Physician practice change II: implications of the Integrated Systems Model (ISM) for the future of continuing medical education.

In a companion paper, the authors provide the development and description of the Integrated Systems Model (ISM). In this article, they describe 14 general implications of the ISM for continuing medical education (CME). They discuss how applying the ISM would change CME by describing (1) how CME and the larger health care environment would be restructured if they were based on the ISM and (2) how the ISM would impact CME under the current environment of health care in the United States. They close by describing how the ISM can be used as CME moves to address the long lag between discovery and practice and begins to decrease its dependence on pharmaceutical companies. The ISM helps not only explain why the current health care system in the United States (or anywhere) produces what it produces, but also predict what that system would produce if it changed. At present, the ISM is a conceptual model, but with more research into measures of its various elements, it could become a more quantitatively predictive model. In its present form, however, the ISM can serve Marinopoulos's call for a "sound conceptual model of what influences the effectiveness of CME" and address Grimshaw's concern that current research lacks "a theoretical base to support the choice and development of interventions as well as the interpretation of study results." The statistician George Box said, "All models are wrong, some models are useful." The authors believe that the ISM is useful and that maybe it will prove Box wrong.