Typical Time to Treatment of Patients With Lung Cancer in a Multisite, US-Based Study.

Introduction: The importance of high-quality, timely lung cancer care and the need to have indicators to measure timeliness are increasingly discussed in the United States. This study explored when and why delays occur in lung cancer care and compared timeliness between two states with divergent disease incidence.

Methods: Patients with small-cell or non-small-cell lung cancer were recruited through cancer centers, outpatient clinics, and community approaches, and interviewed over the phone.

Peering inside the clock: using success case method to determine how and why practice-based educational interventions succeed.

Introduction: No educational method or combination of methods will facilitate implementation of clinical practice guidelines in all clinical contexts. To develop an empirical basis for aligning methods to contexts, we need to move beyond "Does it work?" to also ask "What works for whom and under what conditions?" This study employed Success Case Method to understand how 3 performance improvement CME activities contributed to implementation of tobacco cessation practice guidelines in 9 outpatient practices.

Methods: Success criteria were applied to clinical data from 93 practices, generating a pool of 14 success cases; 9 were recruited into the study.

Evaluation of a collaborative program on smoking cessation: translating outcomes framework into practice.

Introduction: Although evaluating at multiple outcome levels has been proposed for continuing education activities and programs, it is a complex undertaking and is not done routinely, especially in collaborative, multicomponent programs. This article reports on strategies used and results obtained in an evaluation project that examined multiple outcomes of a US-based collaborative, multicomponent smoking cessation educational program for clinicians.

Methods: Evaluation was organized conceptually around the 6 levels of an outcomes-based evaluation model and was conducted using registration data, postactivity evaluations, clinical vignettes with questions assessing knowledge and competence in participants and in a comparison group, a commitment to change approach, data from patient charts to assess clinician compliance on 8 performance measures, and tobacco cessation rates.

Commitment to practice change: an evaluator's perspective.

A commitment to practice change (CTC) approach may be used in educational program evaluation to document practice changes, examine the educational impact relative to the instructional focus, and improve understanding of the learning-to-change continuum. The authors reviewed various components and procedures of this approach and discussed some practical aspects of its application using an example of a study evaluating a presentation on menopausal care for primary care physicians. The CTC approach is a valuable evaluation tool, but it requires supplementation with other data to have a complete picture of the impact of education on practice.

Learning to collaborate: a case study of performance improvement CME.

Introduction: Performance Improvement Continuing Medical Education (PI CME) is a mechanism for joining quality improvement (QI) in health care to continuing medical education (CME) systems together. Although QI practices and CME approaches have been recognized for years, what emerges from their integration is largely unfamiliar, because it requires the collaboration of CME providers and stakeholders within the health care systems who traditionally have not worked together and may not have the same understanding of QI issues to close performance gaps. This study describes how an academic institution and a community-based primary care practice collaborated to enhance patient care in the area of hypertension.

A model of teaching-learning transactions in generalist-specialist consultations.

Introduction: A new paradigm in continuing medical education is characterized by emphasis on physicians' learning in practice. Consistent with this paradigm, our study examined a subset of clinical practice--generalist-specialist consultations--from an educational perspective.

Methods: We applied the grounded-theory method with semistructured interviews.

Education through telemedicine networks: setting quality standards.

Quality standards for educational programming have received limited attention in telemedicine. We selected five sets of standards from the distance education literature established by: (1) the American Council on Education; (2) the American Distance Education Consortium; (3) the Council of Regional Accrediting Commissions; (4) the Distance Education and Training Council; (5) the Innovations in Distance Education Project. The standards were reviewed to determine the purposes they were intended to serve and the process by which they were established.

Learning to use learning resources during medical school and residency.

Objectives: This study (1) examined the natural history of learning to use learning resources by medical students and residents and (2) considered whether that history is consistent with the ways in which physicians approach their learning tasks.

Methods: The authors conducted and analyzed thirty-two open-ended interviews of first-year and third-year medical students and first-year and senior residents in internal medicine, family medicine, or pediatrics.

Results And Discussion: Learning to use learning resources occurs at the same time as learning done to address instructional and clinical problems that physicians-in-training face, with all kinds of learning following well-documented stages.

Setting quality standards for web-based continuing medical education.

Continuing medical education (CME) on the Internet has grown steadily over the past several years. However, the quality of Web-based CME has received limited attention in the medical literature, and there have been few attempts to articulate quality standards. This article describes five sets of standards published in the distance education literature and explores whether the standards might be used to inform and enhance approaches to designing and delivering Web-based CME programs.

Use of theory to interpret elements of change.

Actions useful in reducing unacceptable variation in physicians' clinical activities have been identified through critical reviews of randomized controlled trials, and, from them, Richard Grol proposed six elements of effective change for mounting programs to improve clinical practice. The elements include consideration of the complex reality of clinical practice, attention to the designated change, analysis of the target group and setting, mixed interventions to address needs, and a plan of action. Although empirically based, the elements lack a theoretical underpinning that explains why the elements work.