We built the CE we wished existed.
Every lesson, every recommendation, every script in our courses is traceable to peer-reviewed evidence, current clinical guidelines, or, where the literature is genuinely silent, named expert consensus. Here is how that happens, who reviews it, and how often it gets revisited.
The methodology is the durability.
Most CE is built by working backwards from a credit hour. Someone picks a topic, drafts a slide deck, runs it past a board for accreditation, and ships it. The result satisfies the renewal form, but it ages out of usefulness inside eighteen months, sometimes faster, when a new guideline drops or a once-promising drug acquires a black-box warning.
We built our methodology in the other direction. We start from the question a clinician actually has on the floor ("this 47-year-old wants HT but her sister had ER+ breast cancer, how do I frame this?"), trace it back to the evidence base that should inform the answer, and only then assemble the lesson around it. The methodology lives in how each lesson is sourced, reviewed, taught, and revisited, not in marketing language about being 'evidence-based.'
What follows is the actual sequence: who writes a lesson, what evidence they're required to anchor it in, who reviews it before it ships, what we do in the field when a guideline changes, and how often the back catalog is forced through the same gauntlet again. We are deliberately transparent about this because we think it should be a buyer-side checklist for any CE provider, including, eventually, ours.
Built to catch the wrong answers before you do.
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Origin
Clinical-question scoping
We start with the question a clinician brought to the Community of Excellence or office hours. Every lesson begins as a named question, not a topic, so the deliverable is forced to answer something.
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Quality gate
Evidence search & grading
Structured search across MEDLINE, Cochrane, current ACOG/NAMS/ACNM guidelines, and registry data. Every retrieved source is graded by tier and tagged for relevance. Sources used in the lesson must be cited in the published version.
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First draft
Written with a strict 'what will the clinician do differently?' constraint. Every recommendation is tied to a specific citation. No statement is allowed without a source, including the patient-facing scripts.
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Quality gate
Internal faculty review
Co-founder reads top-to-bottom with a four-question lens: does the evidence say what we claim it says? Is the recommendation safe at the edges? Is the script humane? Would I use this Monday?
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Quality gate
External clinician review
Two practicing clinicians outside the company read the lesson cold and provide written feedback. We publish names + credentials of every external reviewer with the lesson. Reviewers are paid a flat fee, we don't trade reviews for honoraria.
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Pilot only
Pilot cohort
A small invited cohort runs the lesson before public release. They complete the post-test, mark every passage that read as unclear or wrong, and report what they actually changed in clinic. We revise based on what they tell us, not on what we think they should think.
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Publish — & enter the revisit queue
The lesson goes live to all members. The same moment, it's added to a 12-month revisit queue, every lesson in the catalog is force-reread, re-evidence-checked, and either reconfirmed, revised, or retired on an annual cycle.
Total elapsed time from question to publication for a typical lesson: 4–6 months. We're allergic to faster than that because the failure modes are silent, wrong answers don't ring an alarm.
What's actually behind a single course.
We publish a per-course source ledger that's auditable down tothe citation. Below is the live ledger for Implementing Menopause Care into Practice. The proportional bar shows the diet of evidence by tier, heaviest on peer-reviewed primary research, supplemented by guidelines and explicit expert consensus where the primary literature is silent.
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Tier I Peer-reviewed RCTs & systematic reviews 64 sources The strongest evidence in the catalog. Used to anchor every hormone-therapy and pharmacotherapy recommendation in the curriculum. Where this tier disagrees with a guideline, we say so explicitly in the lesson and document why we follow one over the other.
- NEJM
- JAMA
- Lancet
- Cochrane Database
- BMJ
- Annals of Internal Medicine
- Obstetrics & Gynecology
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Tier II Current clinical guidelines & position statements 41 sources Guidelines from the bodies that actually govern practice in this space. We cite the version, year, and section explicitly so you can verify currency in a single click. When a guideline updates, the affected lessons are flagged for re-review within 30 days.
