This post courtesy of Anne Taylor-Vaisey:

Here’s a promising article from the November 2004 issue of the Journal of Clinical Nursing:

Rycroft-Malone J, Harvey G, Seers K, Kitson A, McCormack B, Titchen A. An exploration of the factors that influence the implementation of evidence into practice. J Clin Nurs. 2004 Nov;13(8):913-24.

Background. The challenges of implementing evidence-based practice are complex and varied. Against this background a framework has been developed to represent the multiple factors that may influence the implementation of evidence into practice. It is proposed that successful implementation is dependent upon the nature of the evidence being used, the quality of context, and, the type of facilitation required to enable the change process. This study sets out to scrutinize the elements of the framework through empirical enquiry.

Aims and objectives. The aim of the study was to address the following questions:

* What factors do practitioners identify as the most important in enabling implementation of evidence into practice?

* What are the factors practitioners identify that mediate the implementation of evidence into practice?

* Do the concepts of evidence, context and facilitation constitute the key elements of a framework for getting evidence into practice?

This Dalhousie University study, presented at the SACME fall meeting, looked at why, since interaction with other participants is required for accredited online CME in Canada, and since education and nursing participants thought the interaction was fine in their programs, research in online CME shows a low satisfaction with online interactivity.

The presenter, Dalhousie s Joan Sargeant, lost me a little with her explanation of diffusion theory, which as far as I could tell comes down to people basing their adoption of something new on their perceptions of the innovation. This perception, she said, is based on the relative advantage of the innovation, and how well it correlates with current experience and beliefs.

Experience and perception

So they asked physicians what their experiences were with accredited online CME, and what their perceptions of this way of learning are, in order to find out what s behind these perceptions.

I just read about Stan, Stan, “an emergency care simulator who “resides” in the Emergency Medical Services (EMS) quarters at East Central College” (Missouri). I saw one of these at work during the CME Leadership Conference I attended at Duke a couple of years ago, and it was amazing.

While the technology probably is prohibitively expensive for most CME activities, here’s hoping that it eventually will come down to the point of feasibility–what better way to learn (and engage learners) than by having them learn by doing on a simulator?

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This article from the Johnson County Sun shows just how interdisciplinary an educational activity can get:

More than 300 physicians, nurses, pharmacists, clinical laboratory scientists, mental health providers, social workers, public health professionals, law enforcement officers, firefighters, and emergency medical technicians from across northeast Kansas attended the two-day conference at the Overland Park Convention Center.



The overall focus of the conference presentations was on quickly recognizing and identifying a terrorist event or health emergency; meeting the acute needs of patients; altering the public health systems at the community, state and national levels; and effectively collaborating in a multidisciplinary response.

Whether it’s for disaster planning or your run-of-the-mill health crisis, it seems to me that most of the problems occur when people in all involved specialties don’t communicate with each other and don’t see the big picture, which may lie outside the scope of their own piece of the puzzle.

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At the SACME fall meeting held in Boston Nov. 6, Robert Watson, MD, explained the Association for American Medical Colleges new Institute for Improvement in Medical Education, which is based on a report drawn up by 10 deans who were tasked with creating a new vision of med ed.

Nancy Davis, PhD, director, division of CME with the American Academy of Family Physicians, presented some of what AAFP has been doing to move CME forward at the SACME meeting Nov. 6 in Boston.

Like the AMA, AAFP has been concentrating on evidence-based CME, point of care/just in time learning, and physician performance measurement. Note that AAFP accredits activities, not providers.

The quest for practice-based, evidence-based tools continues, and progress is being made, said director of the AMA s PRA policy Charles Willis at the SACME fall meeting Nov. 6 in Boston. Here s what s been happening.

The physician-directed, interactive Internet CME pilot project, started in December of 2000, is an attempt to capture, as learning, use of professional literature at or near the point of care using technology. The four pilot participants SKOLAR Inc., UpToDate Inc., American College of Physicians Physician Information and Education Resource system, and MerkMedicus have been popping along.

Click here for the December issue of the Alliance for CME Almanac. There’s yet another rehash of the new ACCME Standards for Commercial Support conflicts of interest documents, plus some interesting articles on CME credit for family physicians, and what the medical school and health system providers sections have been up to.

On a totally different note, I just found out that I’ll be able to attend the Alliance’s annual conference in January–wahoo! I’ve never been, but I hear so many good things about it that I can’t wait. I hope to see many of you there!

For those who can’t make it, I hope to blog it endlessly, as I have been with the fall Society for Academic CME meeting–I still can’t believe I got so much out of a one-day meeting. The Alliance may just kill me, if it’s as content-rich as I think it will be. I’m just glad this blog wasn’t up and running when I went to the CME Congress last spring, which was the best CME meeting I’ve been to so far, but would have required volumes of blogging to do it justice!

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This post on JournalClub.org makes some good points about relying solely on evidence-based medicine (and, by implication, evidence-based CME):

An implicit subtext of the evidence-based movement is that it helps counter the millions of dollars of industry propaganda and hype that wash over us every year. And EBM does, indeed, provide tools to judge drugs and interventions more objectively than we think the industry would like us to. But the drug and device industries have evolved along with (or ahead of) their customers.

Pharmaceutical companies have responded to EBM by carefully designing trials destined to apply to as wide a population as possible, while still obtaining (p<0.05) benefit. Then, armies of drug reps sally forth armed with reprints, while researchers are sent out to spread the gospel of statistical significance. EBM has made us particularly avid of hard data (while relegating clinical significance to a somewhat subordinate role). This emphasis on statistically significant data has been digested by industry and is now used to sell drugs and devices.

Something to think about, especially now when more drug data is coming under fire and CME is becoming increasingly evidence-based. As the poster says, "caveat lector."

Anne Taylor-Vaisey just e-mailed me the links to a couple of really intriguing articles from the Canadian Medical Association Journal:

Transparency in drug regulation: Mirage or oasis?

Conflicts of interests and investments

Both are well worth a read, I think.

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