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Moore’s Levels for CME Mindmap created by Yanhong LU, LEFT <Possible…
Moore’s Levels for CME
Mindmap created by Yanhong LU
Approach key features
4 strategies
Start with the end in mind
Do gap analysis
2.Consider physician stages of learning
Focus on clinical problems & knowledge that can be used
in practice
Provide opportunities for practice & feedback in authentic
settings.
Consider factors
Community & societal forces
Organizational factors
Participants
strategies
transfer learning to practice setting
“Predisposing enabling-reinforcing” approach
+presentation-example-practice feedback
3 Assessments
2.Formative assessment
create a teachable moment
+develop skills
+provide reinforcing activities & materials
3.Summative Assessment
1.Needs assessment
Strategies for planning for the outcomes to be measured integrated with strategies for assessing them
Continuum assessment
Level 5 Performance
(DOES)
Assessment
Objective(Observation in patient care setting)
Patient health record
Patient charts
Administrative records/database
Subjective
Physician questionnaire
Patient questionnaire
Example of usage
individual qualitative interviews
assess how educational content has affected their practice
Improved physician performance
Level 6 Patient health
Improved patient health status
Assessment
Objective
Patient health record
Patient charts
Administrative records/database
Subjective
Physician questionnaire
Patient questionnaire
Level 7 Community health
Improved population health status
Assessment
Objective: Epidemiological data & reports
Subjective: Community self-report
Level 4 Competence
(SHOWS HOW)
Improved physician performance
Assessment
Objective(Observation in educational setting)
Observation during practice & feedback during learning activity OSCEs
Scenarios with ARS
Scenarios in small groups
Standardized patients
Subjective
Intention to change
Physician questionnaire
Clinical scenarios ~electronic
Clinical scenarios ~print
Example of usage
Behaviour change survey
surveys
quizzes
interactive polls
individual qualitative interviews
Level 3A Learning-declarative knowledge (KNOWS)
Assessment
Objective: Pre- & post-tests of knowledge
Subjective: Self-report
Level 3B Learning-procedural knowledge
(KNOWS HOW)
Assessment
Objective: Pre- & posttests
Subjective: Self-report
Level 2 Satisfaction
Satisfied (setting & delivery)
Assessment
Questionnaires
Level 1 Participation
Enrolls
Assessment
Attendance records
Predisposing
Create / reinforce “ teachable moment ”
1.Present current performance data
2.Present guidelines/standards of care
academic detailing / local opinion leaders
3.Present comparation
actual performance with guidelines / standards of care
4.Panel discussion
identify factors contributing to the difference between current & desired performance
Consensus on improvement action
education & other
Enabling
1.Presentation/Rule
a. leads to a level 3a outcome
declarative knowledge
“what”
b. review consensus
corrective action
c. summarizing available evidence
detailed, step-by-step description of practice guideline / standard of care
d. Implementation strategies description
management of barriers
summarizing available evidence
Example/Demonstration
a. leads to a level 3b outcome
procedural knowledge
“how to”
b. case
how the practice guideline / standard of care used in practice
c. increase complexity/messiness! in each succeeding case
progressing to as authentic a case as possible
Practice
a. leads to a level 4 outcome
competence
“shows how”
b. clinical reasoning & communications skills:
Reasoning: diagnostic & treatment decisions
1.small group discussion of cases led by expert
2.case studies with audience response system
pause at key decision points
live or on the Web
3.observation with standardized patients
c.psychomotor skill
: surgical & procedural
1.simulation
2.animal lab
Feedback
a. leads to a level 4 outcome
competence
“shows how”
b. expert faculty feedback based on observation of practice
praise correct performance
discuss opportunities for improvement
c.multiple practice-feedback sessions
. optimal performance
Develop competence related to teachable moment
Reinforcing
Assists recall of competence
Commitment to change / intent to practice agreements
Course handouts
Summaries of guidelines
suggestions for implementation
strategies for dealing with barriers
3.Reminders
placed on charts of patients for whom the guidelines is relevant
4.Case studies staggered over several months
opportunities to earn CME credit
5.Invitation/opportunity to participate in a “performance-improvement CME” project
LEFT <Possible Learning Techniques<
RIGTH >Moore Level>
PICTURES:
https://drive.google.com/drive/folders/1yhWEtUQiTbqoGo68NdFnfv5K9FqINpJI
REFERENCE:
Achieving Desired Results and Improved Outcomes: Integrating Planning and Assessment Throughout Learning Activities
https://www.researchgate.net/publication/227627769_Achieving_Desired_Results_and_Improved_Outcomes_Integrating_Planning_and_Assessment_Throughout_Learning_Activities