Pre-IRB Interview Notes - Van H
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Richard Van Harrison
February 6, 2008

Background: organizational behavior, physician performance, knowledge
transfer

Suggests a structured case report for CME, however there will be
problems with unvetted cases. Cases should meet a requirement that
content illustrates a medical concept, validate commonly accepted
principles

Case consult lookup vs. Didactic learning

- aside, what about voting/submitting a case for CME treatment?
Providing some compensation?

Also, CME online should have an component of interaction with the
case, usually a set of 5-8 questions, which would be easier to control
that a moderated discussion group

Someone (specialist and usually a faculty member) has to stand behind
the knowledge in the case, and possibly open themselves up to
liability if they are not ready to prove the value of the case.

CME has a short shelf life
There is an abundance of CME material

Teaching med students involves a lot of what's in the textbook
CME content is NOT YET in the textbook, there is a lag time of 4-5
years

What's changing is included in CME content. In a year, the CME content
will be old.
CME materials can be approved for a maximum of 3 years, many only are
approved for 1
In fact, there were 3 drug alerts for diabetes in a year

Cost of current material is a big issue
Practicing physicians comprise of 75% of the influence of the
economics of health (e.g. drug, medical device purchases)
Drug companies fund free "throwaway" journals to promote their own
drugs
E.g. Purview - marketing or communications
For-profit CME companies

AudioDigest - most widely used CME resource. Why? Because doctors can
multitask by listening to content in the car while driving

A family medicine doctor may subscribe to a few journals, but a digest
of most important findings are what's most useful. Van H's framework
of translational research:

Digest of research results
>>
CME
>>
experts synthesize what's important and why it matters to you for docs
>>
into practice (e.g. perhaps with context-free case vignettes)

Case vignettes are used after principles of how to apply them into
practice

MAIN PROBLEMS
- Shelf life of cases illustrating new concepts is short
- How to be what's better than what's out there, which is subsidized
by medical schools (faculty appts to teach, do grand rounds) and drug
companies (external CME)
- Be useful to users while sustainable for producers
- Having a volume of cases...which is an argument for common
manifestations of diseases for medical education purposes--at least
the content of those cases stay relatively stable and can be used year
after year
- Horse vs. Zebra?

Who is going to use it and for what?

Focus on the TARGET AUDIENCE

What about rural physicians?
Networks in Kansas and Ohio are effective, Area Health Exchange (AHEX)
HRSA funds many grants to reach out to rural physicians

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> it's hard and academic medical centers often don't do much in that
area

Continuum of translation of research developments into regular
practice:

AWARE - expert distills knowledge, CME OK here

AGREE - expert distills knowledge, CME OK here Casepedia is in the
gray area between "agree" and "adopt" Casepedia is OK conceptually,
but with operational issues (financial/organizational)
ADOPT - somewhat weaker

ADHERE - weak

Why do CME for any one kind of question when you can turn to a
colleague and have an answer about all 4 areas?

Live CME is not dead
e.g. hospital meetings (awareness), Grand Rounds (part agree/adopt)

AMA sponsored a CME television network in the 90's - failed. not
interactive, boring, no money because of cost of doing cases