The journal Academic Medicine, which has the highest impact factor of journals dedicated to medical education, just released its annual question of the year edition. The Editor asked, What improvements in medical education will lead to better health for individuals and populations? Over 120 submissions were received and 15 were accepted and published in this month’s edition. One of the published articles was on the future of CME and was co-authored by our Associate Dean and Director, Todd Dorman, MD and is available free through the link below.
Posts Tagged ‘cme’
Academic Medicine
Monday, November 14th, 2011Research in CME, Update
Monday, October 18th, 2010The latest news from our office regarding research in CME is that we are part of one of the AHRQ funded grants for work with the Clinical Effectiveness Research Study Guides. Our office worked with two separate teams submitting two separate and distinct grant applications and we are honored that one of them was indeed funded.
In this project we seek to utilize our successful experience in computer-assisted patient education in order to develop a comprehensive informatics framework for rapid adaptation and dissemination of Comparative Effectiveness Research (CER) products tailored to different categories of health consumers including difficult-to-reach patients. We will refine our current interactive education platform to implement and test a novel system for individualized continuous patient education (iCOPE).
The iCOPE platform will be specifically designed to support rapid adaptation, customization, and dissemination of the CER products to the difficult to reach populations. The iCOPE platform will implement universal means for customized delivery of CER information in the format of interactive self-paced educational modules, quick “question & answer” guides, and interactive decision aids. In addition, the iCOPE platform will support the innovative concept of continuous patient health education by providing patients with easy access to the interactive CER updates via web, MP3 players and phone-based interactive voice response (IVR) technology.
Though iCOPE will be designed to support the whole spectrum of CER products, in this project we will focus on the Comparative Effectiveness Research Summary Guide (CERSG) entitled “Pills for Type 2 Diabetes.” We will assess the impact of the iCOPE platform on CERSG knowledge in a randomized clinical trial (RCT) separately in hospital, primary care and community environments. For this purpose, overall 318 elderly with diabetes will be enrolled and followed for 6 months. The comparison will be made with control group using printed versions of the CERSG.
The following primary hypothesis will be tested in the RCT: Use of the iCOPE platform will be associated with improvement in CERSG knowledge in elderly at 6 month after the intervention. We will also investigate the impact of iCOPE on medication adherence, diabetes medication satisfaction, and HbA1c.
The following secondary hypothesis will be evaluated: The iCOPE intervention will be associated with increase in CERSG acceptance, medication adherence self-efficacy, and positive impact on beliefs about taking diabetes medications. Cost analysis will be conducted to assess the direct costs of implementing the iCOPE intervention.
Great Meetings Happening In CME!
Monday, October 4th, 2010There are great meetings happening in CME!
Check our calendar for upcoming activities. Keep in mind you can search by specialty or key word and importantly in today’s world you can search by core competency.
Also consider checking out the SACME website for information related to this year’s annual fall meeting scheduled for early November in Washington, DC.
The Alliance Meeting will be in January in San Francisco and then the SACME Spring Meeting being held in New York City in early April.
Certified CME can make health care reform work!
Monday, August 16th, 2010CME has been shown to be effective and of value in several large studies. Yes, its effectiveness has been shown more convincingly for knowledge transfer than patient outcomes, but that is mostly secondary to the fact that CME was originally designed as a knowledge transfer medium. Only in the last few years has certified CME focused at level 5, 6 and 7 outcomes. Preliminary data from certified CME activities already looks positive and over the next few years as these projects mature, the results will be published in peer review journals and much of the present argument by a few vocal naysayers will be muted by hard data of improved outcomes.
CME is a strategic lever for change. Providers simply will not change unless they are educated as to why change is needed, what aspects of their practice need to change based on hard data, and a program of change that can be accomplished given barriers to care that exist within the present health care system. This sort of information and access to the experts regarding advances in care are principally provided through certified CME and thus it is fundamentally essential for improvement.
Numerous CME activities focus at quality and safety topics. The activities can and do serve a pivotal role in advancing these important aspects of health care. In case you doubt how important these topics are, at least from a fiscal perspective, recently the actuaries released a report on the cost of errors in health care (see links at bottom). They estimate “that measurable medical errors cost the U.S. economy $19.5 billion in 2008. Commissioned by the Society of Actuaries (SOA) and completed by consultants with Milliman, Inc., the report used claims data to provide an actuarially sound measurement of costs for avoidable medical injuries. Of the approximately $80 billion in costs associated with medical injuries, around 25 percent were the result of avoidable medical errors.” Key findings from the study include:
There were 6.3 million measurable medical injuries in the U.S.(2008); of the 6.3 million injuries, the report estimate that 1.5 million were associated with a medical error.
