Practice gaps leave room for improvement

Waikoloa, Hawaii - Practice gaps may exist within an office setting, even though the physician is not aware of them, underscoring the need for and advantages of continuing medical education on all fronts of the medical spectrum.

With the ever-changing fast-paced developments occurring in the medical arena, it behooves physicians to stay up-to-date regarding every aspect of their practice in order to provide the highest level of care for their patients.

But some physicians - especially those who work in very busy practices - may find it challenging to find the time to stay current with literature in their specialty, and therefore may be unaware of and victim to the potential practice gaps. Continuing medical education (CME) is one avenue that offers physicians an opportunity to stay abreast with the latest developments in their specialty, and may help to close relevant practice gaps.

“A professional practice gap can be defined as the difference between actual and ideal performance and/or patient outcomes, or, the gap between what the professional is doing or accomplishing (current reality) compared to what is achievable on the basis of current professional knowledge,” says Erik J. Stratman, M.D., chairman, department of dermatology, Marshfield Clinic, Marshfield, Wis. He spoke at the 38^th annual Hawaii Dermatology Seminar in February. “Identifying a practice gap and working towards closing that gap is essential in providing the highest level of patient care.”

Minding the gaps

There are three reasons why a physician may experience a practice gap, Dr. Stratman says. A practice gap may be a gap in knowledge, meaning there is new information available regarding the diagnostics and/or treatment of a specific disease or condition, or information that the clinician was not aware of existed that told them they should be doing something different.

There could also be a gap in physician performance, Dr. Stratman says, where physicians know the information, but in their practical nature of providing care, they are unable to implement that knowledge into practice.

The third is a gap in patient outcomes, where the physician knows the information and is doing everything right in practice, but the patient - for whatever reason (patient factors being what they are) - still might not get better.

One of the central objectives of CME traditionally has been to try to close the gaps in knowledge. Dr. Stratman says, however, that a more meaningful step in CME can occur if session objectives are aimed at trying to build a clinician’s performance and actually result in performing differently in clinic.

“The competence and the performance of a clinician are very closely linked. Unfortunately, it is difficult to measure performance through a CME session, unless physicians are bringing in with them some practice data,” Dr. Stratman says.

Competency boosters

One potential competency-boosting approach at CME sessions would be for the speaker to describe certain clinical scenarios in a case-based fashion, and then poll the audience or individual physician for potential responses. Based on the response, Dr. Stratman says those in the CME session sometimes can identify relevant practice gaps, which then could be further explored by the speaker or individual and addressed appropriately.

According to Dr. Stratman, practice gaps can occur across the spectrum of the specialty and can include how a physician manages pediatric skin diseases, adult dermatology, surgical dermatology, cosmetic dermatology, and how dermatopathology is read. Identifying and then correcting practice gaps is part and parcel in offering patients the highest standard of care.

“The exploration of practice gaps is really connected to the quality improvement mantra of 21^st century medicine. Physicians should always be in search of what they could do to provide better care,” Dr. Stratman says.

All physicians are individually responsible for their professional development, he says, which usually involves staying up to date with the latest available information in the medical literature. According to Dr. Stratman, specialty journals are increasingly addressing practice gaps and are including relevant articles in dedicated sections that specifically address these issues.

“Traditionally, a journal publishes an article and the savvy reader would need to interpret practice gaps. But now, journals such as JAMA Dermatology and Dermatologic Surgery are taking it one step further and actually trying to translate what is being published into a more practice gap-focused interpretation of the literature, serving as a kind of Cliff’s Notes for the clinician,” Dr. Stratman says.

Identifying different practice gaps can serve as the foundation for an in-office quality improvement project, Dr. Stratman says, which may not only result in patients receiving a higher standard of care but, if applied correctly, could potentially qualify the physician to meet some of their Maintenance of Certification needs.

“Every clinician has ways that they could provide potentially better care as new information comes out to guide us in our treatments and in our approach to our dermatology patients. The fact that we have a gap does not make us a bad doctor. The goal is to start looking at the best available evidence differently to see how it can impact us in practice, and make efforts locally to try and improve,” Dr. Stratman said.

Disclosures: Dr. Stratman reports no relevant financial interests.