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The annual meeting of the Alliance for Continuing Education in the Health Professions (formerly the Alliance for Continuing Medical Education) often serves as a sort of barometer of the state of the continuing medical education industry.

While some topics are perennially popular—how to improve your chance of securing an educational grant; new ways to implement adult-learning theory, assess needs, and track outcomes; and how to keep the accreditors happy with your program are three that spring to mind—other ideas were notably, and often literally, center stage at this year’s conference, held in January in Orlando. Here are five of the big ideas from the conference that Medical Meetings forecasts will continue to shape the future of CME.

1. CME/CPD’s role in the national performance and quality improvement movements
The biggest, and arguably most exciting, idea for many CME professionals was that their industry is a growing part of the national movement to improve healthcare quality. Often cited was outgoing Administrator of the Centers for Medicare and Medicaid Services Donald Berwick’s “triple aim”: “Improving the experience of care, improving the health of populations, and reducing per capita costs of healthcare.” The national QI movement is attempting to achieve this by measuring the quality of individual patient care and that of entire populations, identifying where individual docs and healthcare systems are falling short, and finding remedies (including continuing professional development, or CPD), then re-measuring to see if it’s actually improving patient/population health.

According to opening plenary speaker Louis Diamond, MD, president of Quality Healthcare Consultants, CPD providers are in the right place at the right time to make a difference.
The question is, said Carolyn Clancy, MD, director of the Health and Human Services’ Agency for Healthcare Research and Quality, who provided a QI bookend with her final plenary session, “Do we continue to frustrate physicians, confuse patients, and not consistently align incentives with improving quality and value, or do we align quality and value efforts with care where it matters on the front line with clinicians and patients?”

Diamond outlined how all the pieces of the national QI movement are starting to come into alignment just as aspects of the Patient Protection and Affordable Care Act call for performance and quality improvement that require an overhaul of the system. Clancy cited progress that includes “unprecedented national investment in healthcare research, access, and delivery,” as well as funding for data infrastructure, and wider opportunities for patient-centered outcomes research and quality improvement. Diamond also noted as progress the inclusion of quality and performance improvement in many maintenance-of-certification requirements.

It’s not enough to just measure and report, though, Diamond said. It’s now time to focus on performance improvement that leads to higher-quality healthcare. To fulfill its role in the process, he said, CME must provide learning that is continuous, rather than consisting of isolated activities; more Web-based; and integrated into practice. CPD also has to be more team-focused, he said, and be based on specific performance gaps evaluated by changes in performance, rather than changes just in knowledge. As Clancy said, “We’ve always assumed that if you know the right thing, the right thing happens.” The reality, she said, is that “it’s far too often an execution problem, not a knowledge problem.” The need now is to get data on where the real problems lie.

Technology will be part of the solution, according to Diamond. The American Recover and Reinvestment Act earmarked $20 billion for health information technology (HIT), including electronic medical records. The hope is that EMRs can help CME providers assess knowledge and performance gaps, and address them with effective performance-improvement processes for individual healthcare providers and teams. To get started, Diamond said, providers should get to know the quality and HIT players, and become a part of the local and national discussions with HIT and QI organizations. “Those two groups are already beginning to get together,” Diamond said. “You need to get into that dance.”

2. Communication and Collaboration
Collaboration and communication are essential components to the successful implementation of the other top trends on both the CME provider and learner levels. Yet some CME providers still are hesitant to truly collaborate for fear that sharing may mean losing their competitive edge, and it’s still a challenge to motivate physicians to be willing to learn with, from, and about the others on their patients’ care teams.

One of the many collaboration case studies showed how the American Red Cross reached out to Penn State College of Medicine to develop education on the screening and referral skills primary care and mental health workers need to care for returning military veterans suffering from post-traumatic stress syndrome and other mental health problems. The two organizations then approached HealthNet Federal Services LLC to provide practice data, help them reach their audience, and get some funding for the project.

While not perfect, the program had some positive results. According to the post-activity evaluations, 83 percent of participants said they learned new strategies to use when working with potential military PTSD patients, and more than half planned to implement what they learned.

The most important thing, said Penn State Medical School’s Bonnie Bixler, MEd, is to take that initial call and be open to seeing where working with unusual partners can take your activities.

Providers also need to know not only how to build relationships with colleagues, but also how to teach this skill to their learners, said Leslie Bainbridge, BSR (PT), MEd, PhD, director, interprofessional education, faculty of medicine and associate principal, College of Health Disciplines, Vancouver, British Columbia, who presented a plenary on teaching interprofessional collaboration in health. Why? She pointed out that 70 percent to 80 percent of medical errors in the U.S. and Canada are due to poor interpersonal communication and collaboration.

But collaboration isn’t easy to teach, she said. You must address how stereotyping, time and geographical issues, power and hierarchy, and policy can hinder team practice. Team members have to build social capital with each other by building trust and respect: “We learn to trust and respect over time and experience, but we can break those [bonds] in a nanosecond,” she said.

Communication and collaboration issues also extend to the patient. AHRQ’s Clancy, whose agency now includes patients’ experience of care in its quality measures, said that while the percentage of adults who reported poor communication has decreased from 10.8 percent to 9.3 percent in the latest “National Healthcare Quality and Disparities Report,” more than 5 percent still reported poor communication with docs and nurses.

3. Team-based learning
The need for more collaboration and better communication among healthcare teams is a natural lead-in to the next big idea: team-based learning. The Alliance had told its members it was serious about its intensifying focus on interprofessional education, or IPE, when it changed its name, mission, and strategic directions to be inclusive of CE for other healthcare professionals. The 2012 meeting offered both education about how to provide good IPE for HCPs, and the opportunity to experience team-based education among healthcare CE professionals themselves.

