Doctors start to practice what they read in journal CME

More than half of physicians using journal-based CME say they are changing their practice habits as a result of what they learn.

By Jay Greene, amednews staff. Feb. 26, 2001.

San Francisco -- With more than half of the states requiring continuing medical education credits as a condition of re-licensure, it's not surprising that surveys show more and more physicians using CME.

Thanks to a push by the CME accrediting body, CME providers are now assessing the outcomes of their programs and in some cases, learning that physicians are indeed putting into practice what they learn.

Reading, going, changing

However, most experts and physicians agree that substantial changes come after several CME courses and often after physicians have discussed what they've learned with colleagues.

Bernd Wollschlaeger, MD, a family physician in North Miami Beach, Fla., reads medical journals regularly to keep up to date with the latest clinical information. While he occasionally applies the knowledge into his daily practice, Dr. Wollschlaeger said he doesn't incorporate changes without talking with peers.

"Reading an article doesn't change my practice," Dr. Wollschlaeger said. "It deepens my practice and stimulates my interest. It can lead me to a long-term change in my practice behavior or prescribing. Interacting with colleagues, exchanging e-mails, helps me test the ideas. ... It is just part of the process of learning."

In a review of evaluation forms physicians submit for CME credit, Jefferson Medical College of Thomas Jefferson University in Philadelphia found that more than two-thirds of physicians said they either changed or planned to change their practices.

"Doctors don't make big changes after a CME event, but they do believe it adds value," said Jeanne Cole, Jefferson's CME managing director, at a recent meeting of the Alliance for CME.

According to the survey, 52%of physicians said they had slightly modified their practice, 15% said they planned no changes, 9% said they had made some changes and 5% said they planned to make major changes. In addition, 3% said they had adapted a new technique to a different use and 2% said they had added a new procedure or technique.

In a follow-up survey six months after the physicians read the CME articles, Jefferson asked physicians if they continued to practice differently and also asked what specific changes were made.

Some 68% of physicians said they had made changes consistent with the evidence-based approaches cited in the articles, 27% said they still planned to make changes, and only 5% said they would not make changes, Cole said.

Of physicians who made changes, 29% said they provided patient education, 23% changed prescribing habits, 21% added a new procedure or technique and 19% said the information had increased awareness, Cole said.

To achieve exemplary accreditation status from the Accreditation Council for Continuing Medical Education, CME providers must do post-CME evaluations on outcomes.

"The traditional method to award CME is to quiz physicians on the content of the article," Cole said. "We don't do that. Our evaluation emphasizes change in practice as reported by participants. This shows effectiveness of CME but also a commitment by physicians to use the information to improve the care of their patients."

While physicians traditionally have cited journals as their most important source of information, few have garnered CME credit by reading journal articles. But that is changing.

Nationally, total journal CME hours increased 31% in 1999, and total journal CME participation by physician registrants increased 41%, ACCME said. As a percentage of total CME activities, total journal CME activities increased to 2% in 1999 from 0.09% in 1998, according to ACCME. Physician registration in journal CME increased 1% to 6.7% of total registration. While saying there has been some increase in the number of physicians using journal CME in the past several years, Murray Kopelow, MD, ACCME's executive director, said the large rise in journal CME might be more a function of how the credit is reported than an actual huge statistical jump in the numbers.

"There has been an increase, but I don't believe it is [41%]," he said. "We are seeing changes going on in how physicians acquire CME. We have anecdotal reports from Internet providers that there is an enormous rise. When we collate our data this year we expect to see a big increase."

One reason for the increase in CME, Dr. Kopelow said, is that more state medical licensing bodies require minimum numbers of CME credit as one condition of re-licensure. Over the past years, six more states have required CME, bringing the total number to 34, Dr. Kopelow said.

"Seventy percent of physicians in the country work in states where CME is required for licensure. That is up from 60% five years ago," Dr. Kopelow said. In addition, some state medical societies, specialty boards, hospitals and managed care organizations require CME credit.

In 1998, Jefferson partnered with Medical Economics to provide three accredited CME articles a month for Contemporary Pediatrics, Contemporary Urology and Contemporary Ob/Gyn. Jefferson accredits the CME articles through the Consortium for Academic CME, which also includes Pennsylvania State University College of Medicine in Hershey, University of Pittsburgh School of Medicine and Temple University School of Medicine in Philadelphia.

Over the past two years, readership has steadily increased for Jefferson CME articles to nearly 1,000 CME credits awarded a month in 2000 from about 550 a month in 1998, an 82% increase, Cole said.

Although few medical schools have partnered with clinical journals using Jefferson's model for provision of CME, most medical journals solicit physician authors to write CME articles. Many subscription-based journals are affiliated either with medical associations or specialty societies that are accredited CME providers. For example, CME-accredited articles appear in the American Academy of Pediatrics' Pediatrics, the American Academy of Family Physicians' American Family Physician and the American Medical Association's Journal of the American Medical Association.

At JAMA, one AMA Physician's Recognition Award category 1 CME credit is awarded for reading three of up to eight articles offered each issue. Physicians must complete a one-page evaluation form and mail it in to receive credit. Like Jefferson, JAMA asks physicians questions about changes they plan to make.

"The first time [in 1997] I looked at how many physicians said they made some commitment to change, it was about 70%. I don't think it has changed much," said Thomas Cole, MD, CME editor for JAMA and the AMA's archive publications. "We are conducting a more in-depth study now on whether physicians made specific changes on a topic they read about in an article."

Dr. Cole estimated that about 10% of physicians make specific changes in their practice based on reading articles. "Our numbers probably are low because we are a cutting-edge journal," he said. "Most physicians probably hear about these things for the first time in JAMA. Many of their peers haven't read the latest, and talking with other doctors about new things is the basis for the changes."

Since November 1997 when JAMA first offered CME, Dr. Cole said physician participation had increased steadily to about 1% of the journal's 800,000 worldwide readers. To increase CME participation and give readers extra value, JAMA is working toward offering CME articles on the Web in the future, he said.

ADDITIONAL INFORMATION:

Reading, going, changing

Physicians are learning to change their habits

More than 60% of the physicians surveyed said they had changed or planned to change their practices following their participation in journal-based CME.
Providing patient education and changing prescribing habits were the two most common outcomes.

They're also reading more, but still going live

Journal CME accounted for 4,977 credit hours in 1999, up 31% from 1998. But Internet use of enduring CME increased more than 175% to 66,731.
Conferences and courses are still most popular -- 547,803 hours in 1998. But that's less than a 1% increase over 1998.

Sources: Habit information from Jefferson Medical College of Thomas Jefferson University, Philadelphia. Reading information from Accreditation Council for Continuing Medical Education