New types of evidence are now available: These can create major changes in patient care: double- blind trials and meta-analyses (statistically valid systematic reviews) have confirmed the efficacy of many treatments & the uselessness or harmfulness of others.
The information isn't getting through: The issue is no longer how little medical practice has a firm basis in evidence but how much of what is firmly based is actually getting applied to patient care. Traditional methods of reading journals and textbooks (already out-of-date) are not working, given the sheer volume of clinical literature.
Our knowledge and performance deteriorate with time: The net effect of the constant failure to obtain up-to-date information is a significant negative correlation between the doctor's knowledge and the number of years since graduation.
Continuing Medical Education isn't improving performance: Traditional, instructional CME fails to change clinical performance or improve health outcomes.