Not your grandfather's CE

The way most continuing education (CE) programs have traditionally been presented — a lecture to a classroom of passive participants — isn't the best way people learn, says Greg J. Neimeyer, PhD, director of APA's Office of Continuing Education.

Although state licensing laws emphasize the number of hours practicing psychologists must spend in CE programs each year, a burgeoning literature on the science of learning — and CE outcomes in particular — is finding that interactivity and practical learning opportunities are more important than clock time.

"There's a move away from CE presented in a didactic, talking-head fashion," says Neimeyer. "The target is behavior change in the workplace setting as opposed to primarily or exclusively information updates."

Now, CE programs at APA and beyond are changing to fit this new model. And psychologists themselves are among those researching what works in CE and developing new programs to ensure that they and other health-care professionals provide the best possible patient care.

Learning about learning

Medicine is leading the way when it comes to improving CE, says Neimeyer. Driven by a push for greater accountability and rapid increases in new knowledge, medicine is shifting to problem-based learning, the use of baseline and follow-up data collection to demonstrate competence and learning that takes place in the workplace rather than the classroom.

These innovative approaches are in line with recommendations the Institute of Medicine (IOM) put forth in its 2010 report Redesigning Continuing Education in the Health Professions, says Ronald M. Cervero, PhD, co-director of the Institute for Evidence-Based Health Professions Education at the University of Georgia.

The report, which calls for a radical overhaul of CE, identifies five factors that are key for effective CE:

• Incorporating needs assessments to ensure that material is relevant to learners' needs.
• Emphasizing interactivity, such as group reflection and opportunities to rehearse.
• Using feedback to engage participants in learning.
• Using multiple instruction methods and giving participants enough time to process content.
• Simulating participants' own clinical settings.

"There's consensus about the mechanisms of action likely to improve practice outcomes," says Cervero, who summarizes the literature in a chapter in the 2012 book "Continuing Education: Issues, Impacts and Outcomes." "We know how to do it, if we would just do it."

Some organizations have already started to put the IOM recommendations into practice, and the changes are having a measureable effect on patient care.

Take heart failure, for instance. Cardiologists generally think they're providing the best treatment for the condition, yet many aren't adhering to evidence-based treatment guidelines, says psychologist Blake T. Andersen, PhD, president and chief executive officer of the HealthSciences Institute in St. Petersburg, Fla.

To change that, the institute developed learning programs and tools for an initiative called Improve HF (Heart Failure). The intervention began with an assessment of how well cardiologists at 167 cardiology clinics were adhering to guidelines for using specific medication and therapies and providing patient education — quality measures selected for their potential impact on patient outcomes. Practices then underwent an intervention that included a one-day training focused on needs identified in their baseline data and ongoing Web-based seminars. They also received report cards that evaluated how each practice was doing compared to others regionally and nationally. And they received best practices algorithms, checklists, pocket cards and other tools designed to remind cardiologists to follow treatment guidelines.

The intervention's goals were to show the cardiologists where they needed to improve and how to develop those competencies, says Andersen. "You believe you're delivering evidence-based care, but until you're actually evaluated on that and receive a profile about what your adherence is, you don't know," he says.

This approach to ongoing professional development is effective, researchers studying Improve HF confirmed. In a paper published in Circulation in 2010, the researchers found that the intervention produced significant improvements in five of the seven quality measures: the use of aldosterone antagonist, cardiac resynchronization therapy, implantable cardioverter-defibillator, beta-blocker and patient education. At the two-year follow-up, practices were providing evidence-based, guideline-recommended care 80 percent of the time, compared with just 68 percent at baseline.

New CE for psychologists

Now psychology is beginning to follow suit by working to ensure that CE means something more than just clocking hours.

"It's not sufficient to document to the public that we sat in a chair for 20 hours," says Neimeyer. "We have to demonstrate that when we get out of the chair, we have something to show for it that translates into what we do differently in the workplace setting."

Although some of the earliest and best theories of learning come out of psychology, says Neimeyer, the irony is that the profession hasn't always applied those theories to its own CE offerings.

When assessing CE, he points out, psychology often looks at the most basic outcomes, such as participation, participant satisfaction and self-reported and objective measures of declarative learning. Less common are assessments focused on what really matters: whether participants know how to apply new knowledge, whether they integrate that knowledge into their practices and whether that integration improves client outcomes.

CE for psychologists is already changing as a result of the growing evidence about what works. In 2012, APA created a working group to advise its Continuing Education Committee on how to improve the association's CE offerings. The group's first task was to review the literature on the science of learning as well as best practices in other health professions.

"We're trying to facilitate the integration of our empirical knowledge about learning, retention and application to improve our current CE system," says Susan J. Simonian, PhD, a psychology professor at the College of Charleston, who heads the APA working group. "And we're working in a mentorship role with CE sponsors to help them do the same."

At APA's 2012 Annual Convention, for example, Simonian and her colleagues hosted a workshop for CE sponsors to encourage them to incorporate the best practices the working group had identified into their CE programs. The workshop leaders modeled the desired behavior by presenting case studies, using multimedia forms of presentation and asking participants to break into small groups. Those small groups then presented ideas for transforming a standard lecture into a presentation that embraced best practices in learning.

"That's just the beginning of what I hope will be a series of workshops that will help bring this information to sponsors," says Simonian, who has changed her own teaching practice by making her classroom more interactive, asking students to apply their knowledge to real-life situations and quizzing students more frequently. "We're looking for ways to serve not just as a regulatory board but a board that helps CE sponsors enhance their offerings."

APA is already taking into account research that demonstrates the effectiveness of what's called distributed learning — extending learning time beyond a single class.

"CE is often not an ongoing process, but a single-shot hour, half day or day where you learn a great deal and then leave," says Neimeyer. "That's a great way to get a lot of information across, but the forgetting curve is massive."

To avoid that problem, starting in April, APA will launch new professional development training institutes that will distribute learning beyond the time spent in a classroom.

Participants will spend two days in workshops at APA, followed a month later by a half-day webcast with the presenter and workshop participants. That follow-up will allow participants to discuss how they've translated their new knowledge into their practices and share with the presenter and each other what worked and what didn't.

"Usually when you walk into a CE program, you assume when it's over, it's a done deal," says Neimeyer. "In this case, it's just the start of the process."

APA is also helping to build the knowledge base on what makes CE effective. For the first time, says Neimeyer, APA will conduct an outcome assessment of the 70 CE workshops offered at APA's 2013 Annual Convention in Honolulu. The goal is to assess whether participants have translated their new knowledge into their practices and determine which methods of instruction helped participants achieve that goal most effectively.

"The convention workshops, which will have well over 1,000 participants, represent a giant lab in which we'll try to determine the best practices in CE," says Neimeyer. "In addition to promoting best practices, we take seriously the science piece of trying to identify them as well."

Rebecca A. Clay is a writer in Washington, D.C.