Johns Hopkins University School of Medicine Baltimore, MD
Correspondence to: Spyridon S. Marinopoulos, MD, MBA, Johns Hopkins University School of Medicine, Division of General Internal Medicine, 401 N Caroline St, Baltimore, MD 21231; e-mail: email@example.com
Dr. Marinopoulos was funded by the Agency for Healthcare Research and Quality (AHRQ) for the systematic review of the effectiveness of CME. He participated in the Genentech Independent Medical Education Advisory Board for 1 year following the publication of the AHRQ evidence report. Dr. Dorman was funded by the AHRQ for the systematic review of the effectiveness of CME. He is the Associate Dean of CME at the Johns Hopkins University School of Medicine. Dr. Bass was funded by the AHRQ for the systematic review of the effectiveness of CME.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).
© 2009 American College of Chest Physicians
We appreciate the commentary of Norman1 regarding the methodology of our evidence-based review of the effectiveness of continuing medical education (CME), and agree with him that reporting effect size can be extremely useful in reporting results.2
Synthesizing the results of educational interventions represents one of the methodological challenges to performing systematic reviews in health care.3 The studies in our review differed in many important ways (used nonstandardized definitions of CME and targeted multiple types of objectives across vastly different audiences and content areas), and often were flawed in the metrics they used and in how those metrics were reported.4
These limitations in the primary literature led to a qualitative synthesis of the evidence, as an aggregate estimate of effect size could have implied greater confidence in the results than would have been appropriate.
In conclusion, we strongly lend our voice to the importance of estimating effect size in systematic reviews of educational interventions and recommend that original studies of CME give more attention to using valid measures of effectiveness that would allow such estimates.
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