Posts filed under ‘Continung Professional Development’

CME – Who Gets the Assignment

I recently visited a small community hospital to talk to them about PI CME. Like  in many  small settings.  responsibility for coordinating the CME program is an add on role. The person assigned the responsibility has other responsibilities. They have no training in CME. They may or may not have experience in education. They may or may not have clinical experience.

One person at the session had just been given the responsibility for CME and was in the Marketing Department. This person had no idea what was required of CME providers. No idea what it means to be an accredited CME provider. Absolutely no knowledge or understanding of what is required by the ACCME, AMA,  etc.  All they know is that the setting in which they work wants to offer the physicians  “CME’s” Whatever CME’s are.  What a learning curve.

In situations like this the person assigned responsibility for the CME Program should get together with the Quality Improvement people and ride the quality improvement initiatives like a tight saddle on a bucking bronco. in fact the CME program should probably be assigned to the QI people in these settings. They have they data. They can learn the CME rules and regulations. They can link  CME to quality initiatives  that make a difference to the patients in that setting.

All approved CME activities have to be evaluated in improvement terms.  Improvement in competence, performance or patient outcomes. Lets put CME where the people have the skills to assess these improvements. Quit screwing around with CME as part of marketing or even the medical affairs office. Enhance the educational skills of some of the the improvement people. Enhancing the improvement  skills of  the CME people doesn’t seem to be working. Let’s try another way to link education to physician competence and performance. Especially if they have patient outcomes data.


May 10, 2012 at 11:48 pm 1 comment

Improvement Resources for the CME Professional

Here are reports on two improvement efforts you may find interesting. I’ll keep a watch out for these when I find them I’ll pass them on.

Development and implementation of a performance improvement project in adult intensive care units: overview of the Improving Medicine Through Pathway Assessment of Critical Therapy in Hospital-Acquired Pneumonia (IMPACT-HAP) study.

Crit Care. 2011 Jan 25;15(1):R38
Mangino JE, et. al.

CONCLUSIONS: Developing a multi-center performance improvement project to operationalize ATS/IDSA guidelines for HAP, VAP, and HCAP is feasible with local consensus pathway directives for implementation and with quality indicators for monitoring compliance with guidelines.
Go here:

A Multifaceted Intervention for Quality Improvement in a Network of Intensive Care Units

A Cluster Randomized Trial
JAMA. Published online January 19, 2011. doi: 10.1001/jama.2010.2000
Damon Scales et. al.


Context Evidence-based practices improve intensive care unit (ICU) outcomes, but eligible patients may not receive them. Community hospitals treat most critically ill patients but may have few resources dedicated to quality improvement.

Objective To determine the effectiveness of a multicenter quality improvement program to increase delivery of 6 evidence-based ICU practices.

Design, Setting, and Participants Pragmatic cluster-randomized trial among 15 community hospital ICUs in Ontario, Canada. A total of 9269 admissions occurred during the trial (November 2005 to October 2006) and 7141 admissions during a decay-monitoring period (December 2006 to August 2007).

Intervention We implemented a videoconference-based forum including audit and feedback, expert-led educational sessions, and dissemination of algorithms to sequentially improve delivery of 6 practices. We randomized ICUs into 2 groups. Each group received this intervention, targeting a new practice every 4 months, while acting as control for the other group, in which a different practice was targeted in the same period.

Main Measure Outcomes The primary outcome was the summary ratio of odds ratios (ORs) for improvement in adoption (determined by daily data collection) of all 6 practices during the trial in intervention vs control ICUs.

Results Overall, adoption of the targeted practices was greater in intervention ICUs than in controls (summary ratio of ORs, 2.79; 95% confidence interval [CI], 1.00-7.74). Improved delivery in intervention ICUs was greatest for semirecumbent positioning to prevent ventilator-associated pneumonia (90.0% of patient-days in last month vs 50.0% in first month; OR, 6.35; 95% CI, 1.85-21.79) and precautions to prevent catheter-related bloodstream infection (70.0% of patients receiving central lines vs 10.6%; OR, 30.06; 95% CI, 11.00-82.17). Adoption of other practices, many with high baseline adherence, changed little.

