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A Rearview Mirror Check: Evaluating the Impact of Independent Medical Education

Independent Medical Education (IME) is education created and delivered without the influence of the funder, pharmaceutical industry, or device company. This fair and balanced approach differentiates these programs from industry educational events and helps explain why a clear majority of healthcare providers prefer the nonbiased approach and impact of IME. Additionally, continuing medical education (CME) can be viewed as similar to IME in that they both:

  1. Offer compliant medical accuracy review with balanced content.
  2. Focus on outcome levels and demonstrating measurable clinical impact.
  3. Are based on an analysis of specific educational needs in current practice.

The growth and impact of the IME sector has been robust. A recent query of the ACCME website shows that there are over 1800 accredited providers of CME in the United States, and close to 159,000 educational activities were offered across the country in 2016. Other key takeaways are that the number of educational events increased 7%, hours of instruction increased 9%, and interactions with HCPs grew 5%.

Earlier this year, a think tank of CME luminaries took an investigative look at how to ideally fashion the next best steps for the field of ongoing medical education. Two key initiatives identified were:

  1. Shortening of review timelines for accreditation standards with more frequent updating.
  2. Accepting mutually agreed upon standards across differing accreditation bodies.

Indeed, a more universal and increased update frequency should dramatically improve the applicable guideline foundation from which IME content is drawn.

It is noteworthy that one of the primary ways in which IME has impacted HCP behavior is that it is placing an increased emphasis on creating an effective bridge between the ideal “expected care” outlined by the current treatment guidelines and the current “actual care” that is being observed in the field. Extensive market analysis and clinical outcomes data identify the presence and severity of “gaps” between HCP expected and actual care. These gaps in clinical practice can then be addressed with the creation of thoughtful IME. When tactful instruction is provided, the impact can be both immediate and enduring.

Impact cannot be overstated when it comes to discussing how IME has evolved. Front and center in the minds of those who fund, create, instruct, and ultimately measure the results of IME is ascertaining how well the IME actually bridged the aforementioned gap between expected and actual care. One of the most basic ways to measure impact is a simple event evaluation form at the end of the IME activity to confirm HCP participation and satisfaction. A more in-depth measure of knowledge acquisition is a pre-activity case-based test followed by a post-activity test comprising the same questions as the pre-test. Behavioral surveys to target material retention and competence can be conducted weeks or months after the IME activity to further measure impact. Finally, objective measures of actual procedures or devices used that were outlined through the IME activity are allowable to some extent through hospital departments and interviews. The guardrails around this last strategy continue to be outlined, highlighting another important way in which IME is evolving.

Financial health and ability to compress costs are now more important than ever in the medical field. As hospitals and clinics experience budget reductions and expect each department to do more with less, how does the quality improvement and value analysis committee address IME impact and pull through? The good news is that IME has evolved in this regard, as carefully structured follow-ups and physician engagement activities can be done with minimal cost and limited labor resources. Proactively engaging HCPs with questions such as, “How do you plan to change your practice based on what you learned?” and providing a list of conversion methods that are current best practices allow for an ideal state of HCP self-reflection and reasonable departmental evaluations. Moreover, HCP engagement to promote personal forecasting regarding current (not ideal) and planned (ideal) practice changes (where they intend to make the better choice more often) can also further the impact of IME with minimal financial burden.

The impact of IME has certainly increased in the past five years, and it is universally agreed that it has markedly done so for the better.

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