The Changing World of Continuing Medical Education (CME) September 08, 2010

1. The Changing World of Continuing Medical Education (CME)September 08, 2010

2. Ginny Jacobs, M.Ed., MLS, CCMEP Director, Office of Continuing Medical Education

3. Objectives for this session Upon completion, you should be able to: • Describe current issues facing medical education • Highlight the direction of CME – renewed emphasis on sound adult learning principles • Discuss course planning and evaluation implications as it relates to course design and development options • Incorporate key adult learning considerations into the future design of a global health curriculum proposal

4. Brief background • Current state of CME • Issues / the “buzz” in the field • Highlights • Formal planning • Independent • Well-designed delivery methods • Real-time access • Measure the impact • Considerations for Global Health curriculum

5. As a profession, medical education is… • Trying to think more broadly • Seeking ways to collaborate across the medical education continuum – pull best practices forward, avoid redundancy • Leverage existing areas of expertise • Appeal to today’s new learners

6. Office of Continuing Medical Education (OCME) – U of MN Medical School Promoting a lifetime of outstanding professional practice Undergraduate Medical Education (UME) = medical school Graduate Medical Education (GME) = residency, fellowship Continuing Medical Education (CME) = remainder of career (30+ years) - Hospitals, licensing boards require varying numbers of CME credits each year

7. Types of Activities Accredited by OCME • Live Courses (full-service and partnered courses) • Enduring Materials (printed monographs, newsletters, journal articles, web-based activities, webcasts, etc.) • Regularly-Scheduled Series (e.g. Grand Rounds/Journal Clubs) Anticipated future trends - Performance Improvement credits, Self-Assessment modules, etc. (tie into Maintenance of Certification)

8. Q. What do all of the following have in common? Senate Finance Committee Macy Foundation American Medical Association (AMA) Council on Ethical and Judicial Affairs Agency for Healthcare Research and Quality (AHRQ) Institute of Medicine

9. A. Over the past several years, they have all been highly critical of some aspect of the field of continuing education for the healthcare professions.

10. Critical of… …identification of need …selection process for topics, content, speakers …the instructional methods applied (e.g. too much reliance on lecture formats) …no requirement for learner engagement (some participants merely “put in their time”) …unable to note any measurable impact? …subsidized tuition….the amount and handling of commercial funding

11. Macy Foundation Report • Issued in January, 2008 • An excerpt: Current accreditation mechanisms for CE are unnecessarily complex yet insufficiently rigorous. Compared to earlier, formal stages of health professions education, the CE enterprise is fragmented, poorly regulated, and uncoordinated; as a result, CE is highly variable in quality and poorly aligned with efforts to improve quality and enhance health outcomes.

12. Institute of Medicine • Issued in December, 2009 • Report was entitled….Redesigning continuing medical education in the health professions • Results gathered from a 12-month study • Reports major flaws in the way CE is conducted, financed, regulated, and evaluated

13. In other words…… • We need to seek to set a higher standard in terms of continuing education (planning, design, development, delivery, and evaluation) • Establish a new paradigm for medical education (Do not necessarily mirror what has been done in the past!)

14. This calls for……Strategic Planning and Evaluation • Identified gaps in professional practice • Educational needs designed to address those gaps • Delivery method designed to effectively reach the target audience • Application of sound adult learning principles

15. What is unfair about the criticism? • Difference between certified CME and non-certified continuing medical education • ACCME only attempts to regulate certified Continuing Medical Education (CME) • There are many excellent educational activities being offered • There are many excellent educators working hard to design impactful courses that make a difference for physicians and (ultimately) their patients

16. What is deserved about the criticism? • Lectures formats - not the most effective way to learn / retain info. / improve patient care) • Some participants are just putting in their time • No true coordination with state maintenance of licensure / maintenance of competence • Few other professions are so reliant upon subsidized tuition fees • Commercial funding likely influences the field

17. Previously… • Lack of planning documentation • No formal link to identified educational gaps • CME had a reputation for its meeting planning skills • Lecture Formats prevailed (Q & A, if we have time!) • Evaluation – only measured level of satisfaction (not learning)

