Redesigning Continuing Education for the Health Professions

1. Redesigning Continuing Education for the Health Professions 2011 BOC Athletic Trainer Regulatory Conference

2. Institute of Medicine Established in 1970 by National Academy of Sciences to exam policy matters pertaining to the health of the public National Academy of Sciences is a private, nonprofit society that was established by congresssional charter to advise the federal government

3. Historical Context for Continuing Education Continuing Education not seen as prestigious as undergraduate or graduate education 1960’s- most was provided by pharmaceuticals Subject to criticism- Conflict of Interest CE industry has grown rapidly in last 10 years Increasing involvement of commercial support and Medical Education and Communications (MECC)

4. Concerns about Continuing Education Flexner report in 1910- concerned about UG medical education and lack of standardization These mirror the concerns we have today about CE CE largely driven by state requirements, certification requirements and regulatory bodies

5. Requirements For MD’s- Michigan- 50 CME credits per year Alabama- 12 CME credits per year Indiana- 0 CME credits per year Nursing varies from 5-15 hours per year Pharmacy varies from 10-60 hours per year No evidence to support the number of hours or the type of education

6. Medicine ACCME- Accreditation Council for Continuing Medical Education-accredits the providers Medical Schools, Professional Societies and MECC (for profit) On average ACCME providers report profits of 23.5% 58% of CME is industry funded 1.5 billion of CME from commercial entities Some effort to develop safeguards but not enough Reports of planted members in audience to ask about a drug What would happen if withdrew all commercial funding- cost each MD on average $3,500 each year

7. Pharmacy Pharmaceutical and medical device companies have a leading role in CE for Pharmacy and Medicine 2006- 43% of CE programs for pharmacists received commercial support Culture where pharmacists expect to obtain CE at minimal cost and the CE providers were dependent on industry to cover their costs

8. Other Concerns 2.5 billion in income in 2007 1.5 billion commercial funds Concerns about quality, inconsistency in number and type of hours, conflict of interest and funding lead to the convening of a conference funded by the Macy Foundation

9. Macy Foundation Report CE was more focused on number of credits than on improvement in performance or patient care Funded by organizations with conflicted interests No incentives for Interprofessional Care They called for the appointment of an IOM committee to consider the development of a national Interprofessional Continuing Education Institute

10. Committee on Planning for a Continuing Health Care Professional Education Institute Gail L. Warden (chair) President Emeritus, Henry Ford Health System David Leach Former Executive Director, Accreditation Council for Graduate Medical Education Lucinda Maine Executive Vice President and Chief Executive Officer, American Association of Colleges of Pharmacy Paul E. Mazmanian Associate Dean for Continuing Professional Development and Evaluation Studies, Virginia Commonwealth University Michael W. Painter Senior Program Officer, Robert Wood Johnson Foundation Wendy Rheault Vice President, Academic Affairs, and Dean, College of Health Professions, Rosalind Franklin University of Medicine and Science Marie E. Sinioris President and CEO, National Center for Healthcare Leadership Jako S. Burgers Senior Researcher, Scientific Institute for Quality of Healthcare Linda Burnes Bolton Vice President and Chief Nursing Officer, Cedars-Sinai Medical Center Catherine DeAngelis Editor-in-Chief and Senior Vice President, Scientific Publications and Multimedia Applications, JAMA Robert D. Fox Professor Emeritus of Adult and Higher Education, University of Oklahoma Sherry A. Glied Professor and Chair, Department of Health Policy and Management, Columbia University, Mailman School of Public Health Kendall Ho Director, eHealth Strategy Office, Associate Professor, Division of Emergency Medicine, University of British Columbia Edward F. Lawlor Dean and William E. Gordon Distinguished Professor, George Warren Brown School of Social Work, Washington University

11. Charge to Committee Review issues in continuing education (CE) of health care professionals to consider the establishment of a national interprofessional CE institute to advance the science of CE

12. Committee Process 12 month study 3 face-to-face meetings 2 public workshops with 17 speakers Extensive literature review 16 external reviewers

13. Conclusions about CE Purpose of CE is to enable health professionals to keep their knowledge and skills up to date, with the ultimate goal of improving performance and patient outcomes CE should be interprofessional and include a broad variety of professionals (e.g., dentists, dieticians, nurses, physical and occupational therapists (etc)

