As I have mentioned before, practicing medicine requires a lot of study following graduation. Most physicians use a combination of methods to attempt to stay current. On of the more common is the medical meeting or what’s known as CME. The format of CME lectures are governed by an accreditation body (ACCME). To put on an accredited CME you have to show evidence of planning, meeting the needs of the audience, and demonstrating at some level that your program accomplished something. In addition, the presenter has to not have a vested interest in anything mentioned in the presentation.
This came up in two separate contexts recently. The first was at the Alabama Academy of Family Physicians meeting at the end of June. Each of the Family Medicine Residency Programs in the state were asked to give 4 hours worth of information to the practicing physicians in the state. John Waits from Tuscaloosa was going to offer a timely presentation on the changes in the periodicity of cervical cancer screening, Timely not only because recommendations have changed but also because physicians in practice are not following the updated recommendations. This would have been a timely talk, that is, until Dr Robert Bentley showed up. As those of you in Alabama know, Dr Bentley is running for governor. He took up our pap smear time with a discussion of the need to fight Obamacare. I only hope those in attendance look elsewhere for the clinical (and political) information.
Secondly, is a project that I am working on with the Mitchell Cancer Institute and the Alabama Department of Public Health to reduce deaths from colon cancer. Although we are still analyzing the data, one of the things we found is that physicians think they know more than they know. We also found that they believe they use the most inefficient way of learning (primary medical literature) much more effectively than they actually do. When studied, it appears that physicians learn best through multiple techniques. Activities that work best are those which include case-based learning as a component of the curriculum. These types of courses were more likely to improve knowledge when compared to a single technique. Case-based learning is an educational technique where actual or authored clinical cases are created to highlight learning objectives; clinical material is presented and followed with questions usually determined by the instructor. This works better over time if additional session are included. These sessions typically use print media, computer media, a repeat live performance, or audio tape to reinforce content. The evidence suggestes that these multiple exposures produce better knowledge gains.
In other words, changing physicians behavior requires more than just a single paper or lecture. It requires a concerted effort to make sure that the correct information is placed in front of practicing physicians again and again. It works even better if that information is followed by measurement to see if improvements take place. Best yet is if physicians are rewarded for delivering excellent care. Not so good if the efforts at education are interrupted by a paid political announcement.