Continuing Medical Education and Maintenance of Certification: Essential Links

Eric S Holmboe, MD; Christine Cassel, MD

Fall 2007 - Volume 11 Number 4


Few question the need for physicians to engage in continuous learning throughout their professional career. Knowledge and technological advances are expanding at a breathtaking pace, as is the evolution of new skills and attitudes required for the physician to just "keep up." For example, major breakthroughs in our understanding of genetics are already beginning to change how physicians make therapeutic decisions with individual patients.1 The introduction of quality improvement science since the 1980s is changing how physicians manage groups of patients.2,3 More importantly, quality improvement requires physicians to systematically examine their practice performance.

To assist physicians with lifelong learning, institutions and organizations have created continuing medical education (CME) programs. Traditionally, such programs involve didactic learning experiences such as grand rounds and lectures by experts at either the local institution or at a regional or national conference. Whereas physician satisfaction with this traditional form of CME is often high, research has repeatedly demonstrated these more "passive" learning activities are ineffective in helping physicians to change their practice.4 Traditional CME seldom involved reflection by the physician on their real learning needs.

Against the backdrop of this changing landscape is the recognition that many physicians struggle to keep current and engage in meaningful lifelong learning. First, many physicians are no longer active in their local hospital’s educational programs and committee activities.5 Second, Choudhry and colleagues reported in their systematic review that, on average, physicians’ knowledge and skill declines over time.6 Third, many physicians are not terribly accurate in self-assessment of their knowledge and skills.7 The inability to accurately self-assess creates substantial challenges for physicians to determine what their true learning needs are.7

This is the "perfect storm": the predominant form of CME, the didactic-based experience, is ineffective in changing behavior; on average, physicians’ knowledge and skills decline over time; and physicians’ ability to perform self-assessment accurately is suspect. Where does this leave the profession? What does effective CME actually look like?


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