CE Spotlight on the University of Iowa, Carver School of Medicine CPD/CE Program

An Interview with Joseph Szot, MD, Associate Dean for CME and Integrative Education

Click here to listen to this informative interview (transcript below): 

If you wish to read the interview, instead of listening to the audio, we have attached the original transcription here:

Interview Transcript

Edited by Robert Dantuono, MHA

Robert:

Hello and thank you for joining us for the winter issue of CE Spotlight. This column, as you know, is devoted to bringing on our most experienced CME program directors and associate Deans and having them give us tell us about their various experiences in CME program development, planning and innovations. So thank you for agreeing to meet with us today. We have Doctor Joseph Szot, who is the Associate Dean for at for CME and Integrative Education at the University of Iowa College of Medicine. I’ve been really interested in learning more about his innovations and the way that the University of Iowa’s program is currently being managed, managed and its evolution over time.  

So let’s begin with our first question on the leadership and organizational challenges at your institution. Dr. Szot, could you describe for us the CME, CPD leadership and governance structure at the school and how it might be any, any kind of special features it might have such as being integrated within the Medical Center. Thank you.

Dr. Szot:

So thanks for having me. Our organizational structure within the CME office itself is an administrative dyad. We have an administrative director who handles much of the finance and business aspects and then I am the other half of the dyad as the associate Dean for CME with really. Oversight of future education and where we want to drive our mission as well as outreach to the departments and learners and then both of us, the CME office answers directly to the associate Dean, the executive associate Dean of the College of Medicine. We are not integrated into our healthcare system, though we are one large system with our Vice President for medical affairs being the Dean of the College of Medicine, as well as overseeing the hospital. Within the healthcare system, I am integrated into several key committees. I sit on the Quality and Safety Oversight Committee as well as the Quality Executive Committee, giving me first-hand information around the initiatives within the healthcare system, around quality and improvement.  I also sit on the Graduate Medical Education Committee, which really gives me the ability to bring CME issues to the graduate medical education community as well as help with faculty development and other initiatives within GME.  So it’s great cross pollination being on that committee too. I think this doesn’t directly fall under the Office of CME in the College of Medicine, but when I became the associate dean, I started a new Vice Chairs for Education, community of practice within the College of Medicine. This had not existed previously and it allows all the Vice Chairs of Education across the college to come together. We meet every other month to address common concerns and challenges, and share solutions to develop best practices around delivering education that could be GME or it could be CME.  So there’s a lot of collaboration that the CME office facilitates across these departments.

Robert:

Excellent. I think just to comment further on your participation, sitting as a standing member of the quality improvement and the GME committees I think is critical since so many of our trends in CME seem to be. They point directly toward creating avenues, opening up channels, developing matrix programs within and with GME, and quality improvement together and individually, of course. So I think that’s a critical element that everyone in an associate dean or director position should work toward if they don’t have it already, it really needs to happen, in my opinion. OK, let’s go to question two. Many of our members talk about the CMA value proposition and what does this mean to you as a CME CPD leader? We’ve heard many others talk about the value proposition. At our annual meetings, and most recently we heard David Price, this past March talking about it.  So what does it mean to you and how do you utilize this concept, if at all, to promote CME CPD at your institute?

Dr. Szot:

You know, I see it being at 2 levels.  At the very base level, we have to acknowledge that all physicians and healthcare providers have a need for continuing education to meet licensure requirements and that is an important part that we have to be able to facilitate that for very busy clinicians. And so that’s one of the values. But then in the larger picture, it’s how do we document and show improved patient care and really demonstrate that we impact patient care?  This comes in a number of ways. It’s the collaboration with the quality improvement teams.  It’s with faculty development for UME & GME to improve faculty’s abilities to teach the next generation. The need for CME, I think, is the other aspect. Our institution has recently obtained joint accreditation status for health professionals. We just completed our first year being jointly accredited and this is an additional value proposition for the institution. Credit for multiple professions has been a real boost to our program overall. We offer great education on a daily basis and these other health professionals were attending yet they weren’t getting full credit.  I think it’s important for us to facilitate people getting credit for the work that they’re doing. We want to try to help with the wellness factors and by really broadening the scope of education that we can provide. I think that it spoke volumes for the leadership of my institution. They see it really as an employee benefit. The employees can now attend regularly scheduled series and obtain credit. They’re not having to do it in their off hours, they’re not having to pay for travel time away. So there are a number of benefits that CME can provide to the institution and to the clinicians. 

