Pri-Med, a medical education company that focuses on serving a community of more than 300,000 primary care physicians and other healthcare providers, recently published a white paper that explores how the rapid pace of change in technology, higher education, and the business and clinical sides of today’s healthcare environment will affect how clinicians keep up to date on the latest information in the near future and longer term.
MM: What are the main forces driving the need for change in post-graduate medical education?
Seligman: First, there is the lack of structure in the post-graduate medical education environment. Clinicians go through a structured education experience from undergraduate through residency and fellowship. Then they go into practice and all that structure goes away. In addition, most clinicians participate in CME offered across a wide variety of providers, educational formats and topics, which can be very unorganized. We need to reassess and evolve if we want to organize and align the CME enterprise. This will involve collaborating more than we currently do—the hope is that technology will enable us to collaborate more.
In addition to this disparate enterprise, clinicians have increasing patient demands. Our primary care learners [Pri-Med produces CME mainly for the primary care market] see an average of 2,300 patients per year. These patients span the spectrum of diseases, ages and co-morbidities—the primary care physician (PCP) has to be skilled in so many areas, as well as be able to determine when it would be best to treat that patient themselves and when to refer [to a specialist]. In addition, while primary care practitioners are on the front line of healthcare, they have the least amount of time to engage in education.
We also need to look at more active ways we can meet the needs of the PCP. It is too easy for physicians to sign up, and then sit there, receiving the education—passively. All clinicians need to learn by thinking, doing, and assessing. We need to reflect on ways the learners can contribute to the education–traditionally, education has been directed one way. We need to find ways to bring the learners into the process so they’re learner and teacher, and engager and doer.
Intersecting with all of this is physicians’ increased comfort and savviness with technology. For example, 60 percent of physicians report using a smartphone to search for clinical information, and 45 percent use a smartphone to download clinical information. Knowing that the technology is literally in the hands of the learners, we need to think about how we can capitalize on that to get education that can be applied to patient care into their hands as well.
Changes in CME will come from the convergence of technology, patient and physician needs, and the growing importance of engagement through active learning.
MM: You talk a bit about the “open education” movement in the white paper. What is it, and what implications does it hold for CME?
Seligman: Open education, or Education 3.0, is a movement away from the traditional approach to education, characterized by an authority passing down information in a closed system toward a more collaborative and self-directed educational experience, due in large part to the rise of digital learning environments. The movement is based in part on the fact that there’s content that can and should be repurposed digitally for those who cannot experience it first-hand. Traditionally, a lecture happens, then it goes away. Sometimes it’s captured digitally, sometimes it’s not. There’s no consistency. We need to break down the silos around to allow greater access to information by more people. And building on that, we need to find ways to have learners contribute to that information. While the open concept has been in use since the early 2000s, it hasn’t reached its potential yet.
MM: How are today’s technological advances changing what docs expect in CME? How are they changing what CME providers want to/are able to do to improve learning, retention, and application of knowledge?
Seligman: While technology can be incredibly enabling, it also can be isolating. Sometimes we wonder if anyone is on the recipient end of a blog post or a tweet. It’s not so much about how the technology will make an impact on CME as it is about how we can bring people together around the technology. Technology is just a tool to get the information out there. For example, the number of tweets in the CME world is still very small. Twitter is a great tool, but we need to find out how we can use these types of features to better support the learner.
For many physicians, CME is a requirement—they don’t necessarily look at it as more than a course they need to take for Board certification or licensure. But we know that CME really is a tool to help drive better patient care. We want to embrace current as well as new technologies to make CME a two-way exchange. Even now at our live events, we use audience response polling to encourage interaction, and we use different formats such as gaming where the answers come from the audience. And, we are bringing that level of engagement into the online and enduring environment as well, so we can extend the learning beyond just a one-time event. We want to continue integrating these learnings into a physicians’ practice and not just an isolated course they took.
MM: But do healthcare professionals really want to have highly engaged, ongoing learning? That requires a lot more energy, time, and commitment from them than sitting in a conference session and collecting credits.
Seligman: We’re hoping that the dialogue around technology can include finding ways to show physicians that CME is not just something you do for licensure once a year, but truly a continuum that they both receive and contribute to. Of course, there may be some resistance to this idea because it is inherently more work, but we believe that aligning technology with physician requirements, such as CME documentation, will benefit physicians and ultimately save them time and effort.
MM: What effect will today’s changing environment have on the value of clinical content? Will it become a commodity that just can be accessed in many different formats (formally and informally, accredited or not)?
Seligman: There will always be the need for content. But I don’t think it will be sustainable to have a “one and done” curriculum for everyone. There has to be a focus on the individual needs of the learner. As we move forward, it will be about how technology and programs can align more closely with physicians’ challenges in practice. This may mean working with individual physicians based on, say, the number of patients they see in a particular week in a particular disease state. We would help them profile their own gaps, then direct them to sources of information they can select to customize their education to their specific needs.
We’re hoping technology will help us to more effectively shift from pedagogy—I’m the expert, I know best, I’m going to push it out to you—to andragogy, where learners pick and choose multiple sources of content to direct their own learning.
MM: How does the whole crowd-sourcing movement play into the development of clinical content?
Seligman: Crowd-sourcing can be an important part of learning. This ability to work together is something we need to foster in CME. For example, you could present a case, and then have the learners crowd-source where to take the care of that patient in different scenarios. For example, a physician could ask, if I don’t have access to an MRI, what do I do? Physicians who see those patients are experts in their care. They do learn from each other, and we need to enable that.
MM: Will the need to obtain CME credits continue to be one of the main drivers for CME participation, or is the ease of some of the technology-driven ways of learning making learning for its own sake more popular?
Seligman: PCPs are active learners—they wouldn’t be PCPs otherwise. There’s certified CME and non-certified CME learning, each of which needs systems and processes. It would be awful if someone gave bad advice in an open education setting, but as you see in wikis, the crowd tends to correct the mistakes. That’s what we’d like to talk about, how technology can help CME help the medical community collectively advance patient care.
MM: What role, if any, is social media having on CME today? How do you see it fitting into the CME structure in the future?
Seligman: All CME has to be about disclosure, transparency, and objectivity. Social media has a negative connotation for learners, we have found. Clinical learners don’t like it. What are you really going to learn in a 140-character tweet? But we can use it to help advance and augment education. If you’re a text-based learner, a tweet can drive you to more text, or to a visual if you’re a visual learner. Social media isn’t going to carry the burden, but it can help augment the learning.
We see social media as enabling the interaction and engagement among learners—both with each other as peers, as well as with faculty and experts in relevant disease areas-- that’s going to be the value of these tools.
MM: How does all this affect the traditional funding model of CME?
Seligman: As the education models change, funding for education has to shift as well. We’re fooling ourselves if we think it won’t change, or hasn’t been changing all along.
According to the 2010 ACCME Data Report, more clinicians than ever before are participating in CME—both non-physicians and physicians. And there is a decline in the number of activities and hours that are being offered. So the demand for CME is high, and technology is making it even more available.
As much as we have to discover how the technology can enable learners to enhance the activity’s effectiveness, we also have to look at how technology can enable us to use the educational funds that are provided from industry more effectively. As others are doing, we’re also making strides with new funding sources—we’re working with new payers, like the Centers for Disease Control and Prevention and a weight-loss company, on CME projects. Instead of having it siloed in a few industries, we’re seeing the funding pool flatten and expand to a greater variety of funders.
I don’t have the answer, but it’s not that change is bad. I think we should embrace change as a good thing in this case, because it helps us evolve our thinking.
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