Virtual Journal Club – Celebration of the Decades

In honor of SACME’s 50th anniversary, Virtual Journal Clubs highlighted seminal articles from each of the past five decades. The last two discussions in the series appropriately focus on guidance for the future direction of CPD.

SACME members may access the complete recordings for each session which can be found at SACME.org/Virtual-Journal-Club-Recordings.

The final virtual journal club in the series labeled the Celebration of the Decades featured David Price who spotlighted and compared two articles drawn from 2021. The first article,  “Reimagining Physician Development and Lifelong Learning: An Ecological Framework” (Mazmanian, Cervero, & Durning, 2021), focused on the individual learner. The second article  “ ‘Systems-Integrated CME’: The Implementation and Outcomes Imperative for Continuing Medical Education in the Learning Health Care Enterprise,” (Price, Davis, Filerman, 2021) views CME through a lens focused on the needs of the organization.

Both articles look to the future of CME and the ways that the current CME landscape falls short of its goals. In Mazmanian’s article, knowledge-based CME is insufficient to create meaningful change in learners and is not tailored to learners at different career stages. In the Price article, the failure is that the current CME training does not meet the system’s need for change that results in meaningful quality-improvement protocols. 

The discussion portion of the journal club focused on burnout and how its prevention and treatment require integrating the individual and the system to be successful. Finally, host and facilitator, Janine Shapiro, made the valuable point that CME education and professional identity formation with the communities it forms can give purpose and meaning, which acts as a bulwark against burnout in the long term.

Summary generated by:  Raghav Wusirika, M.D., MBA, Associate Editor, CE News

In the continuing sequence of the “Celebration of the Decades” Virtual Journal Clubs (VJC), Ron Cervero walked through a sequential review of how the field of CE/CPD continues to respond to a call for transformation from a knowledge-based didactic model to a practice-based system approach. The featured article for this presentation was one that was published in JCEHP in 2015. The article, written by Ronald M. Cervero, who was then a Professor at the University of Georgia, and Julie K. Gaines, an Associate Professor in charge of the University’s Medical Partnership Library.

In 2010, the Institute of Medicine released a consensus study report entitled, “Redesigning Continuing Education in the Health Professions”, in which they delivered a harsh (while seemingly well-deserved) criticism to the field of CE. The report put a spotlight on what they considered to be a “deeply flawed system” that had “become structured around health professionals’ participation, rather than performance improvement.”

Ron noted that since 1977, many systematic reviews have asked two fundamental questions: (1) Does CME improve physician performance and patient health outcomes? and (2) What are the mechanisms of action that lead to positive changes in these outcomes? The purpose of the JCEHP article was to synthesize the work that had been described up to that point in time related to CME effectiveness. (Note: A follow-up scoping review appeared in Academic Medicine in 2021.)

While these two questions certainly mattered, it was suggested that we can be confident that CME/CPD can (and does) ‘work’ when appropriately designed and implemented. The key question is “what enables CME effectiveness?”. In his presentation, Ron summarized what factors we have learned are critical to CE/CPD’s success:

1) Needs Assessment for practice change (depicting a move from an update model to a practice-based change model);

2) Program intensity (calling for more exposures over a longer period of time);

3) More interactivity (citing the importance of engaging learners);

4) Focused on outcomes considered important by physicians (offering education that taps into their motivation to learn is critical);

5) Administrative support and policy incentive for practice changes.

In terms of the last point, Ron noted that the last decade has seen more focus on the alignment that must be in place. We can design the best CE/CPD activity and get commitments to change from learners, however, the system must be supportive to see those changes implemented and sustained. For that reason, the workplace may hold the greatest promise for linking positive change from education to practice, especially if standards exist and data is available to assess the impact.

Ron noted that we must teach physicians in context, not subjects. CE/CPD programs must find ways to:

• use their existing structures,
• embed their measures of impact into key workplace and/or organizational initiatives/priorities, and
• build and sustain critical bridges to overarching quality improvement initiatives.

The discussion portion of the presentation pointed to some of the challenges faced (and alliances needed) when pushing for the type of transformation that is necessary in our field. Niles McCall from the New Mexico Medical Society described an innovative approach his organization has taken to link monthly tumor board education to practice change. Brian McGowan called attention to how our field would benefit from using the taxonomy applied by behavioral scientists. Ron Cervero and Janine Shapiro (facilitator) outlined how we must include faculty development in these efforts and we are wise to include the entire medical education continuum.

In closing, Ron also underscored the importance of leveraging executive leadership across all groups to help support sustainable improvements. Admittedly, there may still be resistance by some to the case being made for CE/CPD’s potential impact and we may only see incremental changes at best. However, we must remember that others are equally driven to see positive impact in terms of organizational effectiveness. CE/CPD must take account of the wider social, political, and organizational factors that play a role in physician (and all healthcare professional) performance and patient health outcomes.

Bottom line – All systems are necessary to create change in healthcare professional practice.

Summary generated by: Ginny Jacobs, PhD, M.Ed, MLS, Chief Editor, CE News