The Design and Evolution of an Adaptable CME Programme to Suit the Changing Educational Needs of the Clinical Community

ABSTRACT

Continuing medical education (CME) plays a critical role in healthcare, helping to ensure patients receive the best possible care and optimal disease management. Considering the obstacles to engaging in CME activities faced by the clinical community, as well as employing learning theory, Liberum IME developed Classroom to Clinic™ – a bespoke, accredited learning format that can be tailored to individuals’ educational needs and time constraints. Through monitoring use, and incorporating qualitative and quantitative feedback, we continuously evaluate the usability, value and accessibility of this programme and adapt subsequent iterations accordingly. An example of this is the way we adapted our engagement of facilitators. Originally this was accomplished by targeting individuals for train-the-trainer events, but it was clear this was more effective in some countries than in others. To address this variability, we piloted launching a new module at a relevant large international congress. This aimed to instigate a cascade in education sharing, from congress attendees to peers at their clinics and across departments and hospitals. So far, the programme has reported encouraging improvements in uptake, as well as knowledge, competence and clinical practice, while qualitative feedback has allowed for the identification of further educational needs and continued evolution of the programme.

KEYWORDS:

• Continuing medical education
• peer-to-peer learning
• accredited CME
• adaptive feedback

Background

Continuing medical education (CME) plays a critical role in healthcare, helping to ensure patients receive high-quality care. Systematic reviews have concluded that CME improves both the performance of healthcare professionals (HCPs) and, importantly, patient outcomes [1]. Barriers to accessing CME remain, with general practitioners reporting lack of time, work overload, lack of digital competence, lack of digital infrastructure and motivational and emotional factors preventing them from engaging with many CME activities [2]. The prominence of these barriers was heightened by the COVID-19 pandemic, which resulted in simultaneous widespread disruption to CME distribution and accelerated innovation in CME and healthcare systems worldwide [3,4]. A need for novel resources that addresses these barriers was evident.

Innovative, digital solutions to CME provision have the potential to improve access, maximise learning and provide flexibility, addressing HCPs’ lack of time and work overload. Liberum IME set out to devise a CME programme format that would offer these benefits to busy HCPs, the underlying design and key principles of which have been outlined in Figure 1 [5–9].

Figure 1. Design and underlying principles of an optimal learning platform [5–9].

Format Development

Based on the aforementioned principles and strategies, Liberum IME devised Classroom to Clinic™ – an online educational tool that allows HCPs to create and run their own small-group, accredited learning sessions with their peers, trainees and/or students. Each module provides materials for a selection of ten 15-minute workshops that cover a range of learning objectives and topics addressing unmet needs in clinical practice.

The workshops are designed for completion in small groups with the guidance of a facilitator and employ a mix of active learning (e.g. quizzes, patient case studies, debates, role plays) and traditional activities (e.g. reviewing specific disease-state data, comparing graphs, completing tables). This blend of activities caters to a variety of learning styles and combines visual and written information to optimise learning and retention [10]. These materials, which are developed by medical writers in close collaboration with expert faculty, and based on needs assessment in the therapy area, are hosted on a free online platform where users can select from the available workshops to create a custom programme that suits the interests, educational needs, and time constraints of their group.

To further tailor the programmes to the specific needs of real-world clinical practice, we worked with expert faculty from different countries to create country-specific versions that are not only translated to local language but also take local considerations into account. These include, but are not limited to, availability of testing and treatment, reimbursement, structure of the local healthcare system and local guidelines. This allows the facilitator to create a learning environment that mimics country-specific, real-life clinical practice and enables experiential learning.

Through joint sponsorship with an Accreditation Council for Continuing Medical Education (ACCME)-accredited provider, and under the relevant regulations, each workshop is accredited for 0.25 CME credits, with up to 2.50 credits available for the full set of 10 workshops on a particular subject. Once the facilitator has selected their workshops, they are able to download a file containing instructions and supporting literature for each workshop, as well as any necessary handouts for attendees. They are also provided with a slide presentation that is automatically customised according to their selection of workshops. Supplementary materials, such as presentation recordings by the faculty and links to external relevant resources, are also provided to support facilitators.

The programme was designed to be measurable using Moore’s Levels 3 (knowledge), 4 (competence) and 5 (performance) [11], primarily employing formative assessment through a variety of tactics [12,13]. Throughout each workshop, guidance is provided in the facilitator handout sheets on giving feedback to the learners and improving and accelerating learning. Quizzes and table-completion exercises assess prior knowledge, while supporting information in the facilitator documents provides opportunities to close the gap between current and desired performance level. Discussion topics are also included in the workshops to encourage dialogue between the attendees and their facilitator. Finally, a post-meeting self-reflection exercise provides learners with the opportunity to further recap their learning and identify how they could improve their own performance. This also affords us the opportunity to gain insight into the perceived value of the provided learning and collect information to help improve and shape further activities.

A post-session follow-up is conducted at 3 months, in which learners discuss the self-reported impact of learning on performance, thus measuring learning outcome at Moore’s level 5 [11]. Later iterations of the programme have also employed pre- and post-assessment questions to help facilitators tailor the workshops to their groups, as well as allowing us to further assess knowledge (level 3) and competence (level 4) [11].

