March 15-18th, Nashville, TN
Nearly 300 SACME members and non-members participated in the very first of its kind—a SACME international hybrid annual meeting. The goal of this year’s meeting, post COVID-19, was to assure access to everyone—whether you could attend live or not. Thus, the meeting was structured to offer two learning formats— in person from Nashville and virtually. The dual experience was supplemented by a creative use of technology offering virtual “channel’s” and other ways allowing full participation in meeting sessions and discussions. Virtual members could listen asynchronously to recorded live sessions, network and chat with others, attend wellness exercises, and read recommended articles online throughout the conference. It was a live plus virtual frenzy of educational activity that did not let up for 5 days.
The CE News editorial team served as conference reporters throughout the meeting and are providing summaries of keynote and selected plenary session panel presentations for all our readers to enjoy.
The Barbara Barnes Distinguished Keynote Lecture…
If You do What You’ve Always Done You’ll Always Get What You’ve Always Got: Toward More Purposeful, Intentional and Collaborative Alignment of CPD in Healthcare
Speaker: David W. Price, MD, Senior Advisor to the President and CEO, American Board of Family Medicine
Reported by Robert D’Antuono, MHA
The opening of the session featured David Price, a national thought leader in the field of CME/CPD for many years. Dr. Price posed some ‘inspiring and igniting’ questions to the audience. He began with “Are we there yet?” Is CME/CPD moving forward and if so, where are we going? Dr. Price indicated he doesn’t know if ‘we are there yet’. To paraphrase Hamilton (the Broadway show), Dr. Price said we should ‘listen more and talk less’ about selling ourselves and help to further the organization. More about this in a moment…
In his own job as a CME director, Dr. Price shifted his frame of reference from ‘ours’ (the CME office) to those of the institutional leaders namely, the CEO, CMO and CQO, and began to attend hospital quality committee meetings, among other department meetings, etc., to get to know what his customers needed most from the CME/CPD office. With this information, he could better understand how to align and collaborate the CME/CPD process with the needs of the rest of the organization. He concluded from this outreach efforts that CME accreditation work is the tail, not the dog. The dog is to change practice and to improve quality of patient care by aligning and collaborating with these institutional leaders in a very direct way.
The CME community today is still not good at designing CME interventions that serve to better the health of communities. A simple CME/CPD program isn’t enough when trying to improve complex health system problems. We need new and better tools than just the standard medical education, ‘one and done’ type approach. Most CME focuses on knowledge of the medical expert and is not explicitly aligned with the health enterprise challenges of today.
Health systems science has the tools and models to design more elegant CME interventions. We need longitudinal learning, that is, truly interprofessional, explicitly and intentionally linked learning to performance. It is made possible by the mutual and multifaceted collaboration among experts and departments. It is both spiraling and reinforced learning. PDSA projects are an example of “spiraling” education and learning. It’s iterative and must be repeated to achieve a result. We must almost try to understand the patient’s perspective. Patients are important to the process of resolving more complex health issues.
As mentioned, in CME today there is far too much “one and done” education. Regularly schedule series, Tumor Boards for example, are typically one-off educational meetings. They are not longitudinal. They rarely provide repetition; they are not multi-modal, sequenced or spiraling. “Repetition is key to adult learning” stated Dr. Price. The answer is to partner for longitudinal CPD programs in health systems. Planning of these activities begins with data: a process outcome metric, cost of care data, interprofessional team performance, and knowledge deficits. It identifies gaps and unwanted variation in care which need improvement. Simplistically, it is learning that follows the ‘What, How and How to do the How’, says Price. It is learning that is contextual, conditional and procedural.
Dr. Price went on to explain the RE-AIM model, frequently used in public health settings and studies, as a useful construct for designing CME interventions. The steps are: Reach, Effectiveness, Adoption, Implementation (more than a commitment to change) and Maintenance. All this change is not simple to implement. An initial first step is how to reframe your work and find an opportunity to try one of these change models suggested here.
The final point discussed was evaluation. Price suggested a new model called ‘realist evaluation’. A realist process of evaluation attempts to unpack the unknown in terms of longitudinal context, mechanisms, processes, barriers, outcomes (what changed?) and contribution analysis. The ultimate goal is to understand CME’s contribution to a positive change and allow the stakeholders to recognize this contribution.
