systems (AAFP, AMA, AOA) strive to assure that CME is evidence-based, in both content and design

12 Evolution of CME present future Traditional CME EB CME (2002) Pt of Care CME (2005) PI CME (2005) Culture of Improvement

13 AAFP AAFP founded the nation s 1 st CME credit system in 1948 with enduring commitment to education that improves patient care. In 2002, the AAFP launched EB CME as a new credit category for activities that met specific EB criteria; offering 2-for-1 credit for those activities, to convey their importance and value. The AAFP recommends using EBM sources that consistently conduct comprehensive systematic evidence reviews appraised and summarized according to predetermined criteria. As of 2011, the AAFP no longer awards 2-for-1 CME credit for EB CME, advocating that all educational activities which qualify for AAFP CME Prescribed Credit should be based upon bestavailable evidence, in content and design.

14 Learners are informed of the sources and levels of the evidence

15 Strength-of-Recommendation Taxonomy (SORT) Grades Strength A B C Basis Consistent, good-quality patient-oriented evidence* Inconsistent or limited-quality patient-oriented evidence* Consensus, disease-oriented evidence,* usual practice, expert opinion, or case series for studies of diagnosis, treatment, prevention or screening * Patient-oriented evidence measures outcomes that matter to patients: morbidity, mortality, symptom improvement, cost reduction, and quality of life. Diseaseoriented evidence measures intermediate, physiologic, or surrogate end points that may or may not reflect improvements in patient outcomes (e.g., blood pressure, blood chemistry, physiologic function, pathologic findings). Source: Ebell MH, Siwek J, Weiss BD, Woolf SH, Susman J, Ewigman B, et al. Strength of Recommendation Taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. Am Fam Physician 2004;69:

16 Evidence for physician core competencies Patient Care Medical Knowledge Practice Based Learning & Improvement Interpersonal & Communication Skills Professionalism Systems-Based Practice

17 Learners are equipped to assess relevance for practice in light of their clinical expertise and their patients needs

18 AMA Educational content of certified CME Core requirements for certifying activities for AMA PRA Category 1 Credit Requirements specific to each learning format AMA Sources of Evidence Task Force

19 CME activities address evidence-based learning needs & practice gaps

20 AOA AOA Sponsor s guidelines policy on EBM and EB CME 2.1 Quality Guidelines for CME Programs The program shall focus on the needs of the participants, address the AOA seven core competencies, and utilize evidence-based medicine Educational Standards and Practices Needs Assessment 4. The needs assessment must be documented at least one source must be evidence based.

21 EB CME Systems Approach Model (D.Burkhart, PhD, 3/3/11) Evaluation and Follow-up Feedback Start here Needs Assessment Collect Baseline Data (for Outcomes Measurement) Set Environment (time/place) Establish Budget and Resources Tie Methodologies to objectives Set Agenda Set objectives for target audience

22 Evidence-Based Sources: Free Access Agency for Healthcare Research and Quality (AHRQ) Bandolier Canadian Task Force on Preventive Health Care Cochrane Database of Systematic Review (Abstracts) Database of Abstracts of Reviews of Effects (DARE) Effective Health Care Entrez-Pub Med (Medline, NIH and National Library of Medicine) Institute for Clinical Systems Improvement (ICSI) National Center for Complementary and Alternative Medicine National Guideline Clearinghouse (NGC) U.S. Preventive Services Task Force (USPSTF)

23 EB Sources: Subscription Required Clinical Evidence -- BMJ Publishing Cochrane Database of Systematic Reviews (complete reviews) DynaMed EBM Online / Evidence-Based Medicine Essential Evidence Plus Natural Medicines Comprehensive Database Natural Standard PEPID Physicians' Information and Education Resource (ACP s PIER) UpToDate

24 Sample of EB CME references Mann KV. Theoretical perspectives in med ed: past experience and future possibilities. Med Educ Jan;45(1):60-8. Clinical Data as the Basic Staple for Health Learning Workshop Summary. IOM Feb. Patel et al. Towards effective evaluation and reform in med ed: a cognitive and learning sciences perspective. Adv Health Sci Educ Theory Pract Dec;14(5): Mazmanian et al. CME effect on clinical outcomes. American College of Chest Physicians Evidence-Based Educational Guidelines. Chest Oct; 136(4):1191. Mann KV. Reflecting on the challenges facing CME today. Med Educ. 2005;39: Knox et al. Organization development strategies for CME. JCEHP Winter;15-23.

25 Info for EB selection of learning formats Effectiveness of CME: American College of Chest Physicians Evidence-Based Educational Guidelines. Chest Mar Supplement;135(3):17S-68S. (several articles) Marinopoulos SS et al. Effectiveness of CME. Evid Rep Technol Assess Jan;(149):1-69. Curran & Fleet. A review of evaluation outcomes of webbased CME. Med Educ Jun;39(6): Olson & Shershneva. Setting quality standards for web-based CME. JCEHP spring;24(2): Mann. Educating medical students: lessons from research in CE. Acad Med Jan;69(1):41-7.