Measuring the impact of a live, case-based, multiformat, interactive continuing medical education program on improving clinician knowledge and competency in evidence-based COPD care

Abstract

Background: Major clinical gaps impede the evidence-based treatment of chronic obstructive pulmonary disease (COPD) in the primary care setting. Studies are needed to measure the effectiveness of continuing medical education (CME) on improving physician competency and performance toward evidence-based COPD care.

Methods: Between September 26, 2009 and December 12, 2009, 769 primary care physicians participated in a series of 12 regional, live, interactive, case-based, multiformat, half-day CME programs on COPD. A subgroup of randomly selected participants (n = 50) and demographically matched nonparticipants (n = 50) completed surveys that included case vignettes, a validated tool for measuring physician performance in clinical practice. Cohen's d was used to calculate the magnitude of difference between participants and nonparticipants in the delivery of evidence-based care.

Results: Physicians who participated in CME programs were 50% more likely to provide evidence-based COPD care than physicians who did not participate. Compared with nonparticipants, participating physicians were more likely to recognize COPD correctly in a patient presenting with dyspnea (74% versus 94%, P = 0.007), recognize that women may have a greater susceptibility than men to the toxic effects of smoking (54% versus 90%, P < 0.001), and identify the mechanisms of action of emerging therapies (33% versus 65%, P = 0.003).

Conclusion: Physicians who participated in a half-day regional CME program on COPD diagnosis, staging, and treatment were significantly more likely than nonparticipants to deliver evidence-based COPD care. With multiformat, interactive, focused educational interventions, physicians can make diagnostic and therapeutic choices in the primary care setting that align more closely with current guidelines and clinical evidence in COPD management.

Keywords: COPD; case vignettes; continuing medical education; effect size; outcomes measurement; practice patterns.

Figure 1

Familiarity with spirometry interpretation. Participants and nonparticipants were asked to rate their level of familiarity with spirometry interpretation on a scale of 1 (least familiar) to 10 (most familiar). Responses were analyzed by mean ranking and by proportion of responses indicating that physicians were not at all familiar (1–3), somewhat familiar (4–7), or extremely familiar (8–10) with spirometry interpretation.

Figure 2

Barriers to the management of chronic obstructive pulmonary disease. Mean barrier severity score on a scale of 1 (lowest significance) to 10 (highest significance).