 | |
| Low density lipoprotein |
Evidence showing real changes in patient outcomes are rare, even
though that's the ultimate goal for most CME programs. A very nice
study, published in the Annals of Family Medicine, showed a change in
practice, and a positive change in patient outcomes after a CME program
(Kiessling, A.; Lewitt, M.; and Henriksson, P. (2011), Case-based
training of evidence-based clinical practice in primary care and
decreased mortality in patients with coronary heart diseases. Annals of Family Medicine, 9:211-218.).
CME on new Guidelines for Coronary Heart Disease
Practice guidelines in Sweden on the use of lipid lowering drugs were developed after the 1994 publication of the effectiveness of lipid lowering in coronary heart disease. In order to help general practitioners follow the new guidelines, a series of CME programs were developed. The training was designed to be interactive and to "activate" learners. They felt that a case-based method was the most effective way to activate the learners and help them improve the sills and attitudes needed for decision making.
CME Design
All participants were mailed a copy of the new guidelines. The instruction began with a lecture deliverd by a specialist. This was followed by a series of seminars, delivered over the next two years. Physicians participated in 1-2 cases each year, in groups of 4-7 people. The cases were designed to be simple and well-organized, and presented a problem without an obvious correct answer. The seminars were one hour each and consisted of the case presentation, followed by interactive problem-solving, with a thorough discussion of the pros and cons of various decisions. Physicians in the control group only listened to the lecture.
Results
This seemingly simple design resulted in changes in practice, that at two years, had significantly reduced patient's low-density lipoprotein cholesterol levels compared to a control group.
Ten years later, the mortality rate of the control group was 44%, while mortality in the intervention group was 22%. That's right, ten years later, patients whose doctors went through a few interactive cases with an specialist, had half the mortality of patients whose doctors listened only to a lecture and read the guidelines.
What Happened?
The results of this study are pretty amazing. Long -term effects are very hard to find in education studies. It's very rare to see a study looking at an effect over a few months, let alone years, but there are a few things that we see with other kinds of successful CME that may be giving us a hint about why this worked so well.
CME on new Guidelines for Coronary Heart Disease
Practice guidelines in Sweden on the use of lipid lowering drugs were developed after the 1994 publication of the effectiveness of lipid lowering in coronary heart disease. In order to help general practitioners follow the new guidelines, a series of CME programs were developed. The training was designed to be interactive and to "activate" learners. They felt that a case-based method was the most effective way to activate the learners and help them improve the sills and attitudes needed for decision making.
CME Design
All participants were mailed a copy of the new guidelines. The instruction began with a lecture deliverd by a specialist. This was followed by a series of seminars, delivered over the next two years. Physicians participated in 1-2 cases each year, in groups of 4-7 people. The cases were designed to be simple and well-organized, and presented a problem without an obvious correct answer. The seminars were one hour each and consisted of the case presentation, followed by interactive problem-solving, with a thorough discussion of the pros and cons of various decisions. Physicians in the control group only listened to the lecture.
Results
This seemingly simple design resulted in changes in practice, that at two years, had significantly reduced patient's low-density lipoprotein cholesterol levels compared to a control group.
Ten years later, the mortality rate of the control group was 44%, while mortality in the intervention group was 22%. That's right, ten years later, patients whose doctors went through a few interactive cases with an specialist, had half the mortality of patients whose doctors listened only to a lecture and read the guidelines.
What Happened?
The results of this study are pretty amazing. Long -term effects are very hard to find in education studies. It's very rare to see a study looking at an effect over a few months, let alone years, but there are a few things that we see with other kinds of successful CME that may be giving us a hint about why this worked so well.
- Learning over a period of time. It takes time to learn new skills and new habits. Physicians in this study had two years of exposure to this material. This repeated exposure may well have helped these doctors incorporate the new guidelines into their daily practice.
Interactive and problem focused. The cases were designed so that they didn't have clear or obvious answers, and participants were given the chance work their way through all of the nuances of these cases, including "defining and valuing the pros and cons, and feasibility of different decisions." One of the problems with presentations by experts is that they don't let learners work through these important details themselves.
No comments:
Post a Comment