Continuing Medical Education

1. Patient care

2. Medical knowledge

3. Practice-based learning and improvement

4. Interpersonal and communication skills

5. Professionalism

6. Systems-based practice

Several of these competencies speak directly to this issue of maintaining one’s ability to practice medicine competently after residency: practice-based learning and improvement, medical knowledge, and patient care.

The concept of a “learning curve” emerged to establish estimates of baseline proficiency for certain procedures.

ASCRS issued a position paper in 1994 that colorectal cancer should best be treated laparoscopically only if the surgeon was participating in a trial or a prospective registry that would allow the evaluation of results at a later date.
It was subsequently recommended that only surgeons who had performed at least 20 laparoscopic colon surgeries should attempt a laparoscopic colectomy for cancer with curative intent.

There is still a lack of a cohesive system to provide ongoing education for the practicing physician as well as lack of a defined curriculum and/or standards of accreditation.

CME, as defined by the Accreditation Council for Continuing Medical Education (ACCME), “constitutes educational activities that serve to maintain, develop, or increase the knowledge, skills, performance, and the relationships a physician uses to provide services for patients, the public, or the profession.”

There is little evidence to support the effectiveness of CME as it is currently structured to improve patient care or outcomes.

History of Ongoing Education

The first requirements for CME began in 1934.
CME remains the primary way that practicing physicians’ document and continue their education outside of the university setting.
State and territorial licensing boards require certain levels of completion of CME for recertification of their medical licenses.

CME Effectiveness on Practice Performance

While the majority of studies report positive outcomes regarding the impact of CME on prescribing, screening, guideline adherence, and others, slightly less than 30 % did not.
It is unknown which media was most effective for CME.
Multiple techniques are more useful than single techniques in achieving a positive impact on practice behavior, including:
- Academic detailing, audience response systems, case-based learning, clinical experiences, demonstrations, discussion groups, feedback, lectures, mentoring or preceptor programs, point-of-care techniques, problem-based learning, team-based learning, programed learning, readings, role play, simulations with standardized patients, and writing
Almost two-thirds of studies that used multiple exposures to CME met their objectives.

CME Effectiveness for Knowledge Application and Psychomotor Skills

Studies demonstrated effectiveness in improving knowledge application in the short term. Multiple exposures and longer duration led to better results.
Weak evidence suggests the methods studied all improved psychomotor skills.