Physicists Seek To Lose The Lecture As Teaching Tool
Here is a very interesting story I found on NPR written by Emily Hanford. With so much CME built around the lecture one wonders what the physicians actually take away from the Continuing Medical Education (Instructional) experience. The story actually shows the power of the principles adult educators have heralded for years as a way to design instruction that is consistent with what is known about adults as learners.
Master of Education in Adult Education (M.Ed.) for Health Professionals: On-line
The Evidence-Based Program in Health Professions Education, in collaboration with the Department of Lifelong Education, Administration, and Policy, has developed an online master’s degree in adult education with an emphasis on health professions education. It brings together courses from the College of Public Health and the College of Education. This program is specifically designed to meet the needs of working professionals who are unable to attend classes in the traditional university setting.
The Master of Adult Education degree with an emphasis in Health Professions Education is designed for healthcare professionals engaged in teaching their colleagues. This includes faculty in medical residency programs, medical, nursing, and veterinary school faculty, and educators in other healthcare settings.
With eLearning Commons (eLC – UGA’s course management system), e-mail, and other telecommunication methods, classes are conducted with the same high degree of instruction as found in traditional classrooms. With the use of technology, this program is delivered to the students’ computers allowing them to study and learn at a time and at the pace that is right for them. The program will admit 15-20 students in each cycle. Courses in the online program are not eligible for the Tuition Assistance Program (TAP). Courses are not available to non-degree seeking students.
The requirements for the degree of Master of Adult Education are met by the completion of an approved program of a minimum of 33 hours (11 courses) of graduate coursework. In addition, students must prepare a M.Ed. Student Portfolio and complete a final oral exam.
http://www.coe.uga.edu/leap/academic-programs/adult-education/m-ed/health-professionals-online/
Revisit…….Why Fund CME?
NOTE: I have published this blog before but had the urge to do it again when I heard this. In a side conversation at the recent meeting of the National Task Force on CME/Provider/Industry Collaboration someone said that an employee in one of the grants offices in industry was told by the higher ups that they were not sure the company was going to continue supporting independent CME. One of the reasons was a reaction to the recent CEJA report calling for “limitations” on corporate support for CME. So here is what I mused before.
Suppose I own a pharmaceutical or medical device manufacturing company. You know what? I am going to shed providing support for accredited CME and I am doing it right now. My company does not need the extra hassles.
Please understand. I see how my company’s support for CME adds value to the relationships we have with our customers. And, in my opinion, this support is not as “evil” as some in organized medicine are making it out to be. But you know what? There are too many in the CME enterprise, the physician community, and government questioning that any value can come from my business supporting CME. Do you think I need that kind of press? What about the exposure coming from the federal government? And I really don’t need a bunch (although a minority) of boisterous customers and organizations that supposedly represent my customers shouting to the world that my company should not be supporting their CME. Nope. No thanks. Nada.
I don’t need the extra costs of staffing the CME function in my company. Grant applications. Grant application reviews. Compliance officers. Compliance reviews. LOA’s. Check requests and disbursements. Project reconciliation processes. Why pay the overhead to house these functions. I don’t need the costs of educating my employees about the CME rules and regulations. I have to pay a lot to monitor employee performance to be sure they don’t get my company in trouble by breaking some inconsequential CME rule or regulation. I really don’t like the entitlement attitude some physicians and physician organizations have that suggests my company owes it to them to support their pet CME project because they use my company’s products. On and on.
I don’t need the hassles and intimidation the federal regulators put on my company to insure compliance with their requirements. Who wants to be looking over your shoulder all of the time for fear the feds will come calling.
I don’t want to wonder if the money my company puts into the CME enterprise is having an impact on health care delivery. I don’t want to have to wonder if the money I put into CME is having and impact on patient health status. You know what? If my company puts money into the CME enterprise my shareholders want to know what impact the money is having on the delivery of evidence based patient care and to the extent possible patient health status in clinical areas of interest to my company. And yes, my stockholders want to know if the investment in CME is having a positive impact or any added value for our customers and the company – bottom line included but not exclusively.
Am I going to put the money I have been allocating to support CME into a big ole pot and let someone outside of my company decide how to spend that money with no accountability back to my shareholders? Are you crazy?
People in my company can’t even talk to CME providers about areas of mutual interest. Like I am going to give money to someone my company representatives can’t even engage in a significant and appropriate dialogue. Right!
