The most revealing session I've ever attended regarding how physicians learn was held back in 1998 at the Alliance for CME conference. Entitled “Patient-centered CE,” it was run by Bob Pyatt Jr., MD, Chambersburg Imaging Associates, Chambersburg, Pa., and focused on a CME initiative about post-polio syndrome that he had co-developed with patients. He turned the lectern over to Phyllis Bailey, MSW, polio survivor — and the leader of the self-described “pushy polios” — the group that had demanded Pyatt's help. As she talked about the misunderstanding and inappropriate care post-polio patients receive from physicians, several of the doctors in the audience became hostile and defensive. It was clear to me that these doctors were not going to be receptive to new knowledge about post-polio syndrome until they made an attitude adjustment.
I thought about that session when I interviewed Suzanne Murray, AXDEV Global, for “Needs Re-Assessment” (page 30). She said CME activities don't usually address the barriers that prevent healthcare professionals from changing their behavior. Their personal values drive their judgments and clinical decision-making, she said.
I couldn't agree more. Consider some of the hot topics in CME today: from evidence-based medicine to end-of-life care to ethical relations with pharmaceutical representatives, from cultural competence to patient communication. All these subjects are complex and emotionally charged.
But how do you design education that persuades participants — highly educated physicians who are not used to being challenged — to express their vulnerabilities and examine their entrenched beliefs? For one thing, while lectures can be effective formats for imparting knowledge, they don't provide an environment conducive to sparking attitude change and debate. CME providers andhave to get creative and take risks. Perhaps they need to examine their own barriers to creating more daring CME. And, the CME community needs to become more inclusive. We all agree that the bottom-line mission of CME is to improve patient care — so consider including patients' voices when you develop education.
If you're doing exciting work in needs assessments, education formats, or outcomes measurements, I'd like to hear about it. It's only through CME providers sharing their experiences and lessons learned that we're going to figure out how to effect real change in physician behavior and benefit patient care.