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Information Seeking in the Digital AgeWhy

Closing Knowledge Gaps Is Not Education
and Why the Difference Matters

JOHN M. HARRIS, JR., MD, MBA

In March 2005 the American Medical Association began

allowing physicians to claim Physicians Recognition Award
Category 1 credit TM for participating in self-directed on-line
searches, categorized as Internet point-of-care ~PoC! learning. In 2006 there were 79 151 physician participants in PoC
activities. This number increased to 103 155 in 2007 and
127 571 in 2008.1 On-line companies are rushing to develop
this new continuing medical education ~CME! format by
offering Web sites where physicians can quickly earn effortless CME credit, . . . for the online research you are
already doing. 2,3
PoC learning is supported by recent CME literature that
discusses information seeking by physicians. These reports
suggest that closing knowledge gaps is the purpose of CME
and that the process of searching for information via the
Internet is an important and evolving CME modality.45 This
reasoning is finding ready acceptance. But is this really a
path medical educators should encourage? Will it lead to
better doctors or will it water down serious efforts to improve CME and further marginalize medical educators?
Step outside of CME for a moment and consider the situation where an airplane pilot contacts air traffic control for
weather information and uses the information he or she collects to adjust the flight plan. The pilot detects an information gap, gathers knowledge to address the gap, changes
course heading, and improves results. Does this process make
a better pilot? Should the pilot be issued a certificate verifying that an educational event occurred? Of course not.
Pilots check the weather and adapt flight plans because they
are already well-trained. In pilot school they are taught how
Disclosures: The author reports none.
Dr. Harris: President, Medical Directions, Inc.
Correspondence: John M. Harris, Medical Directions, Inc., 6101 East Grant
Rd., Tucson, AZ 85712; e-mail: sharris@md-inc.com.
2009 The Alliance for Continuing Medical Education, the Society for
Academic Continuing Medical Education, and the Council on CME,
Association for Hospital Medical Education. Published online in Wiley
InterScience ~www.interscience.wiley.com!. DOI: 10.10020chp.20047

to fly a plane and how to seek information to improve results. These are previously acquired piloting skills; the
weather reports are simply new facts.
PoC learning exposes several fundamental questions. What
is the real purpose of education? Is it about improving outcomes, closing knowledge gaps, or improving individual
skills? Which of these concepts should drive our definition
of CME?
PoC learning seems to have resulted from a gradual acceptance within the CME establishment that the purpose of
CME is to improve health outcomes and that informationdistribution activities associated with better health outcomes
are better CME.6 It is a short step from here to conflating
fact acquisition with CME because fact acquisition really
can improve health outcomes. However, we should not confuse the actions doctors take with the skills they have. Weingarten performed a prospective clinical trial of information
sharing in the coronary care unit with the use of an alternatemonth design. He found that giving physicians information
on their patients cardiovascular risk, along with relevant
clinical guidelines, improved physician decision making, but
only during the months the information was available.7 This
demonstrates that information acquisition can improve physician performance, but that the effects may be due to the
presence of the information, not to durable improvements in
physician skills.
Progressive educators, such as John Dewey, spent their
careers teaching that the true purpose of education was skill
acquisition, not fact acquisition.8 Eventually, better skills
should lead to better outcomes, but so can several other activities that individuals and organizations might take. Are
all of these activities CME? Not if the purpose and raison
dtre of CME is skill improvement. If a physician does not
remember a drug dose or side effect and looks it up on the
Internet, thereby achieving a better outcome than he would
by guessing, this does not make the physician a better doctor. In this case, information seeking is the result of previous
education, which taught and encouraged him to seek out that
which he did not know or could not recall. Although the
definition of a good ~or better! doctor is elusive, most

JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, 29(4):276277, 2009

Information Seeking in the Digital Age

Lessons for Practice

Information seeking may improve patient
outcomes, but neither information seeking
nor outcome improvement means that education has occurred.
The real goal for CME must be assessing
and improving physician skills, not closing
knowledge gaps.

agree that the definition relates more to skills and character

than factual recall.9
By allowing self-directed information seeking to be considered CME, the education community may be giving up
on traditional CME. Commenting on the many shortcomings of existing CME, experts have noted that perhaps it is
indeed time to abandon the medical education0professional
development model and come up with new ways to improve
care.10
If traditional CME goes away, the skills problem will
still exist. Professional skills will get rusty, new skills will
become relevant, and no one will be very good at assessing
him- or herself.11 Whatever other approaches are taken to
improving care, the remedy for this unpleasant future will
still be education, not self-directed on-line searches. Effective education requires incremental, tailored programs that
improve knowledge and skills, most often led by experienced teachers. Skill improvement necessitates the use of
well-designed educationally relevant experiences. Lastly, it
requires external assessment. No amount of self-reflection
can substitute for this.12
A 2009 report from the US Department of Education noted
ample evidence that on-line education is often more effective than live education, quite possibly because students spend
more time on task. It also noted that on-line education blended
with live education may be more effective still.13 This does
not justify Internet information-seeking as CME. Instead it
should provide encouragement to develop more rigorous online CME programs, ones that physicians will use and ones
that will improve skills. For this to happen we not only need

a better understanding of what works and what does not, we

need clarity in the purposes of CME. This may require some
gentle reminders from educators that knowledge acquisition
is part of education, but not all of it.
References
1. Data from ACCME Annual Reports. http:00www.accme.org. Accessed
July 20, 2009.
2. Earn Effortless CME0CE. http:00www.uptodate.com0home0
clinicians0cme.html. Accessed August 10, 2009.
3. Imagine earning AMA PRA Category 1 Credit or AAFP Prescribed
credit for the online research youre already doing. http:00www.
eeds.com0index.asp. Accessed August 10, 2009.
4. Schoen MJ, Tipton EF, Houston TK, et al. Characteristics that predict
physician participation in a Web-based CME activity: the MI Plus study.
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activities change physician behavior or health care outcomes? JAMA.
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11. Davis D, Evans M, Jadad A, et al. The case for knowledge translation:
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12. Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE,
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13. Eva KW, Regehr G. Ill never play professional football and other
fallacies of self-assessment. J Contin Educ Health Prof. 2008;28~1!:
1419.
14. US Department of Education, Office of Planning, Evaluation,
and Policy Development. Evaluation of Evidence-Based Practices
in Online Learning: A Meta-Analysis and Review of Online Learning Studies. Washington, DC, 2009. http:00www.ed.gov0rschstat0eval0
tech0evidence-based-practices0finalreport.pdf. Accessed July 21,
2009.

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DOI: 10.1002/chp

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