So what about the notion that the money my company puts into CME impacts the cost of drugs and thus the cost to the patient. Of course it does. My company is not a charity. I have to recoup those costs. Removing my support for CME will not reduce those costs. If health care providers have to bear the costs of their own CME who is ultimately going to pay? The patient of course. Health care costs might actually go up when I take what I have been spending to support CME and spend it on something that will add value to my relationships with my customers. And I assure you I will find a way to do that.
And by the way the CME enterprise will save money when we stop funding CME. No need for the AMA to spend money on the annual Task Force meeting. ACCME can cut the accreditation application and review process in half by eliminating all of the questions and documentation required related to commercial support for CME. Wow. CME providers might be able to say they are part of the “Green Movement” with all of the paper saved. The Alliance can reduce the number of days needed for its annual meeting saving its members travel and lodging costs to attend the meeting. The CME enterprise won’t need the new “Faculty Development” initiative to teach physicians who speak at CME events the difference between CME and marketing (oh please). CME providers can save money on going to all of the meetings they think they can’t miss because they need to get the latest information on how to effectively beg for bucks. CME providers won’t have to spend all of that time writing grants chasing support. Our sector won’t have to spend the money on all of the high cost conferences that try to address the maze of rules and regulations imposed on our support to the CME enterprise. Wow. What a savings for everybody. Everybody except the physician and patient of course. Physicians will still have to engage in CME and to pay for that CME. Physicians will pass those costs on to their patients.
What will happen in the CME field when money from the pharmaceutical and device sector is gone? The requirements of physician participation in CME are not going away. In fact, those requirements are becoming more rigorous and narrowly focused. Look at maintenance of certification requirements and the proposed rules for maintenance of licensure.
Pharmaceutical and device companies still have the obligation of educating those who purchase and use their products. They must continue to support education of physicians. This will be a bit easier in the absence of the accredited CME hassles.
Every system is perfectly designed to get the results it gets. If the CME system is not getting the results it wants then that system has to change. Pharma and device manufacturers support for CME can and probably will be stopped. The CME system will change as a result of that decision. Will that be the magic bullet that will enable CME to reach its full potential in impacting patient outcomes? Forgive me. I am a skeptic and I approve this question.
Tell me again why pharma and device manufacturers should support accredited CME? I seem to have lost my interest in doing so.
Hypocracy or Not? CME Funding and Higher Ed Policies
I saw this in Life Science Leader and wondered how many industry professionals would share his opinion.
“I recently read a story about industry support for continuing medical education (CME) dropping for the third consecutive year. To this I say, “Well it’s about time.” When I worked in the pharmaceutical industry, it never ceased to amaze me how medical institutions would limit access to drug company sales representatives and yet be the first to have their hand out for financial support of a CME program. The industry still provided $830 million in support of CME events in 2010 — a 31% drop from three years previous. In my opinion it is still too much. Can’t Have Your Cake and Eat It To……………………”
Check the link to read the whole thing.
Can I Improve What I Don’t Measure?
Someone once said, “If you can’t measure something, you can’t understand it. If you can’t understand it, you can’t control it. If you can’t control it, you can’t improve it.”
As a CME professional wanting to improve individual CME activities my organization offers and my overall program I have to have points of measurement of value to me, my learners, and my organization. Things I want to measure to see if we are improving and to show my learners and my organization that we are having a mission focused impact.
Continue Reading September 1, 2011 at 12:04 am Leave a comment
Do We Have a Problem with our Problem Solving Behaviors?
In our drive to design CME activities that we hope will demonstrate impact or improvement on a professional practice gap we often jump to potential causes or even solutions before we fully understand the real nature of the gaps that give rise to presumed educational needs.
CME Shown To Produce Positive Clinical Outcomes
PRLog (Press Release) – May 25, 2011
Physicians who participated in live half-day, multi-format CME symposia were 50% more likely to provide evidence-based care for chronic obstructive pulmonary disease (COPD) than those who did not participate, according to a newly published study. The results reported go on to say:
“In addition to being more likely to provide evidence-based care, participants were more likely than non-participants to correctly recognize COPD in a patient presenting with dyspnea (94% vs 74%; P=0.007); recognize that women may have a greater susceptibility than men to the toxic effects of smoking (90% vs 54%; P< 0.001); and identify the mechanisms of action of emerging therapies (65% vs 33%; P=0.003). Each of these areas had been identified as gaps in current COPD clinical practices; thus, these findings show that continuing medical education can help narrow these gaps.”
This is the kind of report I would like to see more of in the media and the blogesphere. It validates what we have been saying for years about what constitutes effective design in CME.
