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Example of continuing education for a doctor

This article has four sections. The first defines medical simulation and summarizes presumptive findings about simulation-based continuing medical education (CME) from the Agency for Healthcare Research and Quality (AHRQ) Evidence Report.1 The report aims to synthesize the results of nine literature reviews about “the effectiveness of simulation methods in medical education outside of CME.”1 It also serves as a foundation for other sections of this article. The second section amplifies the findings from best evidence medical education (BEME) in one of the nine reviews.2 The BEME review warrants special attention because it receives superficial coverage in the AHRQ Evidence Report,1 addresses a different question about simulation in medical education beyond its effectiveness, is not confined to a single medical specialty or medical simulator, and offers practical advice about simulation-based medical education program planning and operation. The third section distills and presents lessons learned about best educational practices drawn from both the AHRQ report and the BEME review as well as from two graduate medical education (GME) and research programs and other published sources. The fourth section presents implications for CME grounded in the preceding narrative, the changing focus and professional character of CME, and observations about education for other learned professions.

Medical education using some form of simulation generally has been aimed at the junior trainee both for undergraduate medical education (UME) and for GME. The benefits of simulation derive from its standardization and reproducibility in contrast with the traditional apprenticeship approach to teaching where medical students and residents learn through practice with real patients in the clinic or hospital setting. With the increasing number of patients who are hospitalized and the shorter lengths of hospital stays, requirements for limited trainee work hours, and an emphasis on patient safety, simulation has received greater attention at the UME and GME levels. However, simulation seldom is discussed in the context of CME.

This article reviews the use of simulation education in baseline assessment of knowledge and skills, education grounded in learning objectives, intended outcomes expressed in metrics, deliberate practice with feedback, rigorous outcome evaluation, and professional accountability. These constructs are addressed thoroughly in a call for CME reform in the United States.3 This article urges the physician-learner to participate in CME activities that include deliberate practice and where he or she can work toward a mastery learning of CME objectives. Physician-teachers should design CME activities that make use of teaching techniques that assist the physician-learner in mastery learning and deliberate practice, embrace outcome measurement, and address cultural barriers to incorporate these educational approaches. Simulation as a teaching technique can be used by the physician-teacher to achieve these goals.