The average total cost per error was approximately $13,000.
In an inpatient setting, seven percent of admissions are estimated to result in some type of medical injury.
The measurable medical errors resulted in more than 2,500 avoidable deaths and more than 10 million excess days missed from work due to short-term disability.
Given the focus on quality and safety as key components of health care reform and the clear focus on cost control, the role that certified CME can play in this domain is critically important and frankly quite exciting. Certified CME can make health care reform work!
SACME Inaugural Summer Leadership Institute (SLI) a Success!
Monday, August 2nd, 2010The SLI was a huge success. The attendees were enthusiastic and engaged. The faculty utilized almost every conceivable type of interactive education available including (to name but a few) self reflection, small group discussion, large group discussion, game playing and simulation. We even survived a real world crisis management scenario!
Attendees filled out evaluations on the last day. 100% stated objectives were met and 100% stated that they would recommend the activity to a colleague. Only one attendee stated that they would not change their practice, but added the caveat that the course did validate and reinforce changes they have recently initiated.
The most common improvements to present practice stated by attendees included succession planning, enhanced use of strategic planning, especially strategic abandonment and economic evaluation of current system using Porter’s model. That being said team building, conflict management, and media training were also frequently mentioned.
In approximately 60 days a more robust follow up through the online Moodle classroom will be initiated. In addition, a follow up at approximately 9 months will also be pursued. The attendees and faculty will stay engaged through the Moodle classroom/networking site.
The planning team will be debriefing in the next few weeks and then subsequent plans for continued engagement by and with this cohort will be entertained as well as planning for a subsequent SLI with a new cohort.
OIG’s view of CME
Monday, May 3rd, 2010Last December, the New England Journal of Medicine published an article on “The Agenda for Continuing Medical Education—Limiting Industry’s Influence,” by Lewis Morris, general counsel, and Julie Taitsman, chief medical officer, for the HHS Office of Inspector General (OIG). The article stated that “the medical profession will one day eschew commercial support for continuing medical education (CME).” Until that day comes, the authors suggested that a mechanism be developed to allow the medical profession to subsidize CME programs designed to improve patient care. The AAMC viewed this article as an invitation to open a dialogue with the OIG about CME and related issues. As a result, Dave Davis, AAMC senior director for continuing education and performance improvement, and Ivy Baer, director and regulatory counsel in our health care affairs unit, sat down with Lew Morris and Julie Taitsman last week. Their wide-ranging discussion touched on the OIG’s concerns about who sets the educational agenda for all CME providers, and the use of CME for “kickbacks.” There was also much give and take during the conversation on how accredited, academic CME differs qualitatively from that of other CME providers. It was agreed that a broader representation of the academic community would benefit from more discussion on these issues. The AAMC is exploring ways to make this happen in the future.
Blizzard 2010 Follow-Up
Monday, March 1st, 2010So, after reading the last blog you may be wondering…. what are some of the issues that arose from the review and what changes are we making.
We are investigating a system whereby we could record every single activity or presentation that is provided at all of our activities via a laptop in at least audio format via a mechanism that could simultaneously capture the slide presentation and then make the material available in multiple media formats. This would enable a greater degree of flexibility to providing materials to learners as well as provide a rich archive of all activities and presentations.
We will need to rewrite our essential personnel policy and will add to it an essential procedures policy. We will review all crisis management process and consider dividing them into two broad categories; those in which we have some amount of time to prepare and those in which we simply do not. When we have time we need to a priori get announcements up on our website in advance of the activity and we need to be able to better control some of our web processes remotely. We also require a more fluid transition from a planned printed syllabus to storing on a USB device to simply making all material available as a downloadable pdf.
Our dedicated staff also found that remote access required more forethought than expected in some circumstances. We cannot require our staff to have this access, but we did find that many wanted to have the access and were very willing under the conditions of this type of crisis to work from home if they indeed had set up the access and tested it in advance.
These are just several examples of lessons learned from the blizzards of 2010.
The CME Improvement Process
Monday, December 7th, 2009In the October 28, 2009 edition of JAMA, an editorial appeared by Eric Campbell and Meredith Rosenthal entitled, “Reform of continuing medical education: Investments in physician human capital”. Unfortunately these authors seemingly ignored the entire CME improvement process that is already in place in this country. Academic CME in particular has examined itself, has begun an improvement project of its own and has undergone a profound sea change well in advance of this publication.
