MedX | Ed Reflections

I am a medical educator and have been privileged to teach at the Indiana University School of Medicine as a faculty member for over 14 years.  I have had the opportunity to train many residents and students over the years, with the addition of focusing on faculty as well through overseeing the CME unit in recent years.  This is a privilege not taken lightly.  I feel strongly about trying to further my own professional development with respect to being the best teacher and physician I can be.  One such way to do this is to attend conferences relevant to one’s specialty.  I have attended many of these over the years, allowing me access to resources for networking and meeting other people who have similar interests.

Given my interest in emerging technology to improve patient care and education, I submitted an abstract to the MedX | Ed conference this year, and was pleased to have been accepted for an oral presentation related to lifelong learning and emerging technology.  I have watched the MedX conference via the live stream over the past few years, but attending in person—WOW!  What an inspirational two days!

There were so many different things to learn, and this short blog doesn’t truly do it justice; nevertheless, I will give just a few highlights that stick out for me.  Some were about newer technologies, such as what Dr. Neil Mehta presented on how to integrate technology with information management.  Some were about interprofessional education, which makes me excited when I see that the CME/CPD community has been really emphasizing the importance of this over the past several years.  Some were about connection and human touch (I expected to enjoy Dr. Abraham Verghese’s talk, but was inspired beyond my wildest dreams) to show empathy with patients.  Some were medical students themselves creating startup companies to improve medical education (Picmonic and Osmosis).  Some were about shifting the paradigm and creating curricula on updating topics related to medicine on Wikipedia.  Some were about storytelling (both from learners themselves and from patients; INCREDIBLY powerful), which I emphasize but am convinced I must emphasize even more [and for the record, YES, CME/CPD conferences SHOULD be providing MORE patient panels to hear more about the patient perspective].

This is truly a one-of-a-kind conference!  I thought I tweeted a lot during meetings (see my recent reflections on Tweeting the Meeting here and here, but wasn’t even close to some of the influencers in complete “status tweeticus”.  I thought I blogged quickly, but others created wonderful blog posts within hours and even live.

It was also great to meet many of these folks in real life (although I admit I could have been better).  In addition, through the power of social media related to this conference, I was contacted (while in the airport heading to the conference) for my opinion on a story about skills that physicians of the future need to have, which was published on day 2 of the meeting.  

A hearty “Thank You” to Larry Chu and the entire MedX | Ed team for putting on what I think is the most innovative conference I have ever had the privilege of attending.  To solve some of the current problems in healthcare, we need more than just doctors, and this conference delivered on describing some real solutions!  I hope to attend again in the future, and look forward to seeing and meeting new folks in future years.

P.S. Yes, my own presentation did include descriptions of emerging technology, storytelling, and how innovative methods of education can influence the learning process and potentially patient care!

CME, Industry and Outcomes

Recent medical literature describes the challenges of demonstrating the impact of CME on physician learning (with a focus on the lack of impact), and the need to reform the current system.  Writers suggest that it really is not having the impact that it should, given the financial resources provided.  Others have questioned how it is funded, suggesting that it may be biased given the resources provided by industry, and that it should be changed. 

While I admit my own bias as an Associate Dean for CME for a major medical school, I feel that it is important to study the peer-reviewed literature to best understand this important topic.

First, is the industry influence really that significant?  A piece by Cervero discusses this, and found limited evidence of the impact of industry influence on CME.  In the recent ACCME 2014 report (Table 8), only 11% of accredited CME received commercial support from industry.  My interpretation of this is that the commercial support is certainly not an overwhelming part of CME programs (our own institutional data would definitely mirror this finding).

Second, what is the real impact of CME?  The same above author recently published a piece in JCEHP (full disclosure: I am the social media editor for this journal, but was not involved in any way in the creation, revision, or decision to publish this manuscript) that concluded that CME can indeed impact patient outcomes and physician behavior (the former more than the latter).

Third, improvements in how CME is disseminated should occur.  Within this realm, patients should be included, and interprofessional learning should occur in team environments; this is highlighted by the new President and CEO of the ACCME, Dr. Graham McMahon, in a Viewpoint piece in JAMA that came out online earlier this week.

So where should we go from here?  I think there are several things we can consider.  Most importantly, physicians and other healthcare providers should continue to learn in order to provide optimal care of their patients in a changing environment; CME is one way to aid this learning.  Those in the field have been thinking about how to restructure it for many years and have made major strides in focusing on quality improvement.  Second, we should also consider learning healthcare systems as a way to promote learning for those who provide care for patients.  Lastly, we should be diligent about using technology to make our learning more effective.  Examples include online journal clubs and virtual communities of practice.  Given the complexities that abound in medicine in the current environment, anything that can make the process of learning how to "keep up" and best care for our patients easier should be welcomed.  

CPR, High Value Care, and MedPeds

What a whirlwind of a day today.  Lots of productive meetings, and some incredible learning along the way.  I have two “A-HA” learning moments from today.

The first was our Pediatrics Grand Rounds at Riley Hospital for Children.  Our PICU physicians set up a truly innovative Grand Rounds to have a discussion about the topic of “Do Everything?” regarding pediatric patients in the ICU.  It was co-hosted by a nurse researcher at our Ethics Center who has studied "Moral Distress", and a PICU nurse who provided an amazing perspective to the discussion.  It featured two role playing scenarios in how health care professionals speak with families of terminally ill children about CPR.  It was a great way to engage the audience to think about how families understand outcomes from CPR.  A critical learning point of this topic, common to many regarding patient-physician communication, is to avoid overly complex medical terminology, or jargon, when speaking with families.  In addition to talking about using language that matters, we discussed this paper from 1996, in which the authors evaluated the rate of successful CPR on television shows and compared it to the actual rate of survival in real patients.

This blog here is a recent update to that piece with a great infographic comparing the rates on specific shows.  The other great part was that this grand rounds was totally packed: not an open seat in the room!  For a CME person like myself, it is nice to see that so many participants were able to benefit from this presentation.  My tweets from today (1/15/14) convey much of the content of this educational session, for those with further interest on this topic.

Secondly, I am proud to announce that we piloted our first “High Value Care” curriculum to our MedPeds residents today.  The ABIM Foundation has been leading the charge on this, with the creation of the Choosing Wisely campaign.  Luckily, we did not have to reinvent the wheel, and were able to utilize this amazing high value care teaching resource from the ACP which was recently rolled out.  The residents were as engaged in this discussion as they have ever been.  I think this phrase captures their sentiments: “We want to be part of the solution to the costs of health care crisis and not just order tests indiscriminately”.  I couldn’t have been more proud!

For those interested in finding and using ready-made resources to teach cost-conscious care to residents or students, I can say that we were able to easily complete one of the five current modules with 8 formal multiple choice questions in less than one hour, with ample opportunity for robust in-depth discussion of some of the points.  We elaborated on clinical decision making in the context of cost conscious care.  Kudos to Dr. Daisy Smith of the ACP for creating these online modules that educators can use “off the shelf” right away in their training programs.  One does not even need to be an ACP member to gain access to these modules!

Looking back on these two topics noted above, I now see that they are a perfect example of the variety of training in MedPeds: both a Pediatric topic and an Internal Medicine topic in the same day!  Hooray for MedPeds!  I only hope that other days can be as “educationally productive and rewarding” as today was for me.