Recent Trends in Continuing Medical Education Among Obstetrician–Gynecologists
A abstract of arecent article in Obstetrics & Gynecology (May 2011 – Volume 117 – Issue 5 – pp 1060-1064. Burwick, Richard M. MD, MPH; Schulkin, Jay PhD; Cooley, Sarah W.; Janakiraman, Vanitha MD; Norwitz, Errol R. MD, PhD; Robinson, Julian N. MD) reports on a study conducted “To estimate current trends in continuing medical education among obstetrician–gynecologists in relation to the Maintenance of Certification program.”
A validated questionnaire was mailed to 1,030 randomly selected physicians of the American College of Obstetricians and Gynecologists in the United States, Puerto Rico, and Canada. Participants were asked about current practices and opinions regarding continuing medical education activities. Responses were compared between members mandated for Maintenance of Certification (board certification 1986 or later; time-limited certificate) or not (board certification
Some interesting results were provided:
1. College physicians mandated to participate in the Maintenance of Certification program were more likely to rely on Annual Board Certification articles as a major source of continuing medical education credits compared with those not requiring Maintenance of Certification
2. Maintenance of Certification requirement led to decreased use of the national or international meetings and self-selected continuing medical education materials as sources of continuing medical education credits.
3. Physicians in both groups equally valued:
- the relevance of Annual Board Certification articles
- the importance of content at academic meetings
- the usefulness of simulation drills and
- the general ability of continuing medical education activities to improve skills as a physician
As for conclusions it appears that the:
1. requirement of the Maintenance of Certification program has led to significant changes in continuing medical education choices by obstetrician–gynecologists, and,
2. changes in continuing medical education appear related to mandated obligations rather than personal preference.
A subscription is required to access the article so I didn’t see the survey or other results reported. I don’t know if any questions were included and results reported about the performance improvement component of the MOC process.
I find it a little distressing that the changes reported appear to be less matter of personal preference and more related to mandated obligations. I am not sure what to make of this. What do you think?
Physian Performance and Quality – No Relationship?
“Performance improvement” CME
I found on a Blog called Trusted MD. It is syndicated by R. W. Donnell | Mon, 04/18/2011
It is a response to a comment by Daniel Carlat a few days ago.
about the emerging importance of PI CME.
He says, “I knew we were moving in this direction but I was not aware that “PI CME” was official. Dan Carlat blogged this yesterday. As one would expect he’s mainly concerned about industry getting in on the trend, but between the lines of his post I read a measure of concern about the whole idea of PI CME. I’m concerned too. Performance has little to do with quality, or good doctoring by any definition.”
Unbelievable! What physicians do – their performance – has little to do with quality, or good doctoring”? I completely understand there are many determinants of quality and good “doctoring”. To assert that what physicians do -their performance- in patient care has no impact on quality is unfathomable to me.
Why PI CME?
PI CME is gaining traction but there are still few physicians taking advantage of this learning format. Some physicians still say they have no idea what PI CME is. Others say they are too busy to engage in this form of CME because takes too much time or it is too much trouble. So why should we be diligent in offering PI CME and trying to increase the number of physicians engaging in this dynamic learning format? I can think of a number of reasons.
- Improvement is a part of the fiber of the practice of medicine. Every physician I have ever met is continuously seeking ways to provide optimal patient care. They are constantly looking for ways to improve the outcomes their patients can achieve.
- PI CME is physician centric. Yes it is “All about me”. Me as a learner. My practice. My patients,
- PI CME is data driven. Physicians are scientists. Data are important. Data derived from their own practice and compared to “best practices” is informative and challenging. You change what you measure.
- Engaging in practice improvement activities is required for Maintenance of Certification and is in the framework for Maintenance of Licensure. Accredited hospitals must engage physicians in improvement efforts in their own settings. Some third party payers are offering incentives for engaging in improvement initiatives that can demonstrate better patient outcomes.
- PI CME is aligned with sound adult learning principles – physicians learn by solving problems. They have a need to know. This, among other principles, is core to adult learning. .
The AMA has a framework for offering PI CME credit. One of the best things the CME profession could do to support PI CME is to adopt a systematic, sustainable, repeatable approach to guide PI CME initiatives. With the emergence of Lean Healthcare and one of its central tools – A3 Problem Solving- we have a framework that is effective and efficient. We should embrace it as a new way of doing our PI CME business.
Integrating CME and Improvement – The New Normal