Format Launch and Evolution

After releasing the first modules online, we investigated employing a “train-the-trainer” approach to boost facilitator recruitment and programme engagement. This approach was adopted to help drive dissemination of the education, inspired by feedback from other small group learning programmes. A half-day face-to-face meeting was conducted in Spain in September 2019, where clinical leads from across the country were trained on accessing the modules and facilitating these workshops. Trainers were also upskilled in their therapeutic fields via didactic plenaries. This approach resulted in a significant uptick in use of the materials. The inclusion of national expert faculty was deemed critical to ensure value and local relevance of the content. This collaboration allowed the educational content to be localised to reflect current local availability of diagnostic tools, therapies and relevant guidelines.

A second meeting format was developed in the light of the restrictions imposed by the COVID-19 pandemic. Originally planned as an in-person event in France in March 2020, COVID-19 restrictions implemented 2 weeks ahead of the planned meeting required us to make use of available technologies to successfully deliver the event online. This was followed by successful facilitation of workshops by the trainees with their peers. In the following 2 years, modules were launched exclusively using online meetings due to the ongoing pandemic and included advice on adapting the available workshops to a remote learning environment. In most countries, these meetings were well accepted, and recruitment was straightforward; however, other countries presented more challenging environments for this type of education, perhaps due to a traditional reliance on didactic learning styles. To further raise awareness of these resources and reach more learners, we conducted a satellite symposium at an international congress in May 2022. The symposium combined expert faculty presentations with an interactive demonstration of the use of these materials, thus launching the module for attendees who were already in the learning environment of a congress. With bespoke “train-the-trainer” meetings, events reached between 3 and 30 potential facilitators; the symposium enabled us to share this training with over 200 simultaneously, making it a far more efficient and accessible method of dissemination. With one symposium executed and others planned, we will soon be able to compare the efficacy of this recruitment strategy with the previously employed approach of smaller meetings regarding uptake of the online modules.

Over 450 facilitators have been trained to lead these Classroom to Clinic™ programmes to date, although training is not essential, and the resource can be accessed by anyone who may wish to share this education with their peers. So far, over 700 workshop sessions across various topics within rare kidney diseases, type 2 diabetes, vaccination in travel health and oncology have been run reaching over 7500 learners. Evaluation forms have revealed that, overall, learners find the workshops stimulating and relevant. Furthermore, we have found that the modules met the learning objectives and most learners felt confident in the relevant aspects of patient care following the sessions. After post-session evaluation, learners that were interested were also contacted after 3 months to provide further evaluation on how they have incorporated their knowledge into practice.

The most important insights into the reception and value of this programme have been qualitative results from written learner and facilitator feedback. These have been invaluable in providing us with insights into learning, the perceived value of the content and constructive feedback for further programme development. For example, asking learners to describe their current practice allowed us to identify further clinical and educational needs, while self-reported gains in knowledge and competence validated the educational content and provided further insights to aid programme development. Many comments demonstrated that learners were considering how to integrate their learnings into future practice through highly specific actions, such as employing new testing protocols, as well as determining how to overcome barriers to practice change. We also received feedback from some facilitators that the host platform was difficult to navigate. Since, we have adapted the user experience to be more intuitive to facilitators and streamline the way in which learners claim CME credits.

The facilitating HCP uses the simple 3three-step process, illustrated in Figure 2, to customise, download materials and run the programme. The materials provided to the HCP include full lesson plans and instructions for each workshop, key learning points with accompanying supporting evidence, as well as additional resources such as voting cards and printable handouts to facilitate a successful session.

Figure 2. Example of the process for the customization of CME learning module.

Future Development

The development of the Classroom to Clinic™ format was driven by user experience and clinical value, which remain at the heart of the continued evolution of this programme. As described earlier, we collect quantitative and qualitative data regarding the use of the modules, which are routinely analysed to inform and refine the development of this format.

At present, the user interface is being revised to enable use by facilitators with a broad range of technological competence. Further functions are also being added to streamline the preparation and delivery of these bespoke meetings, such as a pre-drafted email invitation that can be quickly customised and forwarded to potential learners. Long-term evaluations beyond 3 months are also currently being performed to assess if participants continue applying their acquired knowledge. It is anticipated that the current professional climate will continue to facilitate hybrid engagement; the programme has, and will continue to, follow suit by providing options for a blend of online and in-person group learning.

Conclusions

Classroom to Clinic™ has been designed to encourage a cascade of learning, from experts to specialists at tertiary centres, with those specialists transferring knowledge to local hospitals and eventually into community care. The option to select applicable workshops ensures that clinical relevance is maintained throughout the cascade.

Using digital platforms ensures this learning is accessible to all HCPs, with the aim of providing them with all necessary resources to confidently facilitate group training in their local setting. In the future, the hope is that the recognition of these resources will continue to expand as we hone our approach to engaging with faculty and learners to raise awareness of the programmes. Through these programmes, we aim to improve access to high-quality experiential group-learning environments, ultimately improving patient care.

Disclosure statement

No potential conflict of interest was reported by the authors.