Conclusion In a collaborative network of community ICUs, a multifaceted quality improvement intervention improved adoption of care practices.

Read More:

Here is a tool kit you might find useful. It uses an approach to QI called FOCUS. You may find this approach communicates very well with your constituents.

QI 101 Toolkit

American College of Cardiology PINNACLE NETWORK: Practice Innovation and Clinical Excellence.

The Toolkit can be accessed here:

Here is my latest mantra: Linking Eduction and Quality Improvement – The New Normal

January 31, 2011 at 1:21 am Leave a comment

My Alliance Experience

Finally, after more than 10 years of urging, nudging, and conceptual bludgeoning the importance of collaboration between CME and quality improvement has come to center stage in the CME profession.

I am sure many of my CME colleagues attending the annual meeting of the Alliance for CME framed their experience around their interests and learning needs. My time at the meeting focused on numerous sessions focused on improvement initiatives and issues surrounding maintenance of certification. I am convinced we are seeing a major shift in the focus of CME from individual physician learners to collaborative learning required to engage in improvement in specific practice settings.

Representatives from numerous national “regulatory” organizations presented at the meeting calling for physicians to establish “cultures of improvement” recognizing that this is going to be a challenging and productive journey but a journey that will be taken. In future posts I’ll share some of their insights and questions.They asked attendees at the meeting if CME was ready to support this effort and how they would do that. Few answers were forthcoming form the CME community but we better have answers. If not, this opportunity will pass and with it our chance to renew our relevance in medicine.

Are we ready? Fortunately many in our midst are deeply involved in linking quality and education. And they have the data to demonstrate significant outcomes. I attended several presentations where reports on successful improvement initiatives were shared – some PI CME others not. Some presentations shared tools they were using to guide their CME efforts like the A3 approach to problem solving I have mentioned several times in this Blog.

The environment of CME has been shifting slowly during the past few years. I have a feeling the corner has been turned and welcome the new direction our field has taken. New skills are required of us. New partners are required of us. Our future is as bright as I have seen it in the many years I have been engaged in CME.

Collaboration Between Quality and CME – The New Normal.

January 29, 2011 at 4:06 am Leave a comment

Alliance for CME Meeting- Got a little less busy for me

If you are a CME Professional or are related to the CME Enterprise at all you want be at the meeting of the Alliance for Continuing Medical Education in San Francisco later this month. There is something for everybody at the meeting.

My meeting is actually a little less hectic than I had hoped it would be. Both sessions I was to participate in as a presenter have been canceled. In one session I had hoped to present results of a pilot study where a group of CME professionals agreed to learn about A3 Problem Solving and use the approach to address an improvement opportunity in their CME operation. Regardless of the encouragement and prodding from the pilot study leaders the project flopped. Several participants in the pilot said they used the approach but we received no evidence that it happened. So I canceled the session. No data. No session.

The second session I was involved in that was canned was to report on establishing a “Community of Practice” focused on PI CME. As hard as the leaders tried to get this one going it didn’t happen.

Both of these failed efforts required a time commitment and a willingness of the CME professional to participate in something a bit cutting edge for the CME Profession. Another commonalty between the two projects was me. I suppose I just might have been the kiss of death for both efforts. Not. Or was it?

See you in San Francisco.

January 7, 2011 at 10:46 pm Leave a comment

A CME Opportunity?

If you work in CME in a hospital setting this study reported in USA Today should give you pause. It’s worth following up on this to see if our profession has a role in changing things in our settings that can result in a shift in these alarming statistics. Are there professional practice gaps in these data that suggest educational interventions in your setting?

