This year’s meeting of the Alliance for Continuing Education in the Health Professions, held in January in San Francisco, pushed beyond the usual comfort zone of evidence-based medicine and performance-improvement CME—though there was plenty of that as well—and into some of the edgier territory where speakers appeal to the heart and soul as well as the mind. The message of where healthcare—and healthcare continuing education—has come from and needs to go played out on the main ballroom stage, where the plenary speakers began with a tweak to the Alliance’s traditional call for change, to an embodiment of what that change might look and feel like for healthcare providers and for those who educate them.
The Need for Change
The meeting began with a plenary by Ed O’Neil, PhD, owner of the healthcare leadership and strategy development firm O’Neil and Associates, who explained that, while Abraham Flexner’s healthcare paradigm was progressive for its time, that was more than 100 years ago, when the biggest healthcare challenges were a haphazard medical education system with loose standards and no real regulation to ensure quality.
His Flexner Report helped to professionalize physicians by basing their education on scientific practice and research, ensuring medical schools were autonomous, and requiring stronger state licensure regulations. “In his world, this is what was needed,” O’Neil said.
But now the Flexnerian pendulum has swung too far, said O’Neil. The knowledge that used to define the professions has created autonomous silos so that knowledge no longer flows freely to all who need it. Today’s healthcare consumers, tired of being powerless over their own care, are becoming more actively engaged.
To meet today’s needs, we must integrate the current silos, develop collaborative practices, engage communities, integrate physical and mental healthcare, focus on the patient, and create “radical efficiencies in resource use.” And yet today’s healthcare providers do not want any disruptions to the Flexnerian pattern they are used to. As O’Neil said, “You can object, but it doesn’t matter. It’s going to happen ... Resistance is futile.” But it doesn’t necessarily have to hurt. O’Neil likened the change-resisters to Sisyphus, whom he said fell in love with the rock he was eternally consigned to roll up the hill. “He didn’t realize he could step aside, let the rock hurtle down, and go home.”
Embrace the Mind-Body Connection In CME
Could change be as simple as putting down our old conceptions? Charles Denham, MD, chairman of the Global Patient Safety Forum in Geneva, Switzerland, said it wouldn’t be enough just to change the healthcare education system; we also need to change what and how we teach. “We’re failing by just delivering knowledge,” he said in his keynote. “It’s not about the what, it’s the why.”
The result of this failure: “We’re killing a staggering number of Medicare beneficiaries,” Dehman said. And we’re doing it at great expense. When it comes to healthcare, “we’re 37th in the world on quality, and we’re first in dollars.”
Continuing healthcare educators can help change this, he said. Using video clips of his movies “Chasing Zero” and “Surfing the Tsunami,” he emphasized that “this is not about business anymore, it’s personal...appealing to the heads, hearts, hands, and voice is all a part of medicine.” And medical education that results in, ultimately, a safer system for patients.
Deep Dive Into the Heart of Healthcare
On the final morning, plenary speaker and playwright Margaret Edson, MA, EdS, further explored the meshing of the personal and professional. Using clips of a video of her Pulitzer Prize–winning play “Wit,” which follows one woman’s cancer journey, Edson explored how healthcare providers can embrace patients and caregivers to heal wounds that clinical treatment can’t touch.
She said we usually think of our “busy self,” our public face, as our identity. But there’s also the “slimy self,” the guts at work keeping us alive that most of us don’t understand, and that we really don’t think about much until something slimy stops working right. “Where the two selves come together is in the doctor’s office,” she said.
But the healthcare environment is also where a third self, what Edson calls the true self, can emerge. For that to happen, we need to move away from the medical narrative (the busy self’s version of the story of an illness, such as onset, symptoms, treatment history, and the like). Instead, healer and patient can create a real dialogue, where “two people talk not to the other’s professional or patient status but as equals ... feeling our way toward what is true.”
That shift from narrative to dialogue, which Denham had also expressed using different words, can mean the difference between healing and curing, she said. Curing has a narrative arc and requires people to be their busiest possible selves, but healing doesn’t have a plot. “Once you let go of curing, you’re open to the possibility of healing.”