Many of the concepts Dr. Price spoke about in his lecture are discussed more fully in a published discussion paper: Systems-Integrated CME: The Implementation and Outcomes Imperative for Continuing Medical Education in the Learning Health Enterprise, David W. Price, MD, David A. Davis, MD, and Gary L. Filerman, PhD, October 4, 2021, Perspectives, National Academy of Medicine. We encourage you to read it. It’s dense, so multiple readings may be necessary.
Annual Meeting Plenary Session…
Advancing the Value of CPD: Aligning CPD with Systems of Healthcare for Greater Systems of Impact
Speakers: Suzan Celine Monette, Todd Dorman MD, and Janine Shapiro MD
Reported by: Sophie Soklaridis, PhD
In this interesting session, the speakers outlined how CPD is the cornerstone for value creation in the healthcare system. However, showing the value of CPD is not without its challenges. A case must be made for why we should invest in CME/CPD. And thus the question becomes, can the value of CPD be measured and quantified in a way that makes a convincing case for investing in CPD?
The speakers described how our context is shifting quickly towards the knowledge age. We have entered an era where artificial intelligence can process information for humans and turn it into knowledge. And in some cases, even help make clinical decisions. In the knowledge era we need knowledge resources to remain competitive. To remain competitive we need to think about how we increase our intellectual capital. The three main components of intellectual capital are human, relational and organizational. Human capital refers to the skills/competences within an organizations workforce. Relational capital refers to partners, stakeholders, patients and their families. Organizational/structural capital refers to the information systems, databases, policies, intellectual property and culture that exists within an organization.
The speakers asked us to consider the following: In the knowledge age, what is the possible role for CPD? CPD can play an important role for increasing human capital; it invests in knowledge and training, with the ultimate goal of improving the care delivered to patients. A CPD office could be a key player by understanding the roles of other players (government and agencies, public health institutes, licensing authorities, academic and research schools, CPD professional societies, clients and patient organizations). CPD provides a mechanism to think about cohesiveness of key stakeholders in healthcare. Through nurturing relationships, implementing interventions and measuring key outcomes CPD initiatives can support system change. As key players, they create connections, strategic planning, build processes, and measure return on value.
So what do we mean by value? We explored the concept of value through two case studies. One examined the notion of accountability. Those of us in CPD feel like we need to justify our work. We have a responsibility to society. And this responsibility goes beyond financial reporting. We often justify our value through quantification (i.e. budget, financial report). However, there is also value in the process. This is where we need to align with the needs of our learners, patients, healthcare systems and society. For this kind of value, we need creativity and connection. To implement a connect strategy, each of us must define who we are, create or integrate in a value in chain, PDSA, manage the asset portfolio, measure and report. Let’s take a look at each case study in more detail.
Case Study 1: How do I make the case for CME and CPD?
Our speakers suggested making the case for value every five years. CME/CPD is an asset, tactical lever to accomplish a mission, and is a force toward quality improvement. We need to demonstrate there is a value for faculty (i.e. learning, promotions) and improvement in clinical outcomes as a result of engaging in CPD/CME.
Case Study 2: How do we take care of faculty?
Our CPD mission is implementing educational activities that build and sustain faculty vitality and advance the professional development of our faculty and academic missions of teaching research clinical care and community health. It is of utmost importance that CPD offices are a source of support for all professional development needs along the lifespan of an individual’s career. Some initiatives could include leadership development, wellness, and research mentorship. These initiatives can be offered in a variety of ways. The pandemic has forced an evolution of CPD from in-person to diverse modalities (in-person, hybrid, hyflex, online).
Capturing the value of these initiatives through metrics will be essential for CPDs continued growth . Some examples include:
- Participation rates
- Participants satisfaction
- Changes in competence
- Changes in performance
- Learner/patient outcomes
The answer to “why CPD” is simple. Faculty and clinicians are critical assets to our healthcare institutions. If we don’t have the faculty, how are we supposed to train our next generation? CPD can be an important component to an individual’s career development. When faculty engage in CPD initiatives, they remain engaged, which in turn can enhance professional satisfaction and help faculty achieve their potential. CPD can also increase academic productivity. And all these value outcomes help to facilitate recruitment, advancement and retention of our next leaders in CPD.
Sophie Soklaridis, PhD is a Senior Scientist, Centre for Addiction and Mental Health and Associate Professor, Departments of Psychiatry and Community and Family Medicine, University of Toronto.