Clinical Pathways at the core of Continuous Medical Education activities

Clinicians in today’s health care environment face an overwhelming quantity of knowledge that requires lifelong learning. In this blog post, we explain why Clinical Pathways are efficient tools to achieve the desired results when designing a training program.

Clinical Pathways at the core of Continuous Medical Education activities

Within Europe, there is no commonly accepted approach to continuing medical education. However, there is broad agreement that patients are best served when those who care for them maintain competencies by engaging in continuous learning and assessment strategies.

Cutting to the chase, the knowledge, and skills acquired at the end of formal undergraduate and postgraduate professional medical education are insufficient to sustain competence and performance over a career, thus physicians are expected to effectively engage in lifelong learning strategies. Furthermore, there are increasing public concerns related to the variability in the quality of care provided, the safety of the health system, and the frequency of adverse events.

In a past article, we summed up some practical examples of how CME activities improved physicians' performance in particular contexts. However, this is not effective in all scenarios and some challenges remain, especially with traditional methods of directly transmitting information that neither produce a behavioral change in professional practice [1] nor meet healthcare professional needs, given the increasing demands on their time.

In fact, learners now expect easily accessible activities that facilitate knowledge synthesis and prioritize clinically relevant problem-solving.[2]

We have already written about why Continuing Medical Education (CME) should be a priority within hospitals, its importance on health teams' retention, and the impact it has on a hospital account, care quality, and patient satisfaction. We have also shared our thoughts on clinical pathways benefits to support decision-making, improve communication and teamwork in multidisciplinary teams, mitigate risk, improve patient care outcomes and reduce cognitive overload.

Now, the question is: why do we believe that clinical pathways are efficient training tools?

How do physicians learn?

For instance, let’s take the conceptual model proposed by Donald et al [3] to help CME planners assessing continuous learning. This framework establishes four stages of learning, as described below:

  1. Declarative knowledge – Knowledge acquisition and interpretation of facts. The clinician “knows what to do.”
  2. Procedural knowledge – The clinician possesses procedural knowledge, meaning he/she can describe how to do something, but may not be able to do it.
  3. Competence – The clinician knows what to do, can describe how to do it, and is expected to demonstrate how to do it.
  4. Performance - The clinician uses the competence developed to treat patients.

Now, let’s recap what is a clinical pathway, with Yang and Su’s definition:

“A Clinical Pathway is a multidisciplinary patient care plan, in which every intervention that should be performed by medical professionals is well-defined and optimized.”  [4]

In other words, clinical pathways enable rapid access to evidence-based resources for professionals to support decision-making, treatment, care planning, referral, and follow-up. Additionally, these tools have also been reported to reduce cognitive overload.

So, clinical pathways are the tools that empower healthcare professionals to succeed in 1 and 2, if used in training activities, and achieving stage 4 if used as a decision support tool in daily practice.

3 reasons why Clinical Pathways should be applied to Medical Education:

1. Support clinical reasoning

Clinical reasoning is the process by which a professional interacts with a patient, collecting information, generating, and testing hypotheses, and determining optimal diagnosis and treatment based on the information obtained. Clinical pathways work as interactive tools to guide this process. In an educational context, provide an opportunity to develop this skill in a controlled and simulated environment, assisting physicians with evidence-based information when in doubt.

2. Provide actionable recommendations

The proliferation of medical information represents a challenge, both in terms of volume and in terms of complexity. In addition, these changes are often associated with new clinical approaches and, consequently, updating professionals is crucial for patient safety and the provision of quality care. Thus, more than endless pages of theoretical and time-consuming information, healthcare professionals need to know what to do when a set of circumstances occur. Clinical pathways give healthcare teams the answers they need to decide what to do in every stage of a patient journey.

3. Initiate a cultural change and renewal in professional practice

Building sustainable, effective, and optimized systems usually depends on constant efforts for continuous improvement. However, transactional solutions, which lead to incremental results with marginally lower impact over time, are no longer enough. It is necessary to promote a deep shift in organizations' behavior and culture, creating an environment that favors continuous quality improvement, patient safety, and unjustified waste reduction. Designing a training program based on clinical pathways makes you able to share clear and customized insights on how each team is deviating from best practices. Consequently, is clear to everyone which processes need to be changed and which gaps should be filled.

In our next blog post, we'll detail how to design a training program for clinical pathways.

References:

[1] Cantillon P, Jones R. Does continuing medical education in general practice make a difference?. BMJ. 1999;318(7193):1276-1279. doi:10.1136/bmj.318.7193.1276

[2] McMahon GT. What Do I Need to Learn Today? -The Evolution of CME. N Engl J Med. 2016;374(15):1403-1406. doi:10.1056/NEJMp1515202

[3] Moore, D. E., Jr, Green, J. S., & Gallis, H. A. (2009). Achieving desired results and improved outcomes: integrating planning and assessment throughout learning activities. The Journal of continuing education in the health professions, 29(1), 1–15. https://doi.org/10.1002/chp.20001

[4] Yang, W. and Su, Q. (2014). Process mining for clinical pathway: Literature review and future directions. In 2014 11th International Conference on Service Systems and Service Management (ICSSSM), pages 1–5.