After spending last week at the ACFAS science conference and gearing up for a full season of conferences, it makes me wonder: What does the evidence support as the best method of delivering continuing medical education? Is the current format in which we sit for multiple lectures over a day appropriate? Is there another way?

A couple of general comments to start this off. First, it’s important to know that we’re dealing with the concept of androgogy (adult learning) as opposed to pedogogy (children’s learning). Adults learn quite differently than children. Second, for a reason I cannot figure out, there seems to have been a lot of research on the subject of best CME methods in medicine during the 1990s, which then tapered off in the early 2000s, and I had a tough time finding anything current (within the last five years). If anyone interested in this subject knows of more current literature, please write in.

Third, here are some of the most common options for teaching adults from my perspective (as a person who spends a lot of time teaching adults):

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“The real outcomes we should be looking at to determine the effectiveness of a CME method are improved physician performance and improved patient outcomes. ”

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Fourth, it’s important to mention that the real outcomes we should be looking at to determine the effectiveness of a CME method are improved physician performance and improved patient outcomes.

Final preliminary comment: During my literature search, I was able to find exactly zero studies directly involving podiatrists. We’ll have to extrapolate a little from studies of other medical providers.

Does our current conference format make sense? Let’s see what the evidence has to say.

In 1992, Davis and colleagues performed a systematic review of 777 CME-related studies, narrowing this down to 50 randomized controlled trials with specific inclusion criteria (had an experimental and control groups, a replicable description of the educational activity, physicians making up 50% or more of the groups, some objective evaluation of outcomes, and appropriate assessment and follow-up). Of these 50 studies, 32 evaluated physician improvement and seven looked at patient outcomes. Eleven studies evaluated both measures.

The researchers found that the most successful general strategies to improve physician performance were those that incorporated knowledge testing, “rehearsal” (think simulations) and practice needs assessment. These more intensive education methods were found to be more effective than passive didactic methods¹.

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“Interactive education methods are more effective than passive didactic methods”

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Several years later, in 1999, these same primary researchers performed another systematic review of randomized controlled trials covering the years 1993 to 1999 to see if formal CME interventions again improved physician performance and patient outcomes. Looking at 14 studies that fit their criteria, they stated, “Our data shows some evidence that interactive CME sessions that enhance participant activity and provide the opportunity to practice skills can effect change in professional practice and, on occasion, health care outcomes.” They went on to state that didactic sessions are not effective in changing physician performance².

Based on research findings such as these, in April 2000, nine organizations committed to providing physician education, held a summit and discussed several CME-related topics. Their overall conclusions were that physician CME should focus on learning at the point of care (essentially in the clinic at the time a doctor has a clinical question) and use technology to more effectively address adult problem-based learning needs³.

A few years later, in 2005, Bloom performed a systemic review of systematic reviews (how about that for convoluted!) covering the years 1986 to 2004. He found 26 reviews that fit the search criteria (systemic reviews and metanalyses of CME programs that included physician behaviors and/or patient outcomes as primary endpoints). As with the above studies he found that interactive educational techniques were most successful at improving physician behaviors and patient outcomes, while didactic presentations and distributing written information have “little or no effect in changing physician behaviors"⁴.

So, based on all these reviews should we just scrap our conferences and large CME events? I don’t think so.

Yes, passive educational methods like the didactic lecture are our least effective methods of teaching adult healthcare providers, but we also must keep in mind that there is more to a conference than just the lectures. None of these studies seemed to take other benefits of conferences in mind, such as networking opportunities, workshops, or interactions with industry.

Additionally, these studies do not take into consideration the current environment of regulations on physicians forearning andreporting CME. For instance, I have a medical librarian at my university that assists with our journal clubs. If I have a clinical question, I can utilize her to help me find answers at the point of care. This is good for me, and the research above has shown this is an effective method to improve outcomes, but I get no CME credit applied to my state requirements. As long as government regulations remain as they are, the large CME conference must be our method of choice.

The answer lies, in my opinion, with making three primary changes:

There are so many options to obtain quality CME that is evidence-based. It just takes a little creativity and a lot of will to change. These methods will likely be challenging to conference organizers and perhaps even more expensive at first. But as we begin to upscale these changes we’ll see it will become easier, more profitable, and physicians and patients will benefit greatly.