14. Key messages There are major flaws in the way CE is conducted, financed, regulated, and evaluated Focus on meeting regulatory requirements rather than identifying personal knowledge gaps Concerns about conflicts of interest in CE activities Regulations that vary widely by profession, specialty, and state, leading to inconsistent learning

15. Key messages (continued) The science underpinning CE is fragmented and underdeveloped Often characterized by didactic learning methods (e.g., lectures) in traditional settings (e.g., auditoriums) Little specific information about how to best support learning Health professionals lack a dependable basis for choosing among CE programs Leaves the larger value of continuing education for health professionals uncertain

16. Key messages (continued) CE should be interprofessional in nature A new, comprehensive vision for CE is needed that prepares all health professionals to perform to their highest potential

17. Toward a system of continuing professional development In CPD, learning opportunities: Stretch from the classroom to the point of care Shift control of learning to individual practitioners Adapt to individuals’ learning needs

18. Toward a system of continuing professional development CPD system offers promise to: Advance evidence-based, interprofessional, team-based learning Strengthen the research workforce, particularly through academic institutions Engender coordination and collaboration among the professions Provide higher quality for a given amount of resources Lead to improvements in patient health and safety

19. Alternatives considered Status quo Program within a federal agency (AHRQ or HRSA) Purely private structure consisting of professional societies Coalition that includes the quality improvement community Public-private structure

20. Recommendation 1 Commission planning of an institute The Secretary of the Department of Health and Human Services should commission a planning committee to develop a public-private institute for continuing health professional development

21. Recommendation 2Envisioning a CPD system The planning committee should design an institute that: Creates a new scientific foundation for CPD Develops, collects, analyzes, and disseminates metrics Encourages development of health information technology Encourages development and sharing of improvement tools and theories of knowledge across professions Fosters interprofessional collaboration Improves the value and cost-effectiveness of CPD delivery

22. Recommendation 3Improve quality and safety The Continuing Professional Development Institute (CPDI) should be designed to work with other entities whose purpose is to improve quality and patient safety and involve patients and consumers in CPD

23. Recommendation 4Improve scientific foundation of CPD The CPDI should lead efforts to improve the scientific foundation of CPD by: Integrating research methods and findings from all disciplines and professions Generating research directions to advance understanding of linkage between CPD and patient and population health status Transforming new knowledge into tools and methods to improve patient care Promoting the development of measurement instruments to evaluate CPD effectiveness and efficiency

24. Recommendation 5Enhance data collection CPDI should enhance data collection at the individual, team, organizational, system, and national levels, including: Relating quality improvement data to CPD Developing national standardized learning portfolios

25. Recommendation 6 Develop national regulatory standards The CPDI should work with all stakeholders to develop national standards for regulation of CPD

26. Recommendation 7Strengthen financial support The CPDI should analyze the sources and adequacy of funding for CPD to develop a sustainable business model free from conflicts of interest (NOTE: The committee expects that with a greater emphasis on quality and patient safety, CPD would be more closely linked to daily operations than is the current case, helping absorb the costs of implementing a CPD system)

27. Recommendation 8Foster development of interprofessional models The CPDI should identify, recognize, and foster models of CPD that build knowledge about interprofessional team learning and collaboration

28. Recommendation 9Support research Supporting mobilization of research findings to advance health professional performance, federal agencies that support demonstration programs should collaborate with the CPDI

29. Recommendation 10Evaluate progress The CPDI should report annually to its public and private stakeholders through a national symposium on the performance and progress of professional development and its role in enhancing quality of care and patient safety

30. Planning committee for the CPDI Function Define scope of work Develop governance model Identify funding sources Manage relationships with stakeholders Structure 13-15 members, approved by the Secretary Competency-based membership Funded by contracts and grants

31. Structure of CPDI Independent, public-private body to guide development of national coordinated CPD system Budget should depend on exact functions and breadth, Standing councils and ad hoc committees to enhance transparency

32. Structure of CPDI (continued) Managed by competency-based board Initial oversight and coordination by federal government as a central convener Board should determine whether the government’s responsibilities should be transferred back to CPD stakeholders. Unless the board determines otherwise, the Secretary will eventually have no formal role in the institute

33. For more information about the report and to download the summary: www.iom.edu/continuinged

34. Thank You 2011 BOC Athletic Trainer Regulatory Conference