Robert:

I think that’s terrific. I don’t think I’ve heard other institutions state adequately that the joint accreditation specifically in and of itself becomes a major component of the value. Proposition. And I’m really very glad to hear you say that, because I think that’s really new information for our audience and perhaps if institutions are struggling with making the case for the value of seeing me and not quite frankly, it confounds me as to why anyone has to. Make a case for CME when it should be so obvious that it’s important and essential. But now at least you can point toward its value towards the rank and file employee in the these other disciplines that require a credit for either recertification or for continuation, or for licensure. So thank you for that.

Our next question focuses on data or use of data by the CME office. Have you had any success at your institution in terms of promoting data-driven interventions where you establish a metric as part of your planning process? You implement A curriculum and a methodology that gathers data for that intervention or as a result of that intervention, and then you have a set of outcomes or conclusions, objective or subjective, or combination of both and. How successful have you been? Have these interventions been and I guess part of our challenge is the CME office is challenged to get a hold of the data in the 1st place. And if they do, is it quality data? Can you specify what data you need, etcetera. So general conversation on use of data? By the CME office?

Dr. Szot:

I think you know, as a CME office, we struggle to get the data to drive programs. I will say that the structure of CME at the Carver College of Medicine, it’s very much a hub and spoke model. The CME Office really serves as the accrediting service. The education itself is really driven by the departments. It may be the chief medical officer or the OR the Patient Safety Office really drives the education. As to data, one example, we run a course on provider communications, trying to improve Press Ganey scores. There was evidence that communication skills were not where we wanted them to be. So we ran a course on provider communications and we have seen improvement in our scores. With this model, again in the quality improvement realm, we had a slightly higher than desired bloodstream infection rate associated with central lines. A curriculum was developed around central line placement and anyone at the institution who places a central line has to complete this course and pass it. It includes didactics, simulations and a hands on test at the end and we have seen a reduction in our in our infection rates. So those are two examples. Where data has really driven an educational intervention and we have seen real improvement.

Robert:

OK, I think the this is what my understanding is too. I think there there’s a comfort level with institutions going after these major health. Problems that are institution wide, that are sepsis is another one. For example, hospital acquired pneumonia, there’s certain there, there seems to be these certain big health issue topics that data is available for either as you say through the departments. Though the department could coordinate and serve as the activity director for the program, or through some other means. What I see lacking is the CME office identifying a specific set of metrics for an activity that requires baseline data from either the hospital QI department, or from some other source so that they can use that baseline data to demonstrate or understand whether or not there’s been an improvement through the methodology developed in the in the CME activity. I don’t hear enough of that, and I’m wondering from your experience is that just too hard to do? Is it realistic that the plan, do, study, act methodology that we’ve all been talking about for 15 plus years now? Is it realistic to think that CME offices will ever really become outcomes based in terms of their day-to-day activities that are? 

Dr. Szot:

I would like to think that we will get there someday. I think right now some of the challenge is obtaining the data because it comes from different sources and no one owns all the data, and I think that poses a challenge. I think the CME office, for one thing, has ventured a little bit into this arena.  We must be able to show what the impact is of this education is having on patient outcomes in clinical practice. I think that’s really what everyone in CME wants to be able to demonstrate. 

For example, we did this intervention and the patient did better because of this intervention. Its going to be hard because most of these are initiatives are multifaceted. They include not only the educational aspects, but it may include interventions within the MMR, whether it’s a best practice alert or an order set. So it’s tough to get clean data on outcomes, but I think that is where we need to be, and I think most of us are working towards exactly this. It’s owning the data—wanting to interpret data for one or two of these big clinical issues, yet we don’t have a data analytics person in my office. For now, these data will continue to reside under the Chief Medical Officer, the Quality Improvement Officer, and other departments. I see data ownership as being a continual struggle for a while longer.

