Clinical practice guidelines and the translation of knowledge: the science of continuing medical education.

of the Mexican Institute of Social Security (page 1295) advances our understanding of the continuing education of physicians and thus its contribution to health care and health care outcomes. Despite some limitations, explored below, it does so in several important ways. First, the article provides a more complex and dynamic definition of continuing medical education (CME) than the teacher-driven vision pictured by most physicians when they see this common abbreviation. That narrow picture has gradually given way to a broader definition. CME, it is now widely recognized, comprises a variety of tools well beyond the traditional didactic lecture delivered in a hotel conference room. This broader concept is explored in the article by Pérez-Cuevas and colleagues and in many others; it includes, among other methods, interactive workshops, small group sessions, reminders and audit feedback, individualized tutorials and peer review. Further, the definition employed in the Pérez-Cuevas study includes an action orientation often lacking in traditional CME. For example, the authors use the term “intervention,” with its attendant notion of altering health service delivery and outcomes. Second, the article reflects remarkable integration, at several levels. The educational study was funded by the health care agency itself, which represents at least enlightened self-interest or, perhaps at most, an understanding of the role that well-constructed CME can play in health care delivery. The CME process described by Pérez-Cuevas and colleagues included both the development and the implementation of clinical practice guidelines, along with a recognition of the problems inherent in the adoption of such guidelines by physicians. The educational intervention was integrated directly into the practice setting, both physically and temporally; it was not a stand-alone event held at a distant, nonpractice location. Finally, the complex educational intervention exemplified the best form of knowledge translation (the integration of knowledge into practice), moving the practitioner from awareness of new guidelines to agreement with the guidelines and finally to adoption and adherence, following well-defined patterns of adoption and based on principles of adult learning applied to CME. Third, the authors have pushed the measurement of CME outcomes well along the evaluation continuum. The Clinical practice guidelines and the translation of knowledge: the science of continuing medical education