“WHEN PEOPLE SAY CME doesn't work and we have to reposition it, I always say hogwash — we've always known what works,” says CME veteran Sue Ann Capizzi. “What works is sitting down with a physician, analyzing his or her particular needs, developing a program, and then evaluating it. It's one-on-one, personalized education. We know that works.”
Capizzi, who has more than 30 years experience in CME, recently joined Woods Development Institute (www.wdi-inc.com) in Oak Park, Ill., as vice president, strategy and operations, because it will give her the opportunity to provide just that kind of customized education for doctors.
WDI's program, based on the executive leadership training used by many corporations, was founded by Michael S. Woods, MD, in 2000. Disillusioned with the bottom-line mentality of modern medicine — a far cry from his father's small-town medical practice, which had inspired him to become a physician — Woods left his surgical practice in 1996, and joined Johnson & Johnson to do clinical research. Like many of J&J's employees, he was put through a personal development training program designed to improve customer service and employee satisfaction. He realized that effective corporate leadership skills were no different from the techniques physicians needed, and that he could adapt the training to help physicians improve their leadership, teamwork, and communication skills, as well as personal satisfaction. Thus he could benefit patient care, which is why he became a doctor in the first place.
The program, which is certified for CME credit through the Physician Insurers Association of America, an accredited provider, begins with a 360-degree evaluation, where the physician's skills in a variety of areas are evaluated by coworkers, including partners, office staff, nurses, residents, and med students. Participants are asked to rate the physician on behavior such as, “is willing to admit mistakes,” “avoids acting arrogant,” and “is open to discussing issues, alternative treatments, ideas.” The physician also does a self-assessment, and the results are compared, showing the physician his or her strengths and weaknesses from a variety of perspectives. (WDI also initiated an online patient experience tracking system in March.)
“Talk about the teachable moment,” says Capizzi. “[Physicians respond:] ‘This is how I'm perceived?!’” WDI coaches then work with the physician to develop a plan for changing behavior and documenting improvement.
One of the reasons many physicians are deficient in communication skills is because of their education, says Woods. “From the day they start college, premed undergraduates are competing against each other, instead of learning forms of collaboration.” This competitive training continues all the way through the medical education system, he says. “Most of us are taught to think we're supposed to be right every time we make a decision.” The result, he says, “is that physicians develop a closed mindset where they think there is only one way to do things. [But] there's never just one way to do things.”
That mindset precludes physicians from paying attention to things like a patient's body language, he says. “Physicians are supposed to make evidence-based decisions using the data at hand. Data is the altar at which we worship. If it's not something that can be proven with a lab test, or it can't be felt by palpating somebody's abdomen, or it can't be seen on a CAT scan, then it doesn't exist. Physicians forget that perception and emotion are data, too — just different kinds of data. Those things include the patient's concerns, what a patient says, nonverbal signals, body language — all those things are data. The patient's perception is always relevant. Nobody has ever shown that becoming appropriately empathetic reduces the individual's ability to make logical decisions. [Emotional distance] is a mechanism doctors use because they are uncomfortable.”
Undoing such deeply rooted attitudes takes more than training. To help physicians really change their behavior, “we believe there has to be built-in accountability and follow-up,” says Woods. “We can say, ‘You have spent three hours taking this course, and so we're going to give you one CME credit — but in order for you to get your two additional credits you have to send us examples of how you are using this material in doing patient charts for the next three months.’” Other CME programs could adapt this approach, he suggests, by devising an e-mail-based follow-up system that links a physician to post-tests that are sent out on a monthly basis. “All of a sudden you have built-in accountability so physicians know they are going to have to use what they learned in order to get credit. It makes them listen harder.”
Typically, an organization contracts with WDI to provide the training for selected physicians. The complete personal development program is expensive — and so far pharma companies have shown no interest in supporting it. It's also time intensive, requiring a three- to 12-month commitment from participants. Physicians will soon have the option of taking most of the modules on CD or online, cutting down on some of the cost and time investment. WDI also offers shorter courses.
But the complete program is well worth it because it works, say Woods and Capizzi. A study of more than 2,000 committed participants showed that 99 percent of them demonstrated improvement of at least 33 percent over their baseline measure. (Committed physicians means just that: participants who want to learn. If, after several sessions, a doctor shows no intention of changing, “We call the organization and explain that we want to stop the doctor's training ‘because it's not worth your money and our time,’” says Woods.
And many physicians do resist executive coaching, seeing it as soft and touchy-feely. “A third [of physicians] hate my guts; a third understand the concepts but are unsure as to what to do; and about a third leave saying that they are going to change,” Woods acknowledges. Overcoming physician resistance is critical, he says, as the healthcare system faces a crisis with malpractice suits and patient satisfaction. “The interesting thing is that 80 percent of medical malpractice lawsuits are not driven by technical competency issues, but they're driven by the patient's perception that the physician has been rude or condescending or there has been ineffective or inappropriate communication.” When physicians balk at training in interpersonal skills, “We tell them ‘You are more likely to be sued because of a patient's perception than because of what you did.’”
While currently most of the groups that bring in WDI are malpractice insurance companies and residency programs, Capizzi thinks there's enormous potential for WDI to collaborate with healthcare networks and organizations such as specialty societies. Woods does introductory presentations at groups' annual meetings, for example.
There is a convergence of forces, Capizzi explains, pushing CME providers to consider interpersonal skills a priority. Under the American Board of Medical Specialties' new maintenance of certification requirements, physicians must demonstrate their competence in areas such as patient care, professionalism, and communication skills, as well as medical knowledge. The Council of Medical Specialty Societies has issued a report calling for fundamental change in the CME system, so that CME will better prepare physicians to fulfill these requirements.
“Most CME providers produce excellent, cost-effective activities that reach broad audiences, but personal leadership programming has not been a part of our educational tool kit,” says Capizzi. “You can create awareness about interpersonal skills with traditional CME, but you don't change behaviors. Physician leadership training, on the other hand, will change behaviors.” CME providers need to become educational coaches and help physicians set personal objectives and evaluate them, she says. “CME now needs to be part of the solution.”