Defining and Identifying Professional Practice Gaps

Educational activities at The Endocrine Society are designed to identify professional practice gaps that underlie the need for the activity and it’s intended target audience.

The professional practice gap is best defined as the difference between the current state of knowledge, skills, competence, practice, performance or patient outcomes and the ideal or desirable state. Several examples are provided below.

Current State Desired State
An international survey of both generalists and specialists showed that more than 40% did not view beta cell dysfunction as a key determinant of T2DM progression (Busse et al., 2007, Diabetes Res Clin Pract 76:445-8) Educational
Gap

Physicians and endocrinologists recognize and understand the importance of interventions to maintain beta cell function in order to prevent progression to diabetes
Only 63% of participants in ESAP 2008 showed proficiency in the use of the ADA's new screening and diagnostic methods for gestational diabetes Educational
Gap
Endocrinologists should employ the ADA's current screening and diagnostic methods to identify and manage gestational diabetes to avoid complications to mother and fetus

Acceptable Sources of Information/Data on Professional Practice Gaps:

  • Notes and/or communications from planning/steering committee or faculty
  • Literature review/search
  • Peer-reviewed scientific/clinical publications
  • Survey data
  • Epidemiologic data
  • Clinical practice guidelines/treatment algorithms
  • Evaluation data/participant suggestions from CME activities
  • Exam performance analysis (e.g. ESAP or ABIM Board Review performance analysis)
  • Quality improvement guidelines
  • Public health data (national, regional, state)
  • Government mandates/legislation
  • Clinical surveys or chart audits
  • Expert input (must identify expert[s] and other support gaps identified with information from another source)

Identifying and Addressing Barriers to Ideal Practice

Below are examples of factors that may impede changes in physician practice and/or impact patient care. Whenever possible, topic-specific barriers to ideal practice should be identified in developing CME content. Identified barriers should be included as part of the content, along with information and practical strategies for overcoming the barriers.

Physician Factors

Sometimes physicians themselves present barriers to change, and physician education can play an important role in helping to overcome such barriers. 

Examples include:

  • Lack of detailed knowledge about new procedures or treatments
  • Resistance to change/inertia
  • “Information overload” leading to lack of awareness about new treatments or procedures
  • Lack of awareness or detailed knowledge about new or updated clinical practice guidelines 
  • Lack of agreement with new or updated clinical practice guidelines

Patient Factors

Various patient factors may present barriers to change. Physicians and other healthcare professionals may be able to help patients overcome these barriers. Education that includes practical strategies for addressing such barriers can be helpful to physicians.

Examples of patient-level barriers include:

  • Poor health literacy
  • Socioeconomic status
  • Limited or no health insurance coverage
  • Resistance to change
  • Inaccurate perceptions/beliefs or fears about treatments (eg, fear of vaccines or fear of self-injection)
  • Cultural differences
  • Noncompliance with treatment

Please note that the Hormone Health Network provides patient education resources, including bilingual patient fact sheets, on a wide range of endocrine disorders that can be downloaded for free online.

Institutional Factors

Often barriers to change are systemic and as such, may be more difficult to address with education alone.

Examples include:

  • Time constraints
  • Reimbursement challenges
  • Lack of resources
  • Hospital restrictions (eg, treatment not on formulary)