“If CME doesn't make any difference to patients, why are we doing it?”
Should patient involvement be a criteria for accreditation of CME programs? Should CME leaders model patient involvement by including patients in their advisory groups? These were a few of the provocative questions raised by Angela Towle, PhD, director, MD Undergraduate Program,of Medicine, University of British Columbia, Vancouver, B.C., Canada, in her article “Shifting the Culture of CME: What Needs to Happen and Why Is It So Difficult?” published in The Journal of Continuing Education in the Health Professions, Fall 2000. As co-director of the Informed Shared Decision Making project at UBC, which teaches physicians, medical students, and patients how to become partners in the treatment process, Towle has first-hand experience grappling with the obstacles to creating effective patient-driven education.
Q: How did you start thinking about ways to involve patients in CME?
A: Patients are important change agents. We know that physicians learn from their patients. It seems a good idea to formalize that [learning] and take advantage of it in CME. [For example], when you apply for CME credit for an event, you might be asked about the ways in which you have incorporated the patient perspective.
Q: In your article you commented that physicians often resist learning the skills. How can CME providers help physicians understand the need for such training?
A: When we've run our communication skills courses, we've given out a little questionnaire for physicians to give to their patients after the consultation. It's anonymous and it gives them a bit of feedback. That could be made more formal in an accredited CME program; in order to get credits, physicians would have to do this activity with their patients, and submit the feedback.
It's fairly expensive to use standardized patients, but it is an excellent teaching technique. One of the interesting things we've found in our workshops where we used standardized patients is that physicians treat the patients as if as they were their own patients and try to get feedback. They say, “I try to do XYZ with my patients — what do you think about that?” Physicians seem very interested in the patient perspective. They don't have many opportunities to actually find that out in a safe way.
Q: What about using actual patients?
A: We've done that on the undergraduate level. If we are doing a course on addiction medicine, we bring in people who have had problems with addictions, who tell their stories and are available for questions. It can be a very powerful learning. You really have to provide a safe environment to bring physicians and patients together. Some patients do have a lot of complaints; many of them are justified. Some see [a program] as a forum for doctor-bashing. You need to find people who are genuinely interested in education, not in airing their grievances.
Q: You suggest that CME providers ask patients to join their advisory boards. How does that work?
A: There are a few examples at the medical school level, and one of the questions that comes up is how can patients contribute — rather than just feeling like the token person who's been brought in to make it look like we have somebody on our committee representing the public. Medical education is a means to an end. If the end is to improve patient care and you don't find out what's important for patients, it seems to me you are only going to get so far in improving patient care. [Education] becomes a doctor-focused activity.
Q: In your article, you noted the importance of opinion leaders in overcoming physician resistance to change. How can the CME community better facilitate the development of opinion leaders?
A: First, there needs to be a debate about whether there is a role for patients in CME. If so, what is the role? Opinion leaders can provide a framework for patient involvement. There could be a handbook of guidelines [similar to the handbook on involving patients in research, published by the United Kingdom's National Health Service Consumer Group].
Opinion leaders can support the development of models and evaluate them. What are the learning needs from the perspective of consumers? How do we measure outcomes? What role, if any, might patients play in assessing outcomes of CME? If it doesn't make any difference to patients, why are we doing it?