ACCME Call For Comment – Knowledge Based CME

January 24, 2010 at 7:34 pm Leave a comment

KNOWING IS NOT ENOUGH!!!!

The ACCME has called for comment on an issue of particular interest to me. Some stakeholders in the CME enterprise are suggesting that the ACCME add the word knowledge to the accreditation Criteria 1.  Knowledge is a critical element of competence, performance and patient outcomes. As the ACCME says, “Providers should try to change learners’ knowledge — when knowledge acquisition will serve the goal of improving physician competence, performance or patient outcomes”. I am opposed to any change in ACCME accreditation criteria that would allow CME providers to offer “knowledge only” CME activities. Criteria 1 is fine as it is stated.

The United States probably has the best graduate and postgraduate medical education in the world. US biomedical science leads the world in discovery. US expenditures on health care lead the world. Despite this, US healthcare is mediocre in terms of delivering all of the care we know how to deliver.

Albert Einstein is said to have defined insanity as “doing the same thing over and over again and expecting different results”. Continuing to increase the knowledge of physicians would in some ways be fulfilling Einstein’s definition of insanity. We can’t expect improve the quality of care because we are doing a great job of sharing knowledge with physicians.

Paul Baltalden says “Every system is perfectly designed to get the results it gets.” The United States healthcare system has demonstrated it is perfectly designed to deliver innovation and discovery. But what the system does not do as well is deliver care based on these discoveries.

Goethe said, “Knowing is not enough; we must apply. Willing is not enough; we must do”.

Systematizing quality care has the potential to improve health and healthcare more than any scientific advances in the foreseeable future. If CME is to be a “bridge to quality” it must focus its efforts on developing the capability (competence) of healthcare providers to engage in quality improvement. Why? To deliver the care we know we should deliver that will have a demonstrated positive impact on the heath the health status and quality of life of people.

Capability (or competence) goes beyond knowing. Capable (competent) healthcare providers know how to apply knowledge in the context of patient care and they do just that. CME providers should be required to provide learning resources that enhance the capability of healthcare professional to provide quality care. This requires that we go beyond simply sharing knowledge. CME providers should be required to show that the knowledge shared with healthcare providers in their CME activities can be appropriately used by the healthcare provider in the delivery of patient care. Gaining knowledge may satisfy a professional curiosity.  But disseminating knowledge as end in itself is not adequate enterprise for accredited CME providers.

CME providers calling for the inclusion of “knowledge-based CME” in the ACCME essential areas cannot possible expect that this will lead to any improvement in the delivery of patient care. The CME literature shows that one off CME activities primarily focused on sharing knowledge is not effective in leading to changes in physician capability. CME providers calling for the inclusion of “knowledge only CME” cannot possibly expect that this alone will position CME as a “bridge to quality”. CME providers must be required to go beyond knowledge sharing only (as important as that is) and provide learning activities that assure that physicians appropriately apply that knowledge in the context of patient care.

KNOWING IS NOT ENOUGH!!!!

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Entry filed under: ACCME, Accreditation, CME, CME Issues, Continuing Medical Education, Continung Professional Development, Physician Continuing Education.

CME in the News and on the Blogs January 23rd, 2010 CME in the News and on the Blogs January 26, 2010

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