CME Is Changing
The Changing World of Continuing Medical Education
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Unless you are new to the field of continuing medical education (CME) and healthcare, or have been hiding under a rock for quite some time, it is brazenly obvious that our worlds are quickly evolving and changing. The changes will continue and they have a direct effect on the expectations and demands of both you as healthcare providers and Primary Care Network, a CME provider. As partners with you in your lifelong learning, professional development, and improving patient care, we as CME professionals must consider some of the most forceful influences.
The evolution and development of Maintenance of Certification (MOC), which commits itself to your lifelong learning and competency in a specialty or subspecialty, has not only taken healthcare providers to a new level of commitment to quality clinical care, but also responsibility, accountability, and transparency. Maintenance of Licensure (MOL), while always required, has also become a more demanding process.
Demands on your time are increasing. The American Medical Association (AMA) reports in their 2003–2004 Physicians Socioeconomic Statistics that physicians work an average of 57.5 hours per week. A national shortage of primary healthcare providers, a growing aging population, and a new national healthcare plan projected to add millions of new people to our healthcare system all contribute to the increased potential for fragmented care and lack of resources.
We also cannot overlook the “faster than the speed of light” growth of information technology in medicine. At the forefront of these advances are the implementation of Health Information Technology (HIT), the use of electronic medical records (EMR), and the achievement of Meaningful Use. While EMRs were introduced 30 years ago, their adoption and implementation now have a sense of urgency. On July 13, 2010, the Department of Health and Human Services released the long awaited Meaningful Use Requirements, which, under the American Recovery and Reinvestment Act (ARRA), will provide financial incentives for primary healthcare providers and hospitals that demonstrate meaningful use of your EMR. (I am sure by now, all of us have read through the 863-page document and possess a full understanding of the core competencies required.) Soon, however, if you have not implemented specific practices of electronic records will be penalized.
The use of EMRs not only indicates a change in the way medicine is currently practiced, but has implications for the future of medical student education as it is becoming a prevalent tool for those entering the field of medicine.
In the world of providing quality CME, we have also experienced a multitude of change. Among those changes are new, updated, and often changing standards for providing CME, political and public scrutiny of provider practices, quality, funding and resources, credibility, and the changing preferences and platforms for offering educational activities to primary healthcare providers.
What have remained constant, however, are the goal, purpose, and responsibilities of providing CME to help you, primary healthcare providers, provide better patient care and increase positive health outcomes and patient safety. As CME providers and stakeholders, we have many factors to consider in meeting our responsibilities. At its core, we must provide education that matters to you, is relevant to your practice and patients, and helps you to make changes in competencies, performance, and patient health. In addition, we must also measure the success of our interventions.
So, where do we begin? We start at the beginning, of course. Who are we educating, and how can we best help you to improve? Consider the factors mentioned above and the myriad of issues that both healthcare providers and CME providers need to consider when developing certified medical education. The best-designed educational activity will not be successful if it is not designed for the true, evidence-based needs of you, as our learners.
Where is this going? Why consider all the environmental influences and your unique needs? Because if we don’t know where we are starting from, we won’t know how to get to the end, or worse yet, we will end up straying off-course completely. Assessing your practice needs should not only include specific disease diagnosis/treatment issues, etc, but the setting and its complexities in which they are practiced.
Evaluating practice gaps should help determine the exact expectations of our education. What we have historically called “learning objectives” are often unrealistic, immeasurable, and unrelated to the true gaps in clinical care. Ultimately, when we miss the mark at the beginning, we will find ourselves further away from our end destination, which in turn makes it difficult to measure whether we have been successful in our educational endeavor.
Rather than thinking in terms of “learning objective,” we should substitute the words “performance expectation.” What is it that you, as the healthcare provider, will do differently? And how will we know? Consider this learning objective: Explain the mechanisms of pain pathways, including clinical correlation to the disease process and diagnosis of fibromyalgia.
Several questions come to mind, the first being, explain to whom? Moreover, how will we know that you will be able to “explain” this? Will we call you on the phone and ask you to do this? Of course not! As a provider of CME, we are charged with the responsibility of not only providing education that changes competencies, performance, and/or patient health, but with measuring the success of our educational efforts. Furthermore, the results need to be relevant to your practice needs.
Ascertaining this information directly from you, to whom we are providing the education, is paramount. It is important to identify partners who and resources that can bring this and other areas of expertise to the table. Collaboration has been a part of our CME for some time now, and in the past few years, it seems to have successfully moved from concept to reality.
It is important that we engage you, as our learners. There are multiple ways we can and attempt to accomplish this, from calling upon our thought leaders, querying you—our current learners—identifying focus groups, and collecting your feedback from current activities. We attempt to gain information directly from you, the most important source of information.
As part of our planning process, information and data obtained from past activities that pertain to the same, or similar subject matter, is utilized. Assessment of past outcomes, activity evaluations, even subjective feedback contributes to the evaluation of the direction of our education. Furthermore, we can tap into the many organizations that are charged with keeping a finger on the pulse of healthcare, its providers, and results of care. While not all inclusive, this can include the Federation of State Medical Boards, American Board of Medical Specialties, specialty societies and associations, the Agency for Healthcare Research and Quality (AHRQ), and state medical societies.
Finding our way to the end starts with a great beginning. The issues are multifaceted, intricate, and constantly evolving. We need to dig deep, be root cause-oriented and proactive, based on the investigation of more than what might appear as immediate and obvious.
Sandy Bihlmeyer, M.Ed, CCMEP
Executive Director
Primary Care Network
sandy@primarycarenetwork.org
Published November 9, 2010
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