Information mastery: integrating continuing medical education with the information needs of clinicians

Traditional continuing medical education (CME) has been disconnected from the actual practice of medicine and has not focused on providing the most useful information in the most efficient way. Physicians have different information needs at different times. When asked at the end of a day of patient care, physicians will typically report having had one question for every four or five patients. However, direct observation during patient care reveals many more questions. In the outpatient primary care setting, most studies have found, on average, that about two clinical questions are generated during every three patient encounters, with even higher numbers reported in the inpatient teaching setting. Thus, a physician seeing 25 patients in a typical day of outpatient care may have 15 clinical questions. Because clinical questions are the result of critical reflection by a clinician on his or her practice, they are central, to physician learning. This connection between "need" and learning is consistent with generally accepted theories of adult learning. When applied to continuing education, this connection suggests that physicians will learn best when learning is in the context of patient care, answers their questions, does not take too much time, and is directly applicable to their work. Pursuing answers to these questions and answering them with the best available evidence, at the time the answer is needed, may well change the physician's general approach to patient care.