IPE is defined as “occasions when two or more professions learn with, from, and about each other to improve collaboration and the quality of care” by the Centre for the Advancement of Interprofessional Education. But, as Moss Blachman, PhD, assistant dean, continuous professional development and strategic affairs, University of South Carolina School of Medicine, pointed out during a mini-plenary summing up some of the conference’s main take-home points, it’s a “bodacious issue” to develop good IPE, and to get all the team members interested in participating.

One way to do that is to address the team members’ professional competency requirements in a single activity. In handouts from their session, panelists Brian Tyburski, Sean Walsh, Linda Ritter, PhD, and Susan Berry, all of whom are with the Center of Excellence Media LLC, pointed out that, for example, an interdisciplinary oncology team includes physicians, nurses, and pharmacists. When developing an IPE for this team, the CME provider would have to examine the core competencies of organizations including the Accreditation Council for Graduate Medical Education, the Oncology Nursing Society, and the American College of Clinical Pharmacy to find common ground upon which they can develop the activity’s educational objectives.

It also helps if you can recruit faculty that represents each discipline, something Berry, who is editorial director of the organization’s print activities, did for a print activity that targeted multiple members of an interprofessional team. Because the articles included each faculty member’s perspective, learners developed a better understanding of the roles of others on their care teams, and faculty also became more aware of each other’s roles, and developed mutual respect as they developed and reviewed the cases.

This is just one of many cases of successful IPE showcased at the 2012 Alliance meeting, and given the Alliance’s new emphasis on team-based learning, it likely will continue to dominate future conferences. As a mini-plenary on IPE and team-based learning made clear, differences in the history and culture, language, level of responsibility and accountability, status, and regulatory requirements of the different disciplines on each medical team will continue to leave CME and CPD providers grappling with the challenges of assessing the needs, providing the education, and measuring the results for teams of disparate learners.

4. Technology
Even before Diamond opened the conference talking about how vital technology will be to improving the quality of healthcare in the U.S., more than 150 CME and CPD professionals flocked to a special, intensive, pre-conference session the Alliance added this year to help those unfamiliar with some of the emerging technologies get up-to-speed. Led by MM’s social media columnist Brian McGowan, PhD, a panel introduced the main social media players and how CME professionals can use social technology in their CME programs. Anne Grupe, MS Ed, assistant director, CME, with the American Society of Clincial Oncology, provided examples of how ASCO was using Twitter and other social media.

Participants also broke into small groups to further explore how to incorporate technology into their CME programs. Depending on their experience, the groups either focused on how to use specific technologies, or how technology could solve some of today’s CME challenges.

According to a pre-con survey on social media use, fewer than one in five of those surveyed had integrated social media into their programs, and one out of three said they are unlikely to integrate social media into their programs in the near future.

A session led by Joseph Kim, MD, Medical Communication Media Inc., provided more insight into why that may be so. Not everyone buys into the idea of using social media for CME, said Kim, citing time, liability issues, privacy and security concerns, and a general lack of understanding about the technology as reasons to keep social media at arm’s length. But, said the panelists, these can be addressed through policies that prohibit discussions of patients and by using closed communities that allow only other healthcare professionals to participate.

But technology isn’t just about HIT and social media—to address the full range of technological advances CME providers have today, there also were sessions on everything from using cellphones to take attendance at regularly scheduled series to designing an electronic system to advance the competency of CME professionals and improve their CME programs.

5. Advocacy
There has been an increasing demand from CME and CPD providers to get their story out to legislators, the media, and the general public about the good work that CME does, not just the “gotcha” stories that tend to get the most play. While how to share those stories remains a topic of discussion, the need for advocacy for the profession took on a more urgent note at the Alliance meeting when many providers learned for the first time about a proposed provision to the Sunshine Act that would make them responsible for reporting what they spend on faculty and other healthcare professionals whose fees are paid for by educational grants from pharmaceutical companies.

At a packed meeting held after-hours at the Alliance for Continuing Education in the Health Professions, the CME Coalition, a lobbying group formed in 2011 to represent the interests of the CME community on Capitol Hill, called on CME providers, medical societies, patient advocacy groups, and other nonprofit organizations to voice their objections to the Department of Health and Human Services before the February deadline. The rule, which is now being evaluated in light of the comments received, would remove the third-party indirect-payment reporting exclusion in the Physician Payment Sunshine Act.

What many found objectionable was the proposed rule’s requirement that pharma companies report any commercial-support money that they become aware of having indirectly benefited faculty or attendees. CME providers would have to pinpoint which commercial-support dollars are used for an activity’s faculty honoraria and travel expenses, for example. CME providers then would have to provide that information back to the commercial supporter to include in its public healthcare provider payment disclosures.

The community stepped up to voice objections to the proposed rule. The Alliance, along with other CME-related organizations—including the Accreditation Council for CME, Association for Hospital Medical Education, Council of Medical Specialty Societies, and the Federation of State Medical Boards—sent comments to HHS about the proposed rule, as did many of the CME professionals who vowed to do so at the meeting. (A list of links/downloads to many of these are collected on this page of the Policy and Medicine blog)The buzz at the meeting was that, if CME professionals don’t speak up about what they do, their work will face being further maligned, regulated, and restricted, with the ultimate victim being the patients whose docs aren’t getting the education they need.

These five ideas, while big, don’t stand alone. They intertwine and overlap each other, and in some cases, one can’t happen unless several or all of the others also become integrated into the way CME and CPD providers work. If this happens, CME, and/or CPD, will in fact become an integral player in the future national healthcare system.

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