Hospital Care Fatal for Some Patients
USA TODAY By Rita Rubin, 11/16/2010

“An estimated 15,000 Medicare patients die each month in part because of care they receive in the hospital says a government study released today.
The study is the first of its kind aimed at understanding “adverse events” in hospitals — essentially, any medical care that causes harm to a patient, according to the Department of Health and Human Services’ Office of Inspector General………”

Read More

A PI CME effort might be the approach called for here with collaboration including Risk Management and Quality Improvement. One way to approach the issue is to use the disciplined, data-based, systematic, repeatable, sustainable tools applied in A3 thinking.

Consider it.

November 16, 2010 at 6:15 pm Leave a comment

CME in the News and on the Blogs, November 2, 2010

I know, I have been pretty lax for the past six months on keeping up with this Blog. I have heard from some of you that you appreciate the effort so I’ll try to do better.

Here us an interesting article that appeared in Minnesota Medicine. It is worth a read by everybody in CME. I actually think the question could be phrased in another way to read “Is the CME System Relevant?” My answer is not very. And further if we don’t get ourselves in gear regarding measuring improvement in knowledge, competence, performance or patient outcomes the medical field will find others outside of CME to do the job. Our choice.

Is the CME System Obsolete?
Barbara Brandt, Ph.D., and Janet Shanedling, Ph.D.


Changes in medical practice and a greater emphasis on lifelong learning are prompting a closer look at the efficacy of continuing medical education (CME). This article outlines the shortcomings of the current CME system, describes findings from two recent reports about its status, and presents recommendations for a new system to make continuing education more relevant to medical practice.

Read More:

Here is an important report from the Robert Wood Johnson Foundation published by the National Quality Forum. A must read for everybody n CME.

The ABCs of Measurement

“How do we know? We measure. How do patients know if their health care is good care? How do providers pinpoint the steps that need to be improved to benefit patients? And how do insurers and employers determine whether they are paying for the best care that science, skill, and compassion can provide? Performance measures give us a way to assess health care against recognized standards.

While measures come from many sources, those endorsed by National Quality Forum have become a common point of reference. An NQF endorsement reflects rigorous scientific and evidence-based review, input from patients and their families, and the perspectives of people throughout the healthcare industry.

The ABCs of Measurement explains how the science of measuring health care performance is making enormous progress, and continues to evolve. Measures represent a critical component in the national endeavor to assure that all patients receive appropriate and high quality care.”

Read the Primer:

November 2, 2010 at 9:36 pm Leave a comment

Improving Quality Improvement in Medical Education

Those of you patent enough to watch for my episodic posts know I am an improvement nut. My contention is that all CME must be improvement based. As I read the ACCME requirements of accredited providers I see that all providers have to demonstrate an impact (improvement) on the competence or performance of their learners or the impact of their educational efforts on the health status of their learner’s patients. CME is in the improvement business.

I saw this in a post a few days ago by Scott Harris in the AAMC Reporter.
“…………….As the popularity of QI and the evidence of its benefits pile ever higher, medical school curricula, graduate medical education (GME), and continuing medical education (CME) programs around the country are working to put QI’s tools and principles into the hands of tomorrow’s doctors and today’s practitioners………..”
Read More

What an opportunity for CME providers. Follow the link to this article and see what is being done or encouraged in QI across the continuum of medical education.

There are some people on the field of CME who are pioneering work in improvement. Take a look at some of the interviews I have done on my podcast with some of these people. They are laying the foundation for the future of effective CME. See What is woefully lacking is a coherent approach to improvement initiatives. We have as framework provided by the AMA for PI CME. A good step would be to identify a systematic, sustainable, repeatable approach to PI that could be adopted and adapted by CME providers across the country. I have some ideas about what that approach could be. If you are interested, in learning more about this approach, comment on this podcast or send me an email at

Until the next time I hope that all of the CME you provide is CME that matters.

September 27, 2010 at 8:36 pm Leave a comment

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