Continuing Medical Education: The Link Between Physician Learning and Health Care Outcomes

 

A recent article in the Journal of the AAMC: Academic Medicine, noted that in the past century, we have “seen spectacular gains in the breadth and depth of biomedical knowledge, but the potential of these gains has been limited by inadequate, inequitable, and inefficient translation of knowledge and skills to the health care workplace.”

To address this inadequacy, the authors proposed that a “radically transformed continuing medical education (CME) system is essential to realize biomedicine’s ever-expanding potential to improve the health of patients and populations.”

The article, written by Todd Dorman, MD, associate dean and director, Office of Continuing Medical Education, Johns Hopkins University School of Medicine, and Bonnie Miller, MD, senior associate dean for health sciences education, Vanderbilt University School of Medicine, Nashville, Tennessee, first noted how “CME today is not the CME of the past. Its historical reputation for ineffectiveness has been dispelled, and new standards of commercial support create a principled firewall that prevents undue industry influence.”

CME

The authors acknowledge that, “With a focus on specific needs and gaps, CME is transitioning from an instructor-centric to a learner-centric model that will increasingly integrate with professional development.”  

“When appropriate, CME seeks to demonstrate associations with patient outcomes and thus is increasingly integrated with performance and quality improvement. A transition from time-based to value-based CME-credit systems is also under way.”

Moving forward, they recognized the need for these “transitions” to accelerate” and for performance-improvement CME (PI-CME) to grow, both in importance and in proportion, within a physician’s CME portfolio.  PI-CME links continuing education (CE) to the documented needs and gaps of institutions and practices.

The authors explained that, “By focusing on precise areas of need, the effectiveness of CME will be measured not only by enhanced physician knowledge but also by the association of that knowledge with improved performance and meaningful patient outcomes.”

Drs. Dorman and Miller also discussed how “health care reform will force a transition to team-based models of care.  This in turn should force an alignment of the CE systems of the various health professions, allowing the development of interprofessional CE with outcomes measured by both individual and team performance.”

The authors predicted “a growth in simulation-based CE, in which providers learn, practice, and demonstrate advanced teamwork skills,” given the “importance of communication in highly functioning and interprofessional teams.

It was asserted that, “For CME to achieve maximum benefit, learning at the point of care must augment the traditional model of learning activities remote in time and place.”  Specifically, they asserted that, “CME must become fully integrated into the workplace, rapidly responsive to what providers do on a daily basis and how they do it.”

The authors highlighted that, “Process-of-care CME will require new technology capabilities, such as automated self-assessment systems in which patient status will direct providers to appropriate educational resources, ensuring that the right patient receives the right care at the right time.” They noted that, “It may even be possible to integrate searches performed during the course of work into CME.”

It was noted that, “the combination of PI-CME and process-of-care CME will create iterative improvement cycles that align education outcomes with patient outcomes, and perhaps even payment incentives, which will be critical as providers become more accountable for the value of care across longitudinal delivery systems.”

They also discussed how “the complexity of the health care system is creating greater time demands on physicians who will find it increasingly difficult to complete maintenance of certification (MOC), maintenance of licensure (MOL), and health system credentialing if these remain distinct processes.”  The authors asserted that the “aims of these processes should be the same—namely, the provision of timely, safe, effective, efficient, equitable, patient-centered care.

As a result, Drs. Dorman and Miller maintained that, “With its dual focus on physician performance and health care outcomes, the new CME can serve as a link that connects and coalesces the processes for MOL, MOC, and credentialing.”

Discussion

Based on these recommendations, the authors noted that the “shifts will move CME from a purely educational paradigm to one that functions more broadly as a professional development paradigm. Using frameworks defined by the core competencies of the Accreditation Council for Graduate Medical Education as well as the specific competencies outlined by specialty boards, CME can enhance continuity between the phases of medical education.”

Drs. Dorman and Miller assert that, “Physicians should experience CME as a truly continuous process, but this demands that the skills of lifelong learning and performance improvement become embedded throughout undergraduate and graduate medical education, beginning with matriculation.”  Academic CME will reside at several important and unique intersections.

• It will sit at the intersection of lifelong learning, knowledge integration, health information technology, and performance improvement.
• As a facilitation tool, it will sit where the various regulatory requirements intersect, including specialty certification, licensure, and institutional accreditation.
• Finally, academic CME will reside at the intersection of emerging theoretic and foundational knowledge about how physicians and health teams learn and the translation of that knowledge into practice for both specialist and primary care teams.

The authors said, the “last intersection is where the confluence of benefits will accrue and where CME will demonstrate its role as an essential component of professionalism as well as its commitment to the creation of a health care system that produces continually improving outcomes for patients and populations in a highly efficient and equitable manner.”

Conclusion

Ultimately, the author’s proposed transformation of the CME system should be applauded and all stakeholders in the CME system should begin evaluating Drs. Dorman and Miller’s recommendations.  Given the tremendous emphasis on interprofessional education, the crossover of CME and MOC/MOL, and a harmonization of all levels of medical education, communication among CME providers and participants will be extremely important moving forward in determining this new model of CME.

More importantly, will be the involvement of other stakeholders, such as insurance companies, and the continued support of the life sciences industry.  The proposed new CME system will require a significant amount of resources and staff for creation, training, education and implementation.  Integrating new models and technologies for interactive education, measuring patient outcomes, and bringing CME into the workplace will be extremely time and resource intensive. 

The involvement of industry and insurance companies can help alleviate this burden on hospitals and CME providers who already face time and resource constraints.  Given that the new standards of commercial support already create a principled firewall that prevents undue industry influence, we should involve the voices of industry along with other stakeholders to ensure a strong partnership and collaboration as we proceed to a new model of CME.