Robert:

One of the things that was mentioned at the annual meeting was linking the CME and QI offices.  This is perhaps having them not only just physically together, but literally having a combined office so that the staff who understand education have ready access to data, the staff who want to see improvement. The QI people have ready access to the education experts to try as one approach, one method at least to improve outcomes. So do you think that has any? Real thread to it.  Do you ever see that happening?

Dr. Szot:

I think it depends on your organizational structure. If your CME office resides within that hospital and the healthcare system, I think it’s more likely to happen. Within a dual reporting structure, I think there are challenges, but I think that’s where it’s important for the CPD professionals to make themselves part of those conversations.  Reaching out to the to the QI team, and getting involved in their committees.  I didn’t get asked to sit on any of the quality committees.  I asked and said I’d like to sit on your committee or how how can I get involved in this committee? So it was really reaching out, you know? Personally, reaching out and asking can I come to this meeting and explain why.  Also we recently hired a new quality and safety manager, who is a physician.  We got on his schedule early when he first started work. So making those personal connections and then having some follow-up meetings to discuss specific topics helped. Maintaining direct lines of communication is essential.

Robert:

Yes, I I think the you’ve hit on it. Certainly if there’s a leadership change, it always makes this easier. Hopefully the new director doesn’t come with an with an established agenda, but is more open minded to new ways. Plus, I think the CME Office director and staff have to be salesmen. You know you have to go there and say “here’s what we can offer you. How about it?” “And by the way, it’s free.”

Dr. Szot:

I think another thing to do is much like you’re reaching out to be on those quality improvement committees. Reach out to your quality improvement leaders, invite them to your CME committee. We have had success doing this and making it a two-way street so they have an understanding of what we’re trying to do in CME and that will facilitate things.

Robert:

I think that something as simple as cross membership on those committees again is really important. It builds relationships, it familiarizes each side of the equation with one another’s work. And I think that’s excellent. Let’s get to  the next question. This is a question that we’d like you to focus on for as long as you’d like.  Please give us an example of at least one activity or more that you consider to be innovative and successful achievement for the CMU CPD program at your institution.  And hopefully I know you have quite a few to talk about, so I’ll let you go at it. 

Dr. Szot:

Thank you, so kind of you.  I feel like I’m going to sit here and brag a little bit about some of the great work my staff does in the CME office, but. The one I would like to talk about first is really our our experience with our CME podcasts. This idea was brought forward by two of our accreditation specialists. We developed a podcast series that launched in December of 20, called “Grounding at Iowa”. Our initial goal was to reach all 99 counties in Iowa to provide continuing education. We are the only academic medical center in the state; we’re a very rural state, so there’s limited access potentially to CME in some of our rural communities.  I can say now we achieved our goal. Within three years, our average monthly podcasts have had over 17,000 downloads of our podcasts, reaching all 50 states, the District of Columbia, and 66 countries. So this is by far more than we had thought we would reach. It’s been a great success and it’s been a great way to get education out to health professionals who otherwise wouldn’t get it.  These downloads are not professionals just wanting to claim CME credit. These are people wanting to listen and learn from the educational program. So that’s been one of our bigger successes and as it happened, it came from a grassroots idea from staff within the CME office. I think they deserve all the credit. 

Also, I think we’ve launched a couple of interesting faculty development programs in the last two years or so. One was launched by our associate Dean for External relations. Jerry Clancy launched what we call our “Thrive” sessions at Carver. These sessions are focused on teaching, healthcare and research innovation in a vibrant environment—to assist faculty to better “thrive” at work. Jerry is a psychiatrist, and he noticed the struggles junior faculty were having during their onboarding process during the pandemic. So he launched this “Thrive” educational support program. It was a combination of work, podcast interviews and an experiential project whereby the participants were expected to develop a care plan based on what they learned. All aspects of their work were touched upon—patient care delivery, teaching, improving the lifestyle of practitioners within the clinic, etc. And they presented plans as Shark Tank ideas to the leadership of the College of Medicine and the hospital. It’s been remarkable. I think there were 23 different proposals that were presented. Our leadership is now in the process of trying to evaluate which one of the improvement proposals to the College of Medicine the hospital will implement and fund to improve different aspects of the institution. 

