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New CME guidelines advise paradigm shift in physician education

New evidence-based educational guidelines evaluate the effectiveness of current continuing medical education (CME) practices and provide the first set of recommendations on how those practices need to change in the future. Published in the March issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP), Effectiveness of Continuing Medical Education: American College of Chest Physicians Evidence-Based Educational Guidelines suggests the majority of CME is based on didactic education, the least effective form of adult education, where the physician-learner is not actively engaged in the learning process. This finding has prompted a strong recommendation for the entire medical community to offer CME that provides a more diversified set of instructional models, strategies, methods, and media. Furthermore, CME experts are calling for all CME providers and physician educators to adopt a consistent set of CME terminology, methodologies, as well as a standardized approach to CME research.

"CME as we know it today is entering a paradigm shift," said Lisa K. Moores, MD, FCCP, Co-Chair of CME Guidelines Panel. "Although lecture-based learning is effective when combined with other modalities, as a single mode of instruction it is the least effective form of learning for physicians. CME providers will need to acknowledge this shift in education and adapt their programs to reflect a more diverse learning experience."

The CME Guidelines Panel, consisting of a number of CME experts from the American College of Chest Physicians and the Association of American Medical Colleges (AAMC), evaluated all CME literature to determine what CME tools and techniques are most effective in improving physician knowledge and skills. Based on the literature, didactic education, including traditional lecture style teaching, as a single mode of instruction, was found to be the least effective form of learning, in terms of physician knowledge retention, skill application, and patient outcomes. In contrast, the most effective CME incorporates a diversified approach to education, utilizing a combination of multimedia, multiple instructional techniques, and multiple exposures to topic areas.

"By alternating didactic learning with other methods of instruction and multimedia, physicians may retain more information and be able to apply what they've learned more readily in a clinical situation," said Dr. Moores. Although a diversified approach to CME is advised, it is not clear which combination of these diverse modalities results in the most effective learning experience. "Additional research is needed to identify which combination of modalities, like simulation education, case-based learning, etc., provides the most impact."

However, CME research provides its own set of challenges. During the literature review process for the new guidelines, the guidelines panel discovered extensive variation in terminology used to define educational interventions, target audiences, learning objectives, content areas, and educational teaching methodologies. This variation has led to a lack of standardized CME approaches and CME research including research controls, making comparison difficult and quantitative syntheses impossible. As a result, the guidelines advocate for a more standardized approach to CME research made easier by the adoption of a consistent set of CME terminology and methodologies.

"The ACCP is to be applauded for its efforts in the area of CME," said John E. Prescott, M.D., Chief Academic Officer for the Association of American Medical Colleges. "Although the research in this field has been clear for two decades about the need for a changed model, this guideline confirms the importance of CME and its effect on changing provider performance--especially when it uses multiple teaching methods or truly engages the clinician. The Association of American Medical Colleges has similarly embraced new methods in--and the centrality ofa more robust presence for CME in the academic medical center, highlighted by its efforts in continuing education and performance improvement."

"Recognizing the impact of multi-modality education on knowledge retention and application, physicians should actively seek CME opportunities that provide a combination approach to education, rather than single-modality instruction," said James A.L. Mathers, Jr., MD, FCCP, President of the American College of Chest Physicians. "Likewise, CME providers and physician-educators should incorporate multiple instructional methods into their education programs and individual presentations." To download a copy of the new CME guidelines, visit


Contact: Jennifer Stawarz
American College of Chest Physicians

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