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In most cases Continuing Medical Education (CME) providers are partially adhering to the American Medical Association (AMA) CME definition. They are certainly providing adequate traditional continuing education; i.e., maintaining, increasing and developing knowledge and skills, but are striving to offer performance improvement method into their CME designs. Traditional CME, such as live events or asynchronous online, and journal-based enduring materials can definitely produce measurable improvements in professional knowledge and skills (Vakani and Sheerani, 2011), but not necessarily performance improvement. Moreover, it was not an error by providers that caused them to focus more on traditional CME for recording attendance than to enhance behavioral change and/or better clinical outcomes (Brown et al., 2011). A key question raised by the authors is to address real-time challenges faced by CME providers and physician learners upon adopting Performance Improvement Continuing Medical Education (PI-CME), as a learning method. CME providers recognize quality movements by various groups (e.g. Institute of Medicine (IOM), American Academy of Family Physicians (AAFP), American Board of Medical Specialties (ABMS), Federation of State Medical Board (FSMB), American Medical Association (AMA), American Osteopathic Association (AOA), Center for Medicare and Medicaid Services (CMMS) and The Affordable Care Act) for promoting and including performance and quality measures in one way or the other in their profile (Bird et al., 2013; Brown et al., 2011). Also, the US healthcare system is interested in a model with the potential to promote lasting changes in physician practice (Bird et al., 2013). Thus, the authors appreciate the AMA three-stage structured PI-CME (performance improvement) method that enables physicians to improve a defined clinical care aspect during a specific time frame. However, there is little evidence that the PI-CME method is followed in designing CME activities (Bird et al., 2013):

  • Stage A: learning from current practice performance assessment (baseline);

  • Stage B: learning from applying performance improvement interventions to patient care; and

  • Stage C: learning from evaluating performance improvement results (follow-up).

The CME offices in some institutions piloted, and then reported through the literature,...

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