Using CME as an "Engine of Transformation"

Physicians and other providers are starting to address patient safety and quality improvement challenges through innovative continuing medical education programs.

For Graham McMahon, MD, MMSc, the power of continuing medical education (CME) is transformative. But he believes far too few health care leaders have truly embraced its potential for addressing today’s top health care priorities.

“There can be an anachronistic perception of CME as dark rooms and lectures or an outdated view of rubber-stamping applications for credit,” said McMahon, president and CEO of the Accreditation Council for Continuing Medical Education (ACCME). “But as I travel around the country, I’m seeing more and more examples of leaders who see the value of education as a driving force to support the change we all know is needed.”

According to McMahon, CME and continuing professional development (CPD) can be effective in advancing two overriding health care challenges: patient safety and quality improvement. In an Academic Medicine  commentary, published online in February 2017, McMahon argued that accredited CME and CPD are evolving, moving from the classroom to the clinic where physicians and other health providers are increasingly leveraging CME opportunities to effect institutional change. And health care leaders who join that evolution, McMahon writes, “can expect a meaningful return—not only in terms of the quality and safety of their clinicians’ work but also in the spirit and cohesiveness of the clinicians who work in their institution.”

“The bottom line is we need to get physicians much more engaged in their education … because ultimately, they are the best resources for change.”

William Rayburn, MD, MBA

University of New Mexico School of Medicine

Many accredited CME activities—in addition to imparting new knowledge—now bring learners together in interprofessional teams that produce safety or quality improvements. For example, McMahon referenced a recent accredited CME activity that engaged multidisciplinary health care teams to improve the quality of trauma care. Over the course of several months, these teams met for didactic learning, standardized patient experiences, and surgical and nonsurgical simulations. Another accredited CME activity created a support system for physicians involved in emotionally traumatic events, with a goal of building provider resilience and preventing burnout. Research cites both interprofessional learning and resilience building as promising methods for enhancing patient safety.

“The way we educate physicians once they’ve finished their training is pretty insufficient—it’s often passive, not active,” said William Rayburn, MD, MBA, associate dean of CME and professional development at the University of New Mexico School of Medicine and coauthor of the forthcoming book Continuing Professional Development in Medicine and Health Care: Better Education, Better Patient Outcomes. “The bottom line is we need to get physicians much more engaged in their education … because ultimately, they are the best resources for change.”

“Education is the engine of transformation”

Change was exactly what Barbara Gold, MD, MS, was looking for in 2014 when she helped launch a CME-eligible quality improvement project at University of Minnesota Health. Gold, executive vice president for medical affairs at the health system, said it was apparent to her as a practicing anesthesiologist that most physicians hadn’t been trained in quality improvement (QI) methodology and didn’t have the tools to bring about meaningful change.

Monday, April 10, 2017

Simulation-Based Training in CME Effective in Promoting Patient Safety

Medical educators have been using simulation-based training for decades, but such training has gained a foothold in the CME/CPD arena only in the last decade, according to Ajit Sachdeva, MD, director of the Division of Education at the American College of Surgeons and president of the Society for Academic Continuing Medical Education. On the issue of patient safety, he said simulation-based CME is effective for a number of reasons: educators can replicate real-life environments, introduce complications and vulnerabilities to test a learner’s crisis response, and set up a deliberate system of practice and feedback, among others.

In a 2016 article published in the Journal of Continuing Education in the Health Professions, Sachdeva argued that CPD is “essential” to improving health care outcomes and value and that simulation-based education is especially effective at promoting patient safety.

Overall, Sachdeva said research shows that simulation-based CME can result in enhanced patient safety and outcomes. “We need to focus on why all of us came to medicine in the first place—to provide the best care to patients,” he said. “We need to tap into that and have a grassroots movement to promote the joy of learning.”

“It seemed to me that we had a really talented physician staff that would be well positioned to effect change given the right tools and education,” said Gold, also an anesthesiology professor at the University of Minnesota Medical School. “Fortunately, there’s a desire to learn, especially in an academic environment.”

In turn, Gold had an idea to team up physicians in leadership roles with health care partners, such as social workers, nurses, and pharmacists, and have them execute a QI project with help from a performance improvement expert. She codeveloped a CME curriculum and encouraged staff to apply as a team with a specific project in mind. Today, the six-month curriculum includes an all-day meeting each month in which the teams take part in didactic sessions, simulations, and shared learning and then report on their progress. Teams also meet with their performance improvement coaches weekly. “It’s really a win-win,” Gold said. “[Providers] get to help create solutions for problems they know well because they’re living them.”

Each project must align with one of the institution’s strategic goals, such as decreasing mortality or readmissions. In one project, the provider team had a hunch that in certain cases telemetry was being used inappropriately, resulting in patients being monitored for too long and creating capacity issues. In closely studying the issue, the team standardized when telemetry was necessary and when it should be discontinued.

The AAMC faculty development program Teaching for Quality (Te4Q) has a similar approach, requiring learners to identify a safety or quality gap and develop and implement a program to address the gap. The goal is to train clinical faculty to integrate safety and improvement into programs for medical students, residents, and other clinicians. Since its launch in 2012, more than 65 institutions have participated in the Te4Q program.

The key to improving safety and quality with such programs is to “embrace that education is the engine of transformation,” according to McMahon. “That’s when you see the cultural transformation that drives the change all of our patients are looking for and benefit from.”