2. Traditional Expert-Based Information Delivery Systems Using an Expert, Being an Expert

3. Roles of Experts Consultation CME Review articles Practice guidelines Decision analysis

4. Using an Expert/Being an Expert Definition of an expert Subspecialist or primary care clinician with special interest Anyone/anything you go to for an answer to a question

5. Using an Expert/Being an Expert “Never ask the barber whether you need a haircut” “So many specialists fall into the habit of looking where the light is -- that is, offering solutions only in territory familiar to them... Wonderful examples exist of otherwise excellent researchers who are unable and unwilling to recognize evidence contrary to their beliefs.”

6. Usefulness Score Work: Low Significant potential for usefulness Relevance: Varies Validity: Expert dependent If either relevance or validity is zero, usefulness is zero

7. Types of Experts Content Expert Clinical Scientist YODA

8. Content Expert Experienced, particularly diagnosis and procedures, not necessarily therapy Not trained in clinical epidemiology (validity) Traditional education favors DOEs (relevance) May not be current, may rely on anecdotes Risky extrapolation: Information is only as current as the last consultation

9. Clinical Disagreement Between/Within Experts Same film: disagree 29% of time Previous read: disagree with self 20% of time Studied with venograms, fundi, MRI, angiography, mammograms, pathology (melanoma diagnosis) March 97 Bandolier on the Web: “Histology as Art Appreciation”

10. “Never ask a barber...” Chalmers: Recommendation highly correlated with training and source of income Management of acute GI bleed Surgeons: surgery- 50%; conservative- 15% Internists: surgery- 15%; conservative- 50%

11. Clinical Scientist Good at evaluating evidence; up-to-date, don’t have to be content experts Separation of therapeutics Medical Librarian, PharmD

13. YODA: Your Own Data Analyzer Content expert and clinical scientist Consider POEMs first, even if this information conflicts with DOEs or clinical experience When POEMs not available, use best DOEs with an open mind Demonstrate appropriate validity assessments Not to be confused with YUCKs

14. YUCK YOUR UNSUBSTANTIATED CLINICAL KNOW IT ALL

15. Experts gone wrong: YUCKs

16. YUCK Your Unsubstantiated Clinical Know-it-all Maladaptive Rigid, Dogmatic All personality types, but people who see things in Red and Green can fall into the YUCK trap

17. The Golden Question: “That’s interesting... Is there any evidence that... ?”

18. If it’s not a valid POEM, it’s just not necessarily so

19. Making the Most of a CME Presentation

20. Dilbert’s Take on CME

22. Continuing Medical Education People remember 90% of what they do, 75% of what they say, but only 10% of what they hear How to make the 10% count

23. Do We “Get” Something From CME?

24. Is post-test performance improved? (DOE) YES Beware “Chinese-Dinner Memory Dysfunction”

25. Are patient outcomes improved? (POEM) No...Multiple RCTs have failed to find a benefit from traditional lecture format (passive) Maybe... with active (hands-on) workshops combined with close follow-up

26. Usefulness Validity: Depends on the speaker Relevance: Depends on POEM:DOE ratio Work: Higher than it seems NBA analogy (only last two minutes count) Tracking down validity of new POEMs

27. Role of the Speaker Present a good mix of POEMs highlighted by clinically relevant DOEs Augment POEMs with clinical experience Identify Level of Evidence (LOE)for listener

28. Role of the Listener Identify, before the talk begins: What you want to learn What are the POEMs you need to know? Actively evaluate information (CME worksheet) When a change-inducing POEM is presented, validate: By questioning the speaker By cross-checking with other sources

29. Identifying “Common” POEMS Will this information have a direct bearing on the health of my patients (is it something they care about)? Is the problem common to my practice? Is the intervention feasible? If true, will it require me to change my current practice?

30. Newer Models for CME Practice-based small group CME Educational prescriptions Point of care Sources Team-based learning Audience response systems CME worksheet Social media