Question: Our organization wants to improve patient outcomes by using a cross-team collaborative approach to an educational initiative, but we’ve been having many problems conceptualizing how to get that done without turning off the physician learners. Do you have any insights that you could share?

The discussions about how continuing medical education and continuing professional development can help physicians adopt the Institute of Medicine’s core competencies for physicians—that they be able to “work in interdisciplinary teams” is one of them—is ongoing.

It sounds like a great idea to ensure that physicians can cooperate, collaborate, communicate, and integrate care in teams to ensure that the care patients receive is continuous and reliable.

However, as you say, getting from concept to reality in CME can be very difficult if not done strategically. It should go without saying, but I’m going to say it anyway: Not every CME activity, whether traditional or performance-improvement–based, is well suited for this strategy. The No. 1 pitfall when addressing interdisciplinary care teams? Having to water down content to fit particular audiences.

The best way to address this is to first make sure that the condition or disease state truly is interdisciplinary in nature. Chronic disease states that utilize not only physicians but other disciplines such as nutritionists, physical therapists, advanced nursing care, and multiple physician specialties are the best targets for a care-team approach. A couple of years ago, we conducted a quality-improvement activity designed to improve the coordinated care team as it related to cystic fibrosis, a disease state that has all these moving parts, plus many more.

Once you decide that your activity passes this test, you must determine if you are addressing an issue shared by all the team members or if you will need different tracks for different provider types. Shared issues often are QI-based, as opposed to performance-based, unless certain people are targeted specifically for improvement. Some examples of issues that can have uniform goals regardless of what role the learners will play in the care team include reducing clinic wait times, improving the follow-up process, and increasing team communication.

In our CF initiative, we targeted wait times, communication, and running effective care-team meetings for improvement. We chose these because our needs assessment showed they were in the greatest need of reform. However, because different team members often have different perspectives about how to improve the components, we also set up tracks for different providers based on the roles they played within the care team.
Tracks are a great way to achieve cross-team collaboration. Essentially, they allow the creator to develop specific content based on designated roles, specialty, or knowledge base (e.g., physician versus nurse; beginner versus advanced). They also separate content into learner groups, which helps avoid the watering-down concerns. Tracks can be used to develop content for primary care physicians and specialists within the same activity. Learners who opt into their track early in the initiative will receive the greatest value.

If it’s appropriate, one component of each track should consist of care-team coordination so learners in all tracks understand how important it is to patient care. Being able to analyze and report on different learner types per track makes your post-activity evaluation closeout reports and publications more valuable.

Cross-team collaboration can easily be achieved in CME and CPD if designed correctly. The keys are to use an appropriate disease state, and develop content that is not watered down, and, when possible, use tracks to involve multiple provider groups in the same activity.

Rick Kennison, DPM, MBA, CCMEP, has been president and general manager of the PeerPoint Medical Education Institute since 2006. He also is a vocal advocate for improving the CME industry as a whole, and he has presented at the Alliance for CME and the ACCME. E-mail him at rick.kennison@peerpt.com.

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