AS THE CARTOON CHARACTER Pogo once said, “We is faced with insurmountable opportunities.” This is a time of change for the CME community — and a time when CME providers are facing some substantial barriers to making those changes happen. National healthcare organizations are developing a vision for CME that moves beyond just satisfying participants and toward actually increasing physician competence and performance, and toward assisting physicians to take responsibility for their continued self-evaluating and self-correcting behaviors.

Different types of CME providers are undertaking new practices that facilitate learning and enhance professional performance, such as

  • Linking CME to healthcare quality data,

  • Undertaking CME research,

  • Assisting the parent organization in meeting regulatory requirements,

  • Reducing medical errors,

  • Enhancing physician clinical performance,

  • Working across the continuum of medical education,

  • Facilitating faculty leadership skills,

  • Enhancing physician learning skills,

  • Exploiting technology in CME delivery, and

  • Providing more practice-based CME.

Most CME professionals want to spend more of their staff time addressing these challenges — and consequently increasing their visibility and their value to their own organizations, the physicians they serve, and ultimately the public. The rub is that all too many are too bogged down in mandated operational functions, such as certifying CME activities, dealing with meeting logistics, and recording and tracking physician credits, to be able to spend the time they'd like focusing on facilitating learning and enhancing physician performance. In fact, a recent informal survey of CME providers found that they spend 95 percent of their time on operational functions. There are so many barriers to change: faculty and organizational leadership's lack of knowledge about CME, inadequate staff and staff's lack of a specific skill set, reduced funding from the organization, magnitude of CME regulatory demands, low priority within the organization, and an institutional culture that does not support physician accountability in performance or learning.

What percentage of your time do you think should be spent on the learning and performance functions? How do you eliminate or reduce the necessary operational functions and move to the learning and performance functions? How do you address the barriers?

In upcoming columns, we'll give you the information you need to propel our profession and our own offices toward this new vision of CME. We'll explore how to prepare individuals and organizations for change, including establishing a sense of urgency, creating a guiding coalition, developing a mission and strategy, and communicating the change vision. Then, to help you put it into practice, we'll discuss how to empower broad-based action, generate short-term wins, and consolidate gains and produce more change. Then we'll look at ways to anchor the changes in the corporate culture to make sure they stick.

And we'll try to make it painless and practical by explaining each step in real-life terms, and by providing specific examples of activities that you can undertake to address the barriers to change. No matter how impossible it may seem, you can lead the way in transitioning your CME unit to the forefront of the new CME vision — facilitating learning and enhancing physician performance.

Joseph S. Green, PhD, is associate consulting professor, Department of Community and Family Medicine and associate dean of CME, Duke Office of CME, Duke University Medical School, Durham, N.C.; James C. Leist, EdD, is co-director, faculty development, interim director, Alliance Center for Learning and Change, and associate consulting professor, Department of Community and Family Medicine, Duke University Medical School; and Robert E. Kristofco, MSW, is associate professor and director, Division of CME, University of Alabama School of Medicine, Birmingham, Ala.