18. The times, they are a changin’Now… • Emphasis on Strategic Educational Planning • Identification of Needs (educational gaps) • Innovative Instructional Design • Practice-based Learning • Interactive Teaching / Engaged Learners • Skills Workshops • Simulations • Emphasis on Measurement of Impact / Learner Reflection / Commitment to Change

19. Critical themes are renewed • Significance of adult learning styles (acknowledge different types of learners) • Shift from teacher-centered to learner-centered • Establish a plan for desired outcomes – able to measure the impact ? (ROI) • Ultimately connect to Maintenance of Certification – a deliberate shift from a time-based to competency-based system

20. Learning Styles • Three main learning styles • Visual • Auditory • Kinesthetic • Provide links to needed information (just-in-time versus just-in-case)

21. Sound familiar ? • A new paradigm for medical education in the global village • Requires a deliberate and innovative plan

22. Planning Process – What are our goals? • What are we trying to accomplish? • Impart knowledge • Change attitudes • Acquire skills • Change practice behaviors • Change clinical practice outcomes

23. What do we hope to change? • Competence(to give physicians new strategies / abilities) • Performance(to help physicians improve their practice, enhance their decision-making) • Patient Outcomes(to help improve patient outcomes)

24. Adult Learning Principles • Be active contributors to the learning • Relate content to learners’ current work or life experiences • Tailor the curricula to current or past experiences

25. Adult Learning Principles (cont’d) • Allow learners to…. • identify their own learning goals and direct their education • practice what they learned in simulated activities • reflect on their learning • observe the faculty role-model behaviors • receive support and feedback from teachers or peers during active learning

26. How will we know if we are successful? • Establish an evaluation / outcomes measurement plan • Start with the end in mind • Set-up the desired level of evaluation / outcomes

27. Moore’s evaluation pyramid

28. The greater the impact – the more challenging to assess Level Measure Outcome 7 Population Health Global data 6 Patient Health Health system data • Performance Follow-up surveys, PI-CME, Correlation w/ patient data (did you apply what you learned?) 4 Competence Able to apply new knowledge • Learning Hands on skills practice, Pre- and post- tests, Self assessment (do you think you learned anything?) • Satisfaction Basic evaluation – pleasant exper. 1 Attendance Claim for credits

29. Elevator Speech (of the past) Use to sound something like this….. “Last year, we accredited over 217 activities which included a total of 42 grand round series. We issued credit for 2,696 hours of education to a total of 39,124 participants.” The majority of what individuals expect are didactic lectures from subject matter experts.

30. Key Components (no longer sufficient) Primary reference to quantity of activities No established standards in terms of quality (other than participant satisfaction) No mention of levels of interactivity (learner engagement) No mention of the impact on physician behavior…much less patient care.

31. We need to be prepared to answer the key questions….. • Why? How? So what ? • What difference was made by this educational initiative? • How did it improve providers’ decision making ability? • …their ability to diagnose and treat? • …the quality of patient care?

32. What should we incorporate into the planning? • Collaboration – leverage common interests, existing resources (avoid redundancy) • Align with strategic priorities • Think in terms of gaps in professional practice • Offer an opportunity to apply new knowledge; hands-on skills workshops

33. What should we incorporate into the planning? • Level of Evaluation = 4+ • Pull patient health data / Common measures • Coordination with maintenance of competence • Performance Improvement CME • Build in metrics

34. Our goal (in terms of design)… will be to develop a robust educational initiative which is…… • Easily accessed (and navigated) by our target audience • Delivered in a flexible format • Utilizes available technologies

35. Up-to-date and reliable • Reaches our target audience • Provides real-time information designed to drive improvements in delivery of patient care

36. Will make a difference in the quality of patient care • Will be reinforced • Can be measured (assessed) • Will be sustainable (in terms of funding)

37. Objectives (reviewed) • Describe current issues facing medical education • Highlight the direction of CME – renewed emphasis on sound adult learning principles • Discuss course planning and evaluation implications as it relates to course design and development options • Incorporate key adult learning considerations into the future design of a global health curriculum proposal

38. Thank you! Discussion / Questions? gjacobs@umn.edu 612-625-4660