How physicians learn and how to design learning experiences for them (Don Moore)

Final Report
This chapter is from the final report of Continuing Education in the Health Professions: Improving Healthcare Through Lifelong Learning, the Macy Foundation report on continuing health education.

Moore DE Jr. How physicians learn and how to design learning experiences for them. From: Continuing Education in the Health Professions: Improving Healthcare Through Lifelong Learning. New York: Josiah Macy, Jr. Foundation, 2008, p. 30-62.

Excerpt: Researchers from multiple studies over the past several years have reported that there are distressing gaps between the healthcare services that patients receive and those that they could be receiving. These studies show that many patients do not receive the best possible care, receive suboptimal care, or are victims of errors, despite the fact that approaches to care are improving and demonstrating enhanced outcomes. A variety of approaches have been suggested to address this gap. Continuing medical education (CME) has been a longstanding suggestion. For many years, however, people have expressed concerns about the effectiveness of CME. As a result, confidence in the ability of CME to address the identified gaps in healthcare delivery was not high. But significant work over the past 20 years has demonstrated the effectiveness of CME, if it is planned and implemented according to approaches that have been shown to work.

This interpretive essay reviews the evidence that describes how physicians learn and proposes six principles from that evidence and research from other fields that can be used to plan formal educational activities designed to facilitate physician learning. Next, the essay proposes an instructional design approach for designing effective formal CME activities. Finally, the essay briefly discusses assessment of formal CME activities.

Table 1. Stages of Learning
Table 2. Questions Physicians Have at Each Stage of Learning
Table 3. CME Planning that is Responsive to Questions that Physician Have at Each Stage of Learning
Table 4. Educational Methods in Formal CME
Table 5. Planning Pre-disposing CME Activities
Table 6. Planning Enabling CME Activities
Table 7. Planning Reinforcing CME Activities
Figure 1. Systems Overview of CME as an Intervention
Figure 2. Levels of Physician Learning and Assessment
APPENDIX A: How Nurses and Pharmacists Learn


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