Faculty Resources For Developing CME Activities

This resource has been established for faculty and authors who are involved in the development of CME activities and manuscripts to assist them with defining professional practice gaps that support the need for the CME activity, writing learning objectives, identifying and addressing barriers to ideal clinical practice, preparing multiple choice questions for post-tests, and addressing physician competencies.

STEP ONE: 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.

Examples:

Current 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—

Desired State
Physicians and endocrinologists recognize and understand the importance of interventions to maintain beta cell function in order to prevent progression to diabetes

Current State
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—

Desired State
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)

STEP TWO: Writing Learning Objectives and Content Development

Learning objectives are provided at the beginning of each activity to allow learners to evaluate the relevance of the activity to their practice. Learning objectives should:

Derive from identified gaps in physician knowledge, competence, and performance or patient outcomes.
Clearly and concisely communicate what learners are expected to know and/or do after participating in a CME activity.
Frame the content to be presented; it is critical that each objective be specifically addressed in the content.

If a post-test or other assessment is associated with the CME activity, the test should include questions that address or relate to each learning objective.

The essential components of learning objectives are who (the learner), how (an action verb), and what (the result).

WHO	HOW	WHAT
Learners will be able	to name	the most sensitive and specific diagnostic testing available for . . .
Participants will be able	to recognize	the physical signs and symptoms of . . .
The physician will be able	to explain	the risks and benefits of . . .
The healthcare provider will be able	to perform

The Endocrine society strives for high level learning objectives to be focused on performance outcomes such as application and evaluation of knowledge rather than simply increasing knowledge and comprehension.Examples of action verbs useful for crafting such outcomes are listed below.

LEVEL (in ascending order)	ACTION VERBS TO USE IN LEARNING OBJECTIVES
Knowledge	define, list, state, identify, label, name
Comprehension	discuss, explain, predict, interpret, infer, summarize, convert, translate, recognize, suspect, provide, account for, review, inform, counsel
Application	translate, interpret, apply, employ, use, practice, decide, illustrate, demonstrate, prepare, modify, obtain, perform, increase, decrease
Analysis	distinguish, differentiate, analyze, criticize, debate, question, relate, solve, examine
Synthesis	design, develop, devise, formulate, plan, diagnose, propose, change, create, construct, change, arrange, assemble, organize, compose, establish, incorporate, prioritize
Evaluation	appraise, estimate, evaluate, assess, measure, rate, justify, revise, select, screen

STEP THREE: Creating Multiple Choice Questions

Test questions should address concepts communicated in the activity’s learning objectives. While it is appropriate for some questions to assess knowledge gained from participating in the activity, questions should go beyond knowledge to assess whether participants can apply the information in clinical practice. Such questions have the advantage of providing participants with reinforcing feedback in specific, practical applications. They also allow the Society to determine whether learning objectives were achieved and may indicate the potential for change in clinical practice as a result of the educational intervention.

Suggestions for creating multiple choice questions:

Use a question format. Do not use incomplete or fill-in-the-blank sentences.
All questions should be multiple choice with a single best answer-no true/false or matching.
Avoid negative question constructions such as “What is the least likely diagnosis?” or “which of the following is FALSE?” Answering such questions requires that participants use “backward logic” that may increase confusion and imprecision rather than reinforcing educational messages.
Avoid trick questions.
Pose one clear concept or task in each question, as shown by examples below.

Examples:

CONCEPT OR TASK	SAMPLE QUESTIONS (CASE-BASED)	SAMPLE QUESTIONS
Clinical features	Which of the following symptoms is characteristic of the patient's adrenal insufficiency?	Which set of symptoms is suggestive of Grave's disease?
Pathophysiology/ Disease mechanisms	How can you best explain this patient's refractory heart failure?	Which one of the following cytokines increases risk of tissue damage? Which of the following factors best explains the reversal of T2DM after bariatric surgery?
Diagnosis	Which of the following is the most likely diagnosis for this patient?	Which of the following strategies represents the best approach to diagnosis of Cushing's syndrome?
Diagnostic testing	Which one of the following laboratory studies would you order next to distinguish primary from secondary adrenal insufficiency?	Which of the following tests would be most useful in diagnosing hyponatremia?
Treatment/ Management	Which one of the following treatments would you recommend to further lower low density lipoprotein levels?	According to NCEP-ATP III guidelines, which treatment combination is recommended for high-risk patients with high triglycerides or low HDL-cholesterol?
Epidemiology	This patient is at increased risk for which of the following?	What is the incidence of acromegaly in the United States?

Writing Answer Choices:

Provide 5 answer options: 1 correct answer and 4 distracters (incorrect choices).
Make sure there is only one right answer.
Use realistic, plausible distracters. Avoid answers that are trivial, implausible, or obvious.Good distracters include common misconceptions, outdated beliefs or treatment recommendations, and frequently confused ideas.
Make the options similar in terms of grammar, length, and complexity.
Do not use “all of the above” or similar answer combinations or “none of the above” either as a distracter or as a correct answer.