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It not only is straight-forward, honest, and real life situations, it has such a great sense of humor with it, saying the things we ALL think and want to say but are "filtered" to actually say. I would recommend this book to physicians, staff, clinicians, coders, billers, administrators, and anyone else in or considering a career in the Medical Field. I have read many practice management books over the past 9 years and this book is a keeper. I would advise any practice manager to make this small investment for their career. An important characteristic of point of care information services is its ability to engineer meaningful and up-to-date syntheses of evidence for use at the point of care.

Point of care information services assemble information from primary eg, clinical trial results, original articles and secondary eg, systematic reviews research articles in authoritative biomedical journals, logically order the data according to a medical scenario, and translate the data into a set of actions. By mimicking the natural thought flow of physicians from diagnosis to treatment, point of care information services can easily integrate into their regular clinical work flow.

Point of care services can increase health professional's competence by moving learning directly to the site of practice. Much of the knowledge that is used in everyday practice is learnt within practice itself; 49 such knowledge, in turn, gains meaning through the context by which it was acquired. Skills are a part of personal knowledge, a representation of individual competence or expertise. These five steps can be consolidated into the three mechanisms of self-directed learning integrated in point of care information services: needs assessment, problem-based learning, and self-reflection box 3.

This approach offers several advantages. It stimulates reflection, a key component of self-directed learning activity that occurs before, during, and after a particular situation eg, patient visit. The purpose of reflection is to develop a greater understanding of both oneself and the situation in order to use the experience to inform and improve future encounters with the situation. These outcomes build upon the physician's knowledge base and help inform future encounters with similar patient cases. Moreover, point of care information services create opportunities for the consolidation of new knowledge.

Practitioners tend to pursue traditional education around topics they are already good at, while avoiding areas in which they lack understanding. The use of point of care information services can also limit the risk of information inertia, a knowledge gap that remains unanswered. The number of high-quality point of care information services on the market is increasing. In , Banzi et al 18 performed a comprehensive search to identify English language point of care information services, which they defined as online-delivered summaries that are regularly updated, claim to provide evidence-based information, and are engineered to be used at the bedside ie, the point of care.

All of the selected services complied with the two pillars of evidence-based information mastery: filtering and organising. In other words, medical literature is selected for relevance and validity filtering and presented in a quick, easy, accessible form organising. The investigators excluded meta-lists and search engines that collects and duplicates information sources to privilege original products that elaborate this information into original and structured contents. The main target audience remained physicians, while three new services targeted nurses and physiotherapists.

When compared with the first analysis , Banzi et al noticed some improvements in the summary content presentation features. However, point of care information services still varied widely in their quality of content development and capacity to update and grade evidence. The high variability of the quality of point of care information services has been assessed in several other studies that considered the speed of updating, 18 62 63 editorial quality and coverage, 64 and type of citations. There remains limited evidence on the effectiveness of point of care information services on practice improvement and patient outcomes eg, morbidity, mortality, quality of care indicators despite the increasing number of available services.

While were unable to locate any data regarding the cumulative diffusion of point of care information services, it is our impression that the use of these services is becoming common.

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Although health professionals use a wide spectrum of information resources such as consulting their colleagues, PubMed, and Google, there is a strong predilection for point of care resources to provide pre-appraised information. Seeking to measure the impact of point of care information services, quasiexperimental and experimental studies have explored different patterns of care in primary and secondary settings with and without access to the information services. By better connecting the information needs of physicians with CME activities, point of care information services can support self-directed learning and help improve the efficiency and quality of healthcare delivery.

The following strategies can support the integration of CME activities with point of care information services to advance the self-directed, competency-based model of CME. Physicians and other health professionals should earn CME credits while searching through point of care information services. The search for high-quality evidence, its filtration, and application to a clinical case are important tasks that should be recognised as CME activities.

When health professionals modify their behaviour or advice given to patients based on evidence from randomised controlled trials or systematic reviews, they are refining their information mastery. In this context, information mastery entails the skills necessary to locate clinically sound and relevant information in the least amount of time, as well as to transfer the information to patients.

Publishers and accreditation entities should coordinate their activities such that point of care information services can easily track, record, and communicate the searches completed by health professionals to accreditation bodies, which can then issue the earned credit. In addition to the recognition of searches using point of care information services as a type of CME activity in and of itself, CME accreditation bodies should support the maturation of point of care information service developers as CME providers.

The accreditation process is becoming increasingly challenging. CME stakeholders are required to produce large amounts of information to fulfil the expectations of accreditation bodies. The content areas addressed by the CME programme; target audience; types of activities; expected results in terms of changes in knowledge, competence, or patient outcomes at the completion of the programme; activity formats; and commercial support are only a fraction of the overall requirements requested by accreditation bodies. Currently, it is easier for a drug company-sponsored residential event to fulfil accreditation requirements compared with point of care information services, especially as the outcome of the latter is considered more unpredictable.

In fact, we cannot predict exactly who will use point of care information service contents, how the content will be implemented, and for which patient; however, the impact of point of care activities potentially exceeds that of commercially sponsored meetings. A few accreditation entities are beginning to recognise the importance of point of care information services and searches as well as other innovative educational programmes as CME activities.

For instance, the CFPC issues up to 0. However, the educational value of using point of care information services may still be undermined. The value of a CME activity is often evaluated according to three dimensions: its absolute value eg, 0. Again, passively participating in a scientific meeting may award more credits than locating essential information that matters to a patient at a crucial time. We urge accreditation entities, therefore, to support the transition from traditional CME models to a competency-based framework that promotes self-directed learning.

Rather, accreditation bodies should evaluate each CME activity according to the quality and utility of the information presented. This policy will address the problem of overwhelming irrelevant information ie, the information paradox.