The other faculty development program is in conjunction with the GME office, and is funded by an innovations grant from the College of Medicine. It is intended to develop more advanced clinical coaches. We target all five “core” residency programs to develop their faculty into more capable clinical coaches, that is, moving beyond just evaluation skills.  Other roles of being a faculty member are addressed as well, but improving their feedback and coaching skills to improve the residency and learning experience of our residents, is the primary focus of this experience. Clinical performance is another faculty development program that we’ve had quite a bit of success with, and we’ll be interested to see how that continues to grow over the the coming years. These are 3 of the more innovative programs we have right now.

Robert:

I have a question about the podcast series. That’s an incredible volume in a very short period of time. Did you have any outside external professional marketing or did your marketing department participate in helping to promote the podcast or was this all just word of mouth?

Dr. Szot:

The marketing department did some initial advertising for us, but mostly it was really targeting within the state within the state. I think one driver was that some of our first episodes were focused on the some of the immunization COVID immunizations and other things. So there were calls from the CME Office and other organizations that if you have any education around COVID, please forward it.  I think that got us some very early buy-in from a somewhat bigger audience than we were anticipating. I think the other thing that’s helped us a lot was within the state of Iowa. There is a requirement for physicians to undergo or to have completed, two hours of education on end of life care (EOL) for relicensure. So we integrated this into our podcast series and every year we add a couple more end of life episodes. This got buy in. I might get an email on a Sunday night from a faculty member: “I have to renew my license.  Where can I find the end of life care education?” I would inform them about the podcast episodes on EOL. Numerous faculty have stopped me to tell me that they have started listening to our podcasts because they needed the end of life care credits. Some of it’s been word of mouth also, but I think having that captive audience in need of this EOL training, has been a great stepping stone for much more frequent participation in the podcast series.  

Robert

I think it’s got to be very satisfying to hear comments like that from the faculty. They’re taking advantage of, you know, these short opportunities to be to hear some education when it’s convenient for them. So I think that’s all around and encouraging message for our readers and anyone interested in creating CME. Programs that podcast might be really the way to go in the future. Question on the faculty development program. I think you mentioned this was a one year program and did were classes every week or once a month, how long did they last? When did you have the classes? And were there any fees involved for the faculty or was it totally free?

Dr. Szot

Robert

Was there role modeling? Did you require them to, you know, listen to a scenario that was really great and listen to another scenario that had a lot of faults or opportunities for improvement and then where they had to sit, listen and identify?

Dr. Szot

Yes, in the program around the advanced clinical coaching, we’re designing what we’ve done in a number of scenarios where participants are actively involved in role-playing or playing out scenarios in various clinical vignettes.

Robert

It’s a matter of simulation, really. To the extent that you’re convinced simulation is a great learning format, I think it certainly is appropriate here. So at the end of the course, is there a certificate awarded the faculty member and does it go to into the faculty portfolio?

Dr. Szot

Yes, yes, there will be.

Robert

Consideration at end of year for their own evaluations.

Dr. Szot

Yes, in both programs, we’ll have an additional program associated with the advanced clinical coaches who will continue to run an annual advanced clinical coaching course. We hope that a number of the participants stay in that as we continue to refine it. The Thrive sessions will be followed-up with another year long course with a focus on healthcare quality. Again faculty will be encouraged to continue in that that realm as well. 

Robert

How large is your class each? Assume everyone starts and ends at the same time.

Dr. Szot

It includes about 30 per class.

Robert

Registration period and you started off and ended for the same group.

Dr. Szot

Yes, about 30 people complete each of the cohorts.

Robert

So it’s relatively small. Have you had a hard time identifying faculty? To teach the faculty either. Have you gone externally to outside speakers and had to bring them in?