CME wasn’t created to change patient outcome in a direct effect model. Physicians believed that they were no longer novices, but masters in the craft of health care requiring only continued exposure to the most current information. Thus the published literature demonstrates that CME is indeed most effective at advancing knowledge. The implication that scant evidence of improved patient outcomes means no evidence is incorrect. This is an issue of lacking evidence not being the same as evidence of no effect.1 Physicians don’t practice in a vacuum and their sources to learn and improve are through a variety of concurrent mechanisms. Consequently, defining a causal pathway for any single activity may never be achievable.
Performance Improvement CME already exists and early projects have shown beneficial outcomes.3,4 Point of care CME is being utilized by many physicians to directly impact care decisions. Simulation-based CME is just beginning.
The goal is not a system of no funding, but a system of no influence that improves practice and patient outcomes. This goal was established by the CME profession itself and is in concert with the IOM. 2 These newer forms of CME which target patient outcomes are much more expensive to conduct and given the steady advance of knowledge in healthcare the costs for CME recur in full each and every year. Training within one’s practice team may require the closing of one’s practice adding additional costs and concerns regarding access to care.
Commercial funding for CME was indeed on a steady increase until 2004 when the revised Standards of Commercial Support were released. 2008 saw a decrease in commercial funding of almost $200 million dollars and the expectations is that the 2009 data will show an even larger fall, a fact supported by preliminary data analysis from the 2009 Harrison Survey. Thus this call by Campbell and Rosnethal for a change in funding ignores what is already at play.
Regulated change comes and goes (e.g. prohibition). Introspective performance improvement is indeed the pathway to sustainable change and this is a path that CME has already begun. In this, the 100th anniversary year of the Flexner report, CME is honored to have seen the need to change and to have embarked on this process. It is unfortunate that Campbell and Rosenthal did not acknowledge the significant improvements already occurring.
References:
1) Marinopoulos SS, Dorman T, Ratanawongsa N; et al. Effectiveness of Continuing Medical Education. Rockville, MD: Agency for Healthcare Research and Quality; January 2007. Evidence Report/Technology Assessment 149. AHRQ publication 07-E006.
2) Institute of Medicine. Conflict of Interest in Medical Research, Education, and Practice. Washington, DC: National Academies Press; April 28, 2009. http://www.iom.edu/CMS/3740/47464/65721.aspx. Accessed June 24, 2009.
3) MB S, Mullikin EA, Loose AS, Olson CA . Learning to collaborate: A case study of performance improvement CME. Journal of Continuing Education in the Health Professions. Summer 2008;28(3):140-147.
4) Laprise R, Thivierge R, Gosselin G, Bujas-Bobanovic M, Vandal S, Paquette D, Luneau M, Julien P, Goulet S, Desaulniers J, Maltais P. Improved cardiovascular prevention using best CME practices: A randomized trial. Journal of Continuing Education in the Health Professions Winter 2009;29(1):16-31.
Annual Fall SACME Meeting
Friday, October 16th, 2009In 2 weeks the Annual Fall SACME meeting will be held in conjunction with the Annual AAMC meeting. This year’s meetings are in Boston. As the President-elect of SACME I help put together a session at the SACME meeting on current hot topics in the field. The line up can always change at the last minute, but at present include a diverse set of short presentations on topics like the upcoming IOM report on a CME Institute, ACCME changes mentioned in testimony before the Senate Ageing Committee, as well as a series of updates on things happening at MACY Foundation, Council for Medical Specialty Societies and others. I am also very excited to participate in a session on establishing a research focus in one’s CME office. Some innovative instructional design will be leverage during this session.
I have also been asked to speak at two additional sessions outside of the SACME meeting. I will be presenting on The Future of CME at the AMA Section on Medical Schools meeting and on CME as a Value Center at the Council of Deans session at the AAMC meeting. I am honored to have been asked to do either of these presentations and excited to be able to contribute in some small way to these important meetings.
Filling the Gap
Tuesday, September 8th, 2009Most physicians trained in an era in which the major educational model was an apprenticeship model. This has been mostly replaced with an adult educational model principally derived from the Malcolm Knowles perspective. Thus most physicians who then contribute to educational endeavors at the medical student, houseofficer and practicing physician level have little experience with the principals and often resist the andragogical approach developing educational activities. Thus, it seems that the major problem is that physicians have a gap in knowledge regarding the educational cycle that needs to be filled as if they understood the steps they could more easily follow them and would grow to appreciate the benefits of such an approach.
Physicians are also very busy and have limited time to learn all of the approaches in great detail especially if the training takes a protracted period of time. With the need for the gap to be filled utilizing a time conscious approach we have created a series of training sessions we are calling “QuickFacts”. These include slides and audio and can be viewed in multiple formats. None last more than 5 minutes and the majority are under 3 minutes. Check these out on our resource page. Send us feedback about the series that we have finished or if you have ideas for future sessions.