Publishers that develop point of care information services should continue to invest in maturing these services for educational purposes. CME on demand might also differ from traditional e-learning platforms owned by publishing groups.

About this book

The advent of Free Open Access Meducation FOAM resources has opened a new outlet for the synthesis and exchange of information within the medical community. Publishers should regularly update users on the availability of new contents and applications in their point of care information services to maximise their use and potential payback. Publishers that provide only one stand-alone service eg, information , regardless of its quality, might be perceived as static and remote from practice.

The information needs of health professionals will be better satisfied through information hubs in which evidence are rearranged to serve different purposes. The key aggregation point is likely to be the electronic health record EHR. These information systems link patient-specific data from EHRs with evidence-based knowledge from point of care information services and generate case-specific reminders or guidance messages through a rule- or algorithm-based software.

CDSSs can also generate structured practice audits and performance metrics for self-assessment. Finland's Evidence based Medicine electronic Decision Support is one such technology. The interaction of point of care information services with EHRs will constitute the core of modern CME activities, and will align the maintenance of certification to best practice uptake. Accreditation bodies and medical societies have already begun to shift from the traditional model of CME towards competency-based CME in which physicians must prove ongoing competence and performance through participation in CME activities.

Accreditation entities, medical societies, and publishers should continue to support this shift by providing physicians with functional opportunities and additional incentives to engage in competency-based CME programmes. Questions arising from patient visits are key opportunities for competency-based CME. To encourage the active seeking of evidence that matters at the point of care, better credit compensation for these efforts should be awarded.

The EHR should be explored as an aggregation point for professional development, a space in which physicians can continuously transfer questions and observations from practice and obtain answers to mature their expertise. These changes would meet the growing needs for competency-based CME reform to optimise patient outcomes and sustain a proficient healthcare professional workforce. Systematic reviews consistently show the modest effects of traditional continuing medical education interventions such as large audience residential meetings, small-group workshops, and printed materials.

Point-of-care services are web-based compendiums that facilitate clinician interaction with information resources at the bedside to support decision making. Information mastery signifies the skills to locate relevant and evidence-based information in the least amount of time as well as the ability to successfully transfer the information to the patient.

Self-directed learning is a novel education model that involves the ability to take control of the mechanics and techniques of teaching oneself a particular subject. Continuing medical education CME is shifting from a traditional, passive model to a competency-based, self-directed learning model. The integration of point-of-care services into web-based CME programmes can better meet the information needs of clinicians during practice.

CME providers should increase physician participation in a competency-based model by recognising and incentivising the usage point of care services as CME activities. What role will the electronic health record play in linking point of care service searches and continuing medical education CME activities?


What is the best organisational infrastructure to support collaboration among health professionals, accreditation bodies, publishers, and CME providers to maximise the benefit of CME activities? Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes?

Notice of approval

JAMA ;— Internet-based learning in the health professions: a meta-analysis. The adult learner: The definitive classic in adult education and human resource development. Burlington, MA: Elsevier, A review of online evidence-based practice point-of-care information summary providers. J Med Internet Res ;e When less is more: a practical approach to searching for evidence-based answers. J Med Libr Assoc ;— This paper was developed as an extension of LM's PhD thesis. The authors would like to thank Jeremy Grimshaw for his valuable support as the thesis supervisor.

Contributors: The coauthors contributed equally to the background research, draft of the manuscript and its critical revision. LM is the guarantor. Funding sources had no role in the writing of this manuscript or the decision to submit it for publication. Provenance and peer review: Not commissioned; externally peer reviewed. National Center for Biotechnology Information , U. Postgraduate Medical Journal. Postgrad Med J. Lorenzo Moja 1, 2 and Koren Hyogene Kwag 2. Author information Article notes Copyright and License information Disclaimer.

This article has been cited by other articles in PMC. Abstract The structure and aim of continuing medical education CME is shifting from the passive transmission of knowledge to a competency-based model focused on professional development. Introduction The medical community supports continuing medical education CME as a key intervention for the advancement of knowledge, development of new skills and capabilities, and, ultimately, the improvement of patient health and outcomes.

Box 1 Evidence of effect of traditional continuing medical education CME methods. Box 2 Key terms used in this review. Self-directed learning: preparing lifelong physician-learners Although the definition of self-directed learning varies across literature, the core of self-directed learning is exemplified by autonomy over the learning process in which an individual chooses what to learn, how to learn it, and where and when to engage in the learning. Evidence for self-directed learning in health professions Self-directed learning is an effective education tool.

Technology and education The advancement of technology has created new platforms for the integration of self-directed learning into CME programmes. The internet as a primary source of information Physicians regularly engage in learning at the point of care, using online resources to support clinical decision making. Use of mobile devices to access information The use of personal digital assistants, tablet computers, smart phones, and other mobile devices is increasing in the medical profession, reflecting the demand for more accessible information to support clinical decision making.

Medical information-seeking behaviour plays a key role in physician learning A specific patient problem has been identified as the most common reason for seeking information on the internet. Point of care information services for self-directed learning Two characteristics distinguish point of care information services from other self-directed learning activities: 1 focus on information that matters and 2 on-site learning.

Information that matters An important characteristic of point of care information services is its ability to engineer meaningful and up-to-date syntheses of evidence for use at the point of care. Front Matter Pages i-xiv. The Basics of the Business of Medicine. Pages Transitioning from Training to Practice.

Koushik Shaw, Thomas F. Stringer, Roger G. Job Search. Insurances and Essential Fringe Benefits. The Coding Aspect of the Business of Medicine. Understanding Financial Statements. Numbers You Need to Know.