Dr. Szot

No, we have not gone external. We’ve offered this to just our own faculty as a ‘teach the teacher’ model. Most of the instructors in the Advanced Clinical Coaches program are program directors themselves. They are experienced and excellent educators and have been leading these sessions and the Thrive sessions. The Thrive sessions are taught by an associate dean and a number of them have been him interviewing healthcare leaders from across the institution to get their perspectives on the different topics, so it’s really been based on our in-house expertise.

Robert

And it sounds consensus driven, which is nice. You’ve got a great formal or informal planning committee to identify the topics in priority order, and that sounds great. Congratulations on that. Anything else you want to want us to know about in terms of an innovative program? What I’ve noticed too on your website is that you have some very long running programs, 45th year for adult education, adult geriatric medicine. I believe it is a conference in geriatric medicine and then 50th year for emergency medicine. How do you maintain an activity that for that long and still make it a success?

Dr. Szot

I can’t take any credit for either of those because I’ve not been here 47 or 50 years, but.

Robert

I know the department. I know they’re departmental, but you know.

Dr. Szot

I I think a lot has to do with the need for the education. Those are two areas that you know, in a rural state there’s huge demand for education in those areas.  I was talking with one of our accrediting specialists today, specifically about Karen, an older adult in the Geriatrics Conference. I said, “how are they able to do so well?” Her response to me was “they are a well-oiled machine.” They have a very clear process they go through to develop the educational curriculum for the year and they are very strict about their deadlines, expectations from speakers, etc. You know, this is again an area that I think that obtaining joint accreditation is going to expand the conference.  When comparing the registrants for this coming year’s conference versus last year’s conference, I saw more pharmacists register, more social workers and other health professionals registering, and I think that’s because we can offer that additional credit. So we are always looking to expand the audience.  You know they’re running on all cylinders with a with a very clear plan and I think they’ve had great leadership from the administrative side and from the course director side for a number of years and that’s really facilitated success.

Robert

Terrific. There’s something to say about historical continuity and learning lessons from the past and staying disciplined and on time. As you say, it’s a structure. The process has to be structured and has to be run like a project. You’re building a bridge. Thank you. That’s great. So let’s go on. Let’s do a wrap here with our final question. Would you please tell us about the challenges and opportunities you will face in 2024 and beyond, perhaps even the next decade? You’re relatively new, I think in your position. And so you must have some idea about what’s coming for you.

Dr. Szot

You know, I I think there are two areas that I see as challenges that will need to be managed in the coming 5 to 10 years. I think one of the big ones that my office is facing is the growth that we’re going to see by going to join accreditation.  All of a sudden we went from being an office accrediting a single profession to now six professions. So we’re going to see a significant growth and we’re going to need to manage that growth, and that we may need to look for additional revenue to increase our staffing. So that will be a challenge that we face in our office.

In terms of CME CPD as a whole, one of the biggest challenges is going to be the delivery of education and what that’s going to look like. The pandemic changed our world.  We went from having numerous in- person conferences and day long day long conferences, or two day long seminars. That’s changed in what the future is going to look like. You know, is it going to be more hybrid education where some people are in person, and some people are online?  Is it going to be more online? And I think at the heart of that is setting the right educational environment.  I think part of the educational environment in CME is availability and convenience.  Where we end up with what’s online, and what’s in person, I think that’s going to be a big challenge.  How we do this successfully and maintain high quality education, are going to be big challenges.  What technology we will have five years from now, is a mystery and none of us know what may be coming at this point in time.  How are we going to adapt to that new technology as it comes out? I think those are all you know and you could lump AI into that. Where is that going to fit into CME CPD in the future? These are all big questions and big challenges I I see coming down for us. I think those are probably be enough to keep me in a job for the next 5 to 10 years!

Robert

I think so too. Doctor Szot, I think we’ve enjoyed and learned during our session today and we’ve certainly learned a lot about your program and wish you much luck in 2024 and in meeting the challenges of the next decade. So thank you very much for agreeing to participate.

Dr. Szot

Thank you for having me.