This resource has been established for faculty and authors who are involved in the development of CME activities and manuscripts to assist them with defining professional practice gaps that support the need for the CME activity, writing learning objectives, identifying and addressing barriers to ideal clinical practice, preparing multiple choice questions for post-tests, and addressing physician competencies.  

Defining Professional Practice Gaps

As part of planning each CME activity, The Endocrine Society is now required to identify professional practice gaps that underlie the needs that the activity will address for the intended target audience.

The professional practice gap is best defined as the difference between the current state of knowledge, skills, competence, practice or patient outcomes and the ideal or desirable state.  Several examples are provided below.

• Notes and/or communications from planning/steering committee or faculty
• Literature review/search
• Peer-reviewed scientific/clinical publications
• Survey data
• Epidemiologic data
• Clinical practice guidelines/treatment algorithms
• Evaluation data/participant suggestions from CME activities
• Exam performance analysis (e.g. ESAP or ABIM Board Review performance analysis)
• Quality improvement guidelines
• Public health data (national, regional, state)
• Government mandates/legislation
• Clinical surveys or chart audits
• Expert input (must identify expert[s] and other support gaps identified with information from another source)
  

 Guidelines for Writing Learning Objectives

Learning objectives in CME activities should be derived from identified gaps in physician knowledge, competence, and performance or patient outcomes.  Learning objectives should clearly and concisely communicate what learners are expected to know and/or do after participating in a CME activity.  Learning objectives should also frame the content to be presented; it is critical that each objective be specifically addressed in the content.  If a post-test or other assessment is associated with the CME activity, the test should include questions that address or relate to each learning objective.  Learning objectives should be provided at the beginning of each activity to allow learners to evaluate the relevance of the activity to their practice.

The three essential components of learning objectives are who (the learner), how (an action verb), and what (the result).

Because CME providers are now expected to design CME activities with the intent of changing physician competence or performance or patient outcomes, as opposed to merely increasing knowledge, we ask that learning objectives be focused on "higher level" outcomes.  Examples of action verbs useful for crafting such outcomes are listed below.

Identifying and Addressing Barriers to Ideal Practice

Below are examples of factors that may impede changes in physician practice and/or impact patient care.  Whenever possible, topic-specific barriers to ideal practice should be identified in developing CME content.  Identified barriers should be included as part of the content, along with information and practical strategies for overcoming the barriers.

Physician Factors
Sometimes physicians themselves present barriers to change, and physician education can play an important role in helping to overcome such barriers.  Examples include:

• Lack of detailed knowledge about new procedures or treatments
• Resistance to change/inertia
• “Information overload” leading to lack of awareness about new treatments or procedures
• Lack of awareness or detailed knowledge about new or updated clinical practice guidelines 
• Lack of agreement with new or updated clinical practice guidelines
  

Patient  Factors
Various patient factors may present barriers to change.  Physicians and other healthcare professionals may be able to help patients overcome these barriers.  Education that includes practical strategies for addressing such barriers can be helpful to physicians. Examples of patient-level barriers include:

• Poor health literacy
• Socioeconomic status
• Limited or no health insurance coverage
• Resistance to change
• Inaccurate perceptions/beliefs or fears about treatments (eg, fear of vaccines or fear of self-injection)
• Cultural differences
• Noncompliance with treatment
  

Please note that The Hormone Foundation provides patient education resources, including bilingual patient fact sheets, on a wide range of endocrine disorders that can be downloaded for free online.

Institutional Factors
Often barriers to change are systemic and as such, may be more difficult to address with education alone. Examples include:

• Time constraints
• Reimbursement challenges
• Lack of resources
• Hospital restrictions (eg, treatment not on formulary)
  

Physician Competencies

The Society is charged with creating CME in the context of desirable physician attributes, as exemplified by competencies set forth by the Institute of Medicine and the Accreditation Council for Graduate Medical Education and American Board of Medical Specialties.  These competencies are listed below.  A checklist documenting which competencies are addressed should be completed for each CME activity.  At least 2 competencies from either the IOM or the ACGME/ABMS list should be addresses in each activity.

Guidelines for Preparing Multiple-Choice Test Questions for CME Activities

Writing Questions:

• Consider the target audience’s level of expertise. Good questions are neither too easy nor too hard.
• Be sure to include test questions that address concepts communicated in the activity’s learning objectives.  In addition, while it is appropriate for some questions to assess knowledge gained from participating in the activity, try to include questions that go beyond knowledge to assess whether participants can apply the information in clinical practice.  Such questions have the advantage of  providing participants with reinforcing feedback in specific, practical applications. They also allow the Society to determine whether learning objectives were achieved and may indicate the potential for change in clinical practice as a result of the educational intervention.
• Use a question format.  Do not use incomplete or fill-in-the-blank sentences. 
• All questions should be multiple choice with a single best answer; no true/false or matching.  
• Avoid negative question constructions such as “What is the least likely diagnosis?” or “which of the following is FALSE?” Answering such questions requires that participants use “backward logic” that may increase confusion and imprecision rather than reinforcing educational messages.
• Avoid trick questions.
• Pose one clear concept or task in each question, as shown by examples below.
  
  

Writing Answer Choices:

• Provide 4 – 5 answer options: 1 correct answer and 3-4 distracters (wrong answers).
• Make sure there is only one right answer and that it is not too obvious.
• Use realistic, plausible distracters.  Avoid answers that are trivial, implausible, obvious, or nonsense.  Good distracters include common misconceptions, outdated beliefs or treatment recommendations, and frequently confused ideas.
• Make the options similar in terms of grammar, length, and complexity.
• Do not use “all of the above” or similar answer combinations as these tend make the question too easy to answer correctly. 
• Similarly, do not use “none of the above” either as a distracter or a correct answer; in the latter case, this response will not reveal whether participants know the correct answer.