How to plan a CME intervention.

I missed the #CMEchat on Twitter this afternoon but instead indulged in some curatorial work on analysing the discussion points.

The chat was about the planning, resources, prioritisation and selection of interventions in a Continuing Medical Education programme.

I have roughly classified the responses to the questions about the various stages and their importance is based on the number of tweeps that voiced support or disagreement. I have also "translated" the language a little to make it a little less North American. :-)

In summary the tweeps at #CMEchat said:

• Educational planning starts in a number of places but primarily with the target audience and the identification of performance gaps. Priority in planning depends on the size of gap, the disease, cost, convenience and the overall aim of the programme.
• Resources are required for planning and this is a complex judgement. Multiple sources are used such as patient encounter data and expert opinion. Caution was expressed on the use of local experts and their views should be validated with other perspectives.
• Prioritising needs can be approached pragmatically by deciding how amenable certain gaps are to a CME intervention. "Areas [where] you can actually make a difference" should be prioritised.
• Selecting the most appropriate intervention involves a knowledge of the target audience's preferences and choosing interventions that directly support the objectives of the programme.

This ties in quite well with my perception and experience of planning educational interventions. What is lacking, perhaps. from the discussion is talk of theoretical frameworks. Previously 'adult learning' and 'Plan Do Study Act cycles' have been discussed but I don't feel these fully reflect the range of approaches that could be used.

The transcript is available on www.cmeadvocate.com and my summary of the themes is below.



T1 How / where do you begin your educational planning?


ask the audience ... "sometimes with target audience ... depends" @CuratioCME, "polling physicians & healthcare pros ... if they choose topics, they participate" @MedMarketingCOE, "base planning on participant evaluations" @FOREonline ... "ask which patients are problems" @YogAlicia3

performance gaps ... "begin with the gaps" @rmtyner, @CuratioCME, @KansasPCMH

industry ... "request from industry supporter" @pharmaguy, @CuratioCME

"a report will trigger you" @improvecme
"planning begins in several places" @meducate
"start planning as one year ends" @FOREonline
"process for identifying gaps" @meducate
"start with the end in mind" @spelletier
"course directors choose" @FOREonline

prioritization

"validate one person view for larger audience" @meducate
"size of gap and how common the condition" @YogAlicia3
"cost and convenience" @CommPharm
"start with the end in mind" @KansasPCMH


T2: Stage 2, how do you select the right planning resources? how do you know the limitations of anyone resource?

"multimodal" @meducate
"medical claims data" @CuratioCME
"planning process helps find appropriate data" @meducate
"faculty are nationally involved and take [things] into account" @FOREonline ... "KOLs are great when non-academic" @MedMarketingCOE (disagree ... @meducate, @CuratioCME, @CMEComplyQueen, @YogAlicia3)



T3: Stage 3, How do you prioritize needs? (perceived, real, impact, champions…etc.)

impact ... "most likely to impact patient care and integrate successful practice change" @YogAlicia3, "what can I impact today" @KansasPCMH, "areas you can actually make a difference" @SusanBConnelly "greatest need" @improvecme

"Quantitative + Qualitative x impact as a function of resources." @KansasPCMH
"tough ... needs vs. gaps confusion" @CuratioCME
"identify those gaps related to education" @SusanBConnelly


T4: Stage 4, in the same vein, how do you select the best mode of intervention? ---4 what audience?

ask the audience ... "preferred learning format" @CuratioCME, @YogAlicia3
supporting objectives ... "format supporting objectives" @meducate, "purpose" @KansasPCMH (disagree "format not helpful for working backwards" @SusanBConnelly)
focus ... "bite off smaller needs first" @improvecme "Very Good!" @CuratioCME
"little evidence for doing x impacts y" @cmeadvocate
"Methodologies are selected based on physician preferences, accessibility to learners, reach vs cost" @meducate

e-mail efficacy for CME adherence ... and patient communication

e-mail is a very familiar tool and it is clear from the way it is used by popular online services (PubMed, LinkedIn, Facebook, Twitter ...) that regular e-mails is one way of maintaining interaction with subscribers.

Many of the educational projects I've been involved in have employed some form of semi-automatic e-mail communication to encourage participation from learners.

It was interesting to read some recent papers that have looked at the relationship between engagement and e-mail communication. E-mail clearly has some efficacy but many questions remain. Is it the interactive nature of the content - perhaps in the form of clinical case problems (1) - or is it simply the critical timing of the reminder in the working week (2)? Is it the 'spacing effect' of the reminders with cycles of repetition built into the programme (3)?

There is evidence that email is effective in patient education in the form of weekly and monthly personalised emails (4). Some have even looked at assessing e-mail competencies of clinicians (5).


1. Kerfoot BP, Lawler EV, Sokolovskaya G, Gagnon D, Conlin PR. Durable improvements in prostate cancer screening from online spaced education a randomized controlled trial. Am J Prev Med. 2010;39(5):472-478. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20965387. Accessed April 13, 2011.

2. Houston TK, Coley HL, Sadasivam RS, et al. Impact of content-specific email reminders on provider participation in an online intervention: a dental PBRN study. Stud Health Technol Inform. 2010;160(Pt 2):801-805. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20841796. Accessed April 24, 2011.

3. Kerfoot BP, Fu Y, Baker H, et al. Online spaced education generates transfer and improves long-term retention of diagnostic skills: a randomized controlled trial. J. Am. Coll. Surg. 2010;211(3):331-337.e1. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20800189. Accessed April 24, 2011.

4. Thomas D, Vydelingum V, Lawrence J. E-mail contact as an effective strategy in the maintenance of weight loss in adults. J Hum Nutr Diet. 2011;24(1):32-38. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21114552. Accessed April 24, 2011.

5. Mittal MK, Dhuper S, Siva C, et al. Assessment of email communication skills of rheumatology fellows: a pilot study. J Am Med Inform Assoc. 2010;17(6):702-706. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20962134. Accessed April 24, 2011.

Qualitative analysis of #CMEchat

Took part in the 2nd #CMEchat yesterday which is every Wednesday at 11am EST on Twitter and, with a bit of regular expression wizardry (1), removed all the @ # and RT stuff from the Twittering.



http://www.wordle.net/show/wrdl/3463096/%23CMEchat_-_13-April-2011

Not sure what the Wordle says but, to me it looks like "good social Learning [in] CME" ... which I think it probably was.

Thanks to Brian McGowan for hosting it. There were 25 tweeps and 225 tweets.

Of course this Wordle is only a bit of a cheat really but I will have a look at the themes and the links to help communicate the discussion to audiences outside Twitter.




1) Regular Expressions in Notepad++ to find Twitter-related stuff.
hashtags
"\#[a-zA-Z0-9_:]* "
end of line hashtags
"\#[a-zA-Z0-9_:]*$"
tweeps' names
"\@[a-zA-Z0-9_:]* "