February 2000 Bulletin

Interactive learning tops didactic

Case discussion, role play, hands-on sessions change performance

By Carolyn Rogers

While most CME course moderators can’t expect to compete with Oprah in terms of audience involvement and enthusiasm, educators need to "work" their audience in much the same way if they want the information they’re imparting to be retained and put to use in the real world.

At least that’s the finding of the latest in a string of studies showing that didactic CME course methods do not change physicians’ performance or health care outcomes. The study, led by Dave Davis, MD, Continuing Education and the Centre for Research in Education, University of Toronto, was published in published in the Sept. 1, 1999, issue of the Journal of the American Medical Association.

According to the report, physicians spend, on average, 50 hours per year in formal CME activities. While formal CME is highly variable—ranging from passive, didactic, large-group presentations to highly interactive methods, such as workshops, small groups and individualized training sessions—most CME activities still are patterned after undergraduate medical education consisting of lectures, audiovisual presentations, and printed materials. This method of CME appears to be underpinned by a belief that gains in knowledge will lead physicians to improve how they practice and thus improve patient outcomes.

In this study, the group’s objective was to review, collate and interpret the effect of formal CME interventions on physician performance and health care outcomes.

Their chief finding? Didactic interventions analyzed in this review failed to achieve success in changing physician performance or health care outcomes.

"While such interventions may change other elements of competence," the authors wrote, "such as knowledge, skills or attitudes, didactic lectures by themselves do not play a significant role in immediately changing physicians’ performance or improving patient care."

In contrast, studies that used interactive techniques such as case discussions, role-play or hands-on practice sessions were generally more effective changing those outcomes.

"Sessions that were sequenced (learn-work-learn) also appeared to have more impact," the report says. "Both of these finding match closely those principles promoted by adult educators, who describe successful adult education as learner-centered, active rather than passive, relevant to the learner’s needs, engaging, and reinforcing."

About four years ago, the Academy invited several consultants to work with the education committee to help them understand adult learning techniques.

"We learned that the most effective methods have to do with interaction, " says Joseph Zuckerman, MD, chairman of the Council on Education. "The format of sitting in a lecture hall is not the way adults learn—they need to interact."

Since that time, the Academy has tried to be responsive and innovative in the design of its courses by incorporating as much interactivity as possible.

"Even in the didactic courses—the two- and three-day courses, comprehensive sports medicine or foot and ankle course—while there may be lectures, we have many more case studies, panel discussions and audience interaction," Dr. Zuckerman says. "In some cases, we have the moderator go out into the audience to get the audience members to ask questions. You’d be surprised what will stop some people from getting up to a microphone in the middle of the room. The moderator can really draw them out.

"And in the Orthopaedic Learning Center (OLC)—which is so interactive already—we’ve made it more interactive by making sure that didactic lectures are no more than 20 percent of any course. Surgical skills, case studies and panel discussions are the primary focus."

At this year’s Academy Meeting, an audience response system also will be introduced in several courses. Each course attendee will utilize a handheld response box allowing them to respond to various questions.

"For instance," Dr. Zuckerman says, "a presenter who’s speaking about a special shoulder technique might ask, ‘How many people treated it this way?’ or ‘How many people prefer this technique?’ The technology allows us to have the answer immediately tabulated and put up for the audience to see. We’ll also ask some questions before and after the course to see what people have learned or how they might change their practice as a result."

Interactive education doesn’t have to take place in person, Dr. Zuckerman adds. The computer also offers possibilities for interactive learning.

"Our first online CME course—on ACL rehabilitation—has a significant interactive component," he said. "And, as we expand our online efforts, we’re considering the possibility of creating a chat room with an instructor available online to discuss new techniques. These are all very exciting technologies that will allow us to incorporate even more interactivity into our courses."

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