CME: "Shadows & Dust"

CME: “Shadows & Dust” 

In this line from the movie “Gladiator” Proximo the gladiator trainer tells the General (Maximus) that his perspective and vision of Rome wasn’t consistent with reality, urging him just to accept things the way they were because after all, “we mortals are but mere shadows & dust Maximus, just shadow & dust”.

In keeping with the theme above, is our perspective of CME obscured by shadows & dust? Shadows & dust (as well as smoke and mirrors) certainly seem to obscure our view when it comes to CME. A common thought in EBP is that CME is not effective in changing clinical behaviors. I know myself and many of my colleagues have touted this as being fact. This tenet is based on a 1995 systematic review of the topic published in JAMA by Davis et al. and comes right out of the Sackett EBP text.

OK, I have to ‘fes up here: I have been spouting off that CME is not very effective for quite some time now when actually I haven’t really sufficiently read about the topic (shadows) and had just been repeating what my esteemed mentors and colleagues had been expounding (dust). In fact, I just got through saying that very thing this weekend (while doing what else…..teaching a CME course!), always couching my comments that our approach was different and challenging the participant to be different also. Well, a systematic review of the same topic published in JAMA in 1999 by the same Davis DA caught my eye because the conclusions were somewhat different than those published previously.  Upon further reading of both articles (always a good thing), here is the BLUF (bottom-line-up-front):

Download EducationalCMEDavisJAMA1995.pdf

Download EducationalCMEDavisJAMA1999.pdf

1. Traditional CME activities consisting primarily of didactic lecture and conferences do little to change practice behaviors

2. There is some evidence that CME sessions that are interactive and provide and opportunity to practice skills can effect change in professional practice and, in some cases, change health-care outcomes.

3. The earlier 1995 study had found certain interactive educational methods to have some measure of effectiveness, which I would have known about had I bothered to read the study more fully.

4. We can only assume that these findings generalize to physical therapy as these studies pertained to physician CME. We need pragmatic educational research dealing with physical therapy CME….takers, anyone?

 Hey, what can I say? That’s why this thing is called Evidence in Motion…..something is always changing. And that is also why we need EBP….to lighten the shadows and clear the dust a bit. Getting back to CME for a minute. It appears that CME that includes an interactive format is capable of changing practice behaviors in some instances. If that is the case, don’t we want to let the next shoe drop and insist that any changes in practice behavior result in better outcomes? Yet another case for evidence-based CME, and I mean the real-deal and not the plethora of “Poser” courses you see today being advertised as such.

 By the way, have you had any good EBP CME lately?

Rob

Comments

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