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.  

Advocacy in Academic Medicine

Today’s blog covers advocacy from a variety of angles, and reflects my thoughts over what I learned from the #AAMC13 meeting over the last 24 hours.

Advocacy within Social Media

The University of Utah is taking a huge presence at this meeting with its Innovations theme.  At a booth set up in the exhibit hall, they were interviewing folks coming through to provide brief reflections.  I was able to spend a few moments reflecting on what the impact that social media can have on medicine and medical education.  What a timely opportunity to focus on what so many great folks have done parlaying the importance of vaccines for communities, as well as providing truthful, succinct messages to society.  See the audio interview here.

Advocacy within Education

Daphne Koller, who started Coursera, spoke to the participants on the power of what MOOCs (Massive Online Open Courses) can do, not just for the schools or professors who host them, but for society as well.  I was moved by the stories from student learners from sub-saharan Africa and others who became more educated from their use of Coursera.  The potential ramifications of the betterment of the entire planet: wow!

Advocacy within Continuing Education

I attended a workshop on CME in which Don Moore described a tool that integrates the IHI Model for Improvement with PI CME (Performance Improvement CME) to help clinicians better understand the pieces needed to make improvement science and lifelong learning relevant to their day-to-day practice.  Some in the community have questioned how Maintenance of Certification actually “helps” them provide better care for their patients.  This session helped clarify the potential benefits of the Maintenance of Certification program.  We also heard from Mary Turco and George Blike about a concept at Dartmouth called “Value Grand Rounds”, which itself showcases improvements in the health system, but also itself has the opportunity for members of a team to see the fruits of their labor, and also drives them to want to get better.

Advocacy for Research

At the Town Hall meeting, Dr. Darrell Kirch answered questions from the audience about a variety of topics.  One comment hit home: the public is “scientifically illiterate”.  A new initiative by the AAMC entitled “Research Means Hope” focuses on how the public can better understand why research funding is so desparately needed, because the end product of research should be improved patient livelihood. 

Advocacy for Graduate Medical Education

Also at the Town Hall meeting, a question was raised about the “rate limiting step” in producing new physicians in the United States—namely, the shortage of residency positions for graduates of medical schools, who themselves have increased enrollment by 25-30% over the past few years.  Atul Grover discussed bills in Congress that aim to address the “GME crisis”: HR 1180, HR 1201, and Senate 577.  We hope that these campaigns can be successful in providing the resources for the physicians of the future, hoping to achieve the ultimate goal of improved patient outcomes in our communities.

Advocacy for Me

I was honored to have met Dr. Lewis First as well, the editor of the journal Pediatrics, and a giant in the world of pediatrics.  His own career embodies the best of academic medicine, and the best of how physicians can make a difference.

A hearty thanks go out to the AAMC on a fantastic meeting, with so many opportunities for reflection, for networking, and for the opportunity to improve the education of future physicians and leaders in health care.

#AAMC13: Saturday November 2, 2013 Reflections

It is currently the first night of my time in Philadelphia at the 2013 AAMC meeting.  I’ve only been here a little over 24 hours, but today has just been phenomenal for thinking about the future of medicine and medical education.  This blog is a few reflections from the day.  There were many other sessions that I attended, but these are some key elements from a few of the sessions that had a great impact on me.  The credit truly goes to the speakers whom I heard discuss these topics.

CME (Attribution: David Price)

The old way of thinking about CME is this: a “credit” required to justify “widgets” of learning.  This is shifting to a new CME/CPD model: aligning education with the gaps/needs of our communities.  In this new model, we can study why things work or don’t work.  For example: Does it work?  Can it work in real life?  How/why does it work?  Does it work better/cheaper?   What I think the challenge will be is finding the linkage to determine how the education is created, disseminated and implemented across health care systems.

Teaching Costs of Care/Value in Health Care (Attribution: Chris Moriates, Vineet Arora, Neel Shah)

The ABIM Foundation created a wonderful program as part of the Choosing Wisely Campaign which was a competition for programs/schools to present educational innovations to teach this important topic.  The criteria for this necessitated that the innovations be FINER: Feasible, Interesting, Novel, Ethical and Relevant.  Ultimately, interventions needed to address “COST”: Culture, Oversight, Systems Change, and Training.  3 speakers from different institutions highlighted their innovations, which demonstrated a variety of techniques to tackle this critical component of health care. My take home is that the health care providers have an obligation to our patients and society to tackle the issues of health care costs stemming from the unsustainable strain that these costs are putting on society.  This program showcases the fact that medicine as a field, under the leadership of the ABIM Foundation, is not pointing fingers at others (insurance companies politicians, or lawyers, for example), but rather is looking introspectively at how can we make a difference in addressing the cost issue.  The issue is real, but we are no longer burying our heads in the sand.

The Future of Medicine and the Need for More Residency Training Positions

I had the fortune of having dinner with our Associate Dean for Medical Student Affairs and 3 medical students from the IU School of Medicine.  We all reflected on the day, and what we all can take from the conference so far.  One big theme from that discussion is that advocacy is alive and well in the current generation that is going through school and training now.  Advocacy can take many forms, such as helping the disenfranchised, educating patients and families about the importance of vaccines, and/or even lobbying Congress to secure more positions for residency training.  The future of health care needs more physicians: medical schools have responded by increasing enrollment (and adding new schools), but the “bottleneck” is truly at the GME level.  In order to alleviate this, the number of residency positions need to increase.  This is not just a way to help students secure a residency position, but is the ultimate path towards addressing societal need for more health care providers.

Thank you, AAMC, for a wonderful first day of learning, camaraderie, discussion and interaction.  I look forward to the next few days as well!

Reflections on ACEHP13 - Halfway Through

The Alliance for Continuing Education in the Health Professions annual conference is going on right now in San Francisco.  It is about halfway done now, and this post is a series of my thoughts so far based on discussions I have had, or comments people have made in workshops or plenary presentations, that have impacted me as a part of my personal learning network.

1.       The far-reaching, ultimate goal of continuing education is really about improving and optimizing patient care, specifically at a population/community health level.

2.       Quality improvement and patient safety are not fads; they are an integral part of the practice of health education, and linking education to these areas is crucial to achieving #1 above.

3.       Research about education practices is critical to advance the field.

4.       There is a broad scope of activities beyond “live activities” for education of health professionals [I especially like Performance Improvement CME and Point of Care Learning CME as examples, and we need to be doing more of these].

5.       Emerging technology is becoming more relevant every day in continuing education, and we need to embrace it rather than shy away from it.

6.       We need a new paradigm for health care education that needs to be learner-centric, ultimately to achieve #1 above, and communication skills will be a critical component of that education.

7.       Engaging all members of the health care team (from physicians to pharmacists, from nurses to social workers, just to name a few) is critical to the success of optimal patient care and #1 above.  This includes interprofessional education, and also interprofessional practice.

So what do you think?  What are some other take-home points from the conference so far?  Please let me know by coming to the breakout session I am privileged to host with Dr. Jennifer Gunter on February 1, 2013, at 3:15 pm, on “Perspectives in Learning Through Social Media”.