Robert Fox, EdD, offered an inside look at the The Institute of Medicine's plan to redesign continuing education in the health professions at this year's Alliance for Continuing Medical Education Annual Meeting, held in January in New Orleans. Fox, who is professor emeritus of adult and higher education, Department of Educational Leadership, University of Oklahoma, Norman, was one of the 14 people asked to serve on a committee charged by the IOM with reviewing issues concerning the continuing education of healthcare professionals, and with considering the establishment of an interprofessional Continuing Health Care Professional Education Institute. The IOM was asked to look into the idea by the Josiah Macy, Jr. Foundation after its 2007 conference resulted in a consensus that there may be a need for a national interprofessional continuing education body.
One of the key messages of the report, which was released in December 2009, was that there are major flaws in the way continuing education is conducted, financed, regulated, and evaluated overall, Fox said. Part of the problem is the way CME focuses on regulatory requirements rather than identifying an individual's knowledge gaps, he added. In addition, the science behind healthcare CE is fragmented and underdeveloped, making it difficult to determine the most effective educational formats to use to meet the needs of the full range of health professionals.
Other concerns were conflicts of interest, an overreliance on didactic teaching methods in traditional settings, the lack of specific information on how to support learning, and a shortage of available interprofessional training. The move toward a system of continuing professional development requires a shift from the classroom to point of care, a shift in the control over the learning from the provider to the individual practitioner, and a shift toward team-based learning.
The committee quickly rejected the idea of simply maintaining the status quo due to the flaws already noted, said Fox. But it did consider alternatives to establishing an institute to address the concerns. Those included creating a program within an existing federal agency such as the Agency for Healthcare Research and Quality or the Health Resources and Services Administration; and a purely private structure consisting of professional societies. Neither made the cut. After much discussion, the committee decided the best answer would be to develop a continuing professional development institute, or CPDI, an independent public/private entity that would foster collaboration among all stakeholders.
While it would be organized and developed initially by the U.S. Department of Health and Human Services, Fox said the hope was to eventually transfer management back to the stakeholders. An audience member expressed concern about the involvement of the secretary of HHS in appointing members of the institute. “I'm worried about further encroachment of the government into CPD,” he said. Fox said that the fragmentation of the field required the federal government to step in, at least temporarily. “Once it gets its house in order, CPDI will not be a government institute,” he said.
To keep it accountable, the CPDI would hold an annual national symposium outlining its actions and results to its public and private stakeholders. The institute would be funded by financial support from both the federal government and the private sectors in order to prevent any stakeholder from having undue influence.
Creating a Mission
The institute's mission would include developing and prioritizing a national research agenda, Fox said. “We can't make good decisions until we have a system of science to serve as a foundation,” he added. The institute would develop, collect, analyze, and disseminate metrics, encourage the development and sharing of new tools and technologies across the various healthcare professions, and foster interprofessional collaboration while improving the cost-effectiveness of CPD delivery.
The committee also recommended that the CPDI focus on making the accreditation, certification, credentialing, and licensure process more consistent across professions. This would make it easier to deliver consistent learning to the full range of healthcare professionals. David Davis, MD, the Association of American Medical College's vice president for continuing health care education and improvement and a co-presenter at the session, later added that, “the process of accreditation and certification has devalued the process of CME.” The hours spent on paperwork could instead be used to make the education more effective.
Fox said the committee also wants the CPDI to look into new ways of financing education that would support a broader CPD system while avoiding conflicts of interest. The committee considers conflicts of interest to be any instance where more emphasis is placed on industry's return on investment than on the educational value of the CPD. It also would identify and promote models of CPD that foster greater interprofessional team learning.
“My belief is that the institute creates the potential for a common vision we all can get behind,” said Fox. “This is a positive step that will bring together forces that are now pulling us in separate directions.”
When asked about a possible timeline for the creation of the CPDI, Fox said while he personally “feels a great urgency to move forward at a fast pace,” he believes the current focus on healthcare reform is likely to keep the institute on a back burner. “I suspect that this will be delayed until healthcare reform is settled.”
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