This spring Toronto played host to two big continuing medical education events: the CME Congress, a quadrennial meeting of the CME/continuing professional development minds; and a smaller, but very dynamic group of CME professionals worldwide who came together just down the street the day before the CME Congress for the Global Alliance for Medical Education’s annual meeting. While different in focus, the two meetings shared several themes, including understanding the effects organizational, environmental, and cultural systems on CME; and finding ways to enhance patient safety and improve healthcare quality.

Charles Boelen, MD, an international consultant in health systems, set the tone for GAME with a talk about the changing world today’s healthcare professional works in, from demographic changes and environmental shifts to the recent global and country-specific economic shake-ups, the growth of globalization, and the need for more transparency. CME professionals need to start by looking at the big picture of societal needs, then work their way backwards to design education that will address those needs. As he pointed out, “We’ve been educating for decades, and only now are asking what for.”

The biggest of those societal needs that make up the “what for,” he said, were relevance, equity so all can benefit, quality, and cost-effectiveness. People tend to confuse medicine with health, he said, but medicine addresses only about 10 percent of our health issues; the other 90 percent is due to social and environmental factors.

Organizational and cultural issues also play a big role in interdisciplinary continuing education, said Scott Reeves, PhD, founding director, Center for Innovation in Interprofessional Healthcare Education, University of California, San Francisco, in a CME Congress plenary. Among the organizational and contextual issues CME/CPD providers have to grapple with are the logistical problems involved in coordinating among the different schedules for each discipline; the imbalances in funding among the different fields, with physicians receiving the lion’s share of commercial support while other professionals receive little to none; and socioeconomic imbalances that can also affect the learning environment.

Putting Patient Safety First
Charles Denham, MD, chairman, Global Patient Safety Forum, tackled the opportunities and challenges involved in patient safety globally. He told GAME attendees that we too often are pushing the norm of patient care beyond what can be managed safely. “The first things hospitals cut are nurses and housekeeping staff—just what you need to prevent those expensive errors,” he said. Communication problems also are rife, particularly among multidisciplinary teams.

Over at the CME Congress, Matthew Weinger, MD, professor of anesthesiology, biomedical informatics, and medical education, Vanderbilt University School of Medicine, Nashville, Tenn., explored how and why CME and safety and quality initiatives often are kept separate from each other, when improved patient care demands that they work together. “Medicine lags other industries,” he said. Its methods and practices aren’t standardized, novices are allowed to practice in the operational environment, there are few objective measures of training success or continued competence, and outcomes and safety rely on multidisciplinary teamwork, though team training remains a rarity.

Safety issues and system issues are, not surprisingly, intertwined. He proposed that we use British psychologist James Reason’s “Swiss cheese model,” in which failures on a number of different levels have to momentarily align like holes in a constantly varying stack of Swiss cheese. In the case of healthcare, those slices could represent the healthcare system as a whole, the organization, the local environment, equipment/tools, and the providers involved. The holes can come from a variety of sources, such as when non-routine events distract HCPs from providing optimal care. They also represent poor team communication and equipment problems, organizational issues, and societal factors.

“Healthcare reform of any kind will look to reduce costs while increasing effectiveness/productivity,” he said. “The problem is when they push these two to the point where society is compromised.” Instead, he said, we need to take what we know about how we relate to the world around us as individuals and in groups and use it to improve the safety and quality of healthcare.

As George Mejicano, MD, associate dean for continuing professional development at the University of Wisconsin School of Medicine, said later, “Dysfunctional systems produce expensive, poor-quality care.”

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