- NAMS Position Statements
- ACOG Practice Bulletins
- ACNM Clinical Bulletins
- AANP Position Papers
- ANCC Standards
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Tier III Observational studies, registry data, RWE 28 sources Where RCTs are impractical (long-term safety follow-up, rare adverse events, drug-interaction profiles) we cite the strongest observational evidence available, clearly labeled as such so you can weight it appropriately in your own clinical reasoning.
- WHI Long-Term Follow-up
- FDA Adverse Event Reporting
- KP Pharmacovigilance Registry
- ClinicalTrials.gov RWE arms
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Tier IV Named expert consensus 9 sources Reserved for narrow gaps the primary literature doesn't address (counseling scripts, shared-decision-making framing, edge-case management). We name every expert by credential and institution; consensus is never anonymous and never substitutes for primary evidence when primary evidence exists.
- AMCB Clinical Consensus
- ACNM Member Consensus
- Faculty consensus (with attribution)
The full bibliography is downloadable from every course's resources page in your member account. We are explicit about evidence currency: any source older than five years that's still cited has a footnote explaining why it remains the standard, or what newer evidence has refined it.
The five rules that govern every lesson.
Cite the source, not the summary
We never cite a guideline that cites a paper. We cite the paper. Summaries drift; primary sources are what your colleagues and your patients deserve to be on the receiving end of.
Name the uncertainty
Where the evidence is mixed, contradicted, or absent, we say so plainly in the lesson. 'We don't know yet' is a clinically useful sentence, and absence of evidence is not evidence of absence, both directions.
Test the recommendation against a 20-minute visit
Every recommendation has to be deliverable inside the visit length you actually have. Beautiful frameworks that require an hour belong in a textbook, not on a renewal-credit lesson plan.
Re-read the back catalog
Every lesson is forced through annual re-review whether or not it 'feels' current. Catalog rot is the failure mode of long-lived CE, and we refuse to assume our 2024 lesson is still right in 2027 without checking.
Show your work — publicly
Methodology, source ledger, review process, and faculty list are all on this page. If a competitor wants to copy the framework, that's fine, it raises the floor for everyone's CE. We compete on execution, not on hidden process.
About the method behind the courses.
Affected lessons are flagged for re-review within 30 days of the new guideline's publication. Members get an in-product notification when a lesson they've completed has been revised; the certificate remains valid but you can re-read the revised lesson at no additional cost. If the revision is material (rare), we issue a free supplementary lesson and notify all enrolled members directly.
Reviewers are paid a flat fee per review, never a per-revision rate. We publish reviewer names and credentials alongside the lesson, so anyone, including critical readers, can verify independence. Multiple reviewers have asked us to retract specific claims, and we have. The fee is for their time, not their opinion.
We use AI for narrow tasks where it demonstrably helps: literature search expansion, alternative-phrasing drafts of patient scripts, transcript polishing. We do not use AI to generate clinical recommendations, to summarize primary literature without human re-reading, or to author entire lessons. Every clinical claim is read, sourced, and signed off by a named human author.
The per-tier source ledger above is published on every course's marketing page. The full citation-by-citation bibliography lives in your member account once you enroll, it's a few hundred entries per course and is updated as the lesson is revised. If you want to verify the academic foundation before enrolling, email contact@excellenceingyn.com and we'll send you a preview PDF.
Every lesson page shows the last-revised date and the date of the next scheduled review. The full revision history (with diffs of what changed and why) is accessible from the lesson page. If a lesson is in the revisit queue with material changes pending, that's visible too.
Yes, and roughly a third of our published lessons started life as a Community of Excellence thread. Email contact@excellenceingyn.com with the question, the clinical context, and (optionally) the evidence you've already found. We don't promise to build a lesson, but every proposal is read and replied to by a human.
The methodology is the product.
Implementing Menopause Care into Practice is the working example of everything described above. 142 sources cited, four external clinician reviewers named on the lesson page, annual re-review built in, and 8.0 CE hours that hold up to whatever audit you put them through.