IT HAPPENS ONLY once every four years, rotates among different locales, attracts people from all over the world, and is very competitive. No, we're not talking about that giant athletic event in Athens this summer; when it comes to mental gymnastics, it has to be the CME Olympics, otherwise known as the CME Congress 2004, which was held May 16 to 18 at the Fairmont Royal York in Toronto, Ontario.
More than 560 CME providers hailing from Australia to Iran — though predominantly from Canada and the United States — came to leap some of the main hurdles of the CME world: taking CME from educational theory to real-life activities, and placing CME in the context of the broader regulatory and healthcare environment.
Sponsored by the Alliance for CME, the Society for Academic CME, and the Association for Hospital Medical Education, in association with the University of Toronto and the Canadian Association of Continuing Health Education, the Congress was an information-packed three days of plenary sessions, symposia, workshops, research papers, and poster sessions to give participants many different learning formats.
Lassoing the Lone Ranger
It started off with a bang with a very lively presentation by Mark Smith, MD, MBA, president and CEO of the California Health Care Foundation in Oakland. To get both a laugh and a rise out of the audience, he began with, “I've been the beneficiary — or should I say victim — of CME orthodoxy for 20-plus years.” He went on to skewer three basic assumptions underlying much of “traditional” CME: that the physician acts as an individual in practice; that the brain is the best tool to “retrieve all the information we cram into it”; and that physicians manage patients.
“Doctors go into medicine because they reject teamwork,” he said, adding that they tend to think of themselves as the Lone Ranger. “But modern medicine is a team sport. Even with the trend toward measurement … you're not measuring the performance of an individual, you're measuring the results of the team. Yet you teach them as individuals.”
Addressing his second point, Smith talked about the reams of data resulting from the half a million randomized trials conducted since 1948 that doctors believe they should keep in their heads. “Remembering long lists of things is no longer possible or even desirable,” he said. Computers, he said, are much better at this than human beings are.
To his third point, he suggested that while physicians can prescribe, they have no way of knowing if patients follow their advice. “The reality is that patients manage themselves, with help and advice from docs and other information sources.”
To be effective in today's environment, CME needs to focus on teaching teamwork, technology, and communication skills, and on using the latest technology in the teaching process. “Pilots learn on simulators, doctors learn on patients. We need to have not just learning in lectures, but in functional groups with simulation techniques and technologies.”
Another highlight was a plenary session on the second day by Karen Mann, PhD, professor and director, Division of Medical Education, Dalhousie University, Halifax, Nova Scotia, on the role of educational theory in CME, and how theory and practice actually inform and strengthen each other. “Theory isn't set, rigid rules, but interrelated to practice,” she said.
Some of the questions posed during the Q&A were fascinating, such as, “Should we have evidence rankings for educational theory, the same way we have evidence rankings for materials used in CME?” Mann answered that while some aspects of the theories could be linked to evidence, “they haven't all been tested in CME. My first step would be to link theory and evidence more clearly.”
Another interesting question was, “The people who employ marketing theories to educate consumers about their products definitely see behavior change as a result — where do marketing theories fit into theories of learning?” Barbara Barnes, MD, MS, associate dean, CE, with the University of Pittsburgh, who participated in a panel after Mann's talk on applying theory in various settings, answered that social cognitive theory gets at the attitudinal/behavior issues. “It's important to look at organizational and business theories,” she said. “We need to do more of that.”
But for some, the biggest highlight was watching Dave Davis, MD, chairman of this year's Congress and associate dean, continuing education, with the University of Toronto, close the event with a one-man dialogue between Dr. Harold Old-CME, a retired orthopod, and Dr. Todd New-CME, a young primary care physician — complete with hat changes and some decent acting skills — to accent the differences between where CME has been and where it is headed.
Back to the Future
Physician performance assessment also is going through some changes, said Donald Melnick, MD, senior vice president, National Board of Medical Examiners in Philadelphia, during a highly entertaining session on how this will affect CME over the next few years. NBME is an independent, not-for-profit organization that provides a voluntary, nationwide examination — the United States Medical Licensing Examination, co-sponsored and co-owned by the Federation of State Medical Boards — that medical licensing authorities can use to judge candidates for medical licensure.
Melnick said there are several key trends CME providers should be thinking about, including:
Point-in-time assessment will shift to summative, or cumulative, assessment, which measures behavior over time. “What we need is a sort of portfolio, a structured collection of information that is representative of a person's work on an ongoing basis.” While well-tested measurement tools for summative assessment aren't yet available, Melnick believes point-in-time tools, such as simulation, standardized patients, and chart-stimulated recall, can be adapted for continuous measurement.
Technology will spawn a whole new set of tools. Some companies already have developed sensory tools that go beyond 3-D to encompass other senses. Virtual reality and virtual surgery will move from a computer-assisted virtual environment to a complete submersive environment — think the holodeck on the Enterprise in “Star Trek: The Next Generation.”
Also on the horizon are observational assessment through electronic medical records systems, and online information-retrieve simulations in which physicians who answer a question correctly move on to the next question, and those who don't are given more information and then take a retest.
“Competence means knowing how to use resources to get the job done,” he said, summing up what could have been the theme of this year's CME Congress.
CME Congress Gets Innovative
The CME Congress, held May 16 to 18 in Toronto, tried to practice what it preached by offering “learning communities” that people could sign up for ahead of time or on-site. In keeping with the educational theory that adults learn well when they have the opportunity to share learning goals, insights gained, and professional challenges with colleagues, members of these communities were to gather for breakfasts and two lunches at numbered tables.
While the idea didn't gain a lot of traction — by lunch on the last day, only a few tables'-worth of people showed up — those who did take part for the most part found it to be a useful enhancement to the program. Several participants suggested that perhaps it would be better — if the next Congress intends to include the learning communities — to have people sign up by areas of interest rather than be randomly assigned to groups, as they were this year.
Another very smart move the organizers made was to incorporate the annual meetings of the Society for Academic CME and the Canadian Association of Continuing Health Education into the meeting, and to schedule the Congress to immediately follow the spring meeting of the Association for Hospital Medical Education, making it easier for members of those groups to attend.