Eddie Edhayan
How to Improve Continous Medical Education activity – Modeled on the Institute for Health Care Improvement
By nature physicians are high achieving individuals who want to improve their outcomes. The field of medicine is constantly changing and evolving with old paradigms being discredited and new ones being developed. Physicians need to keep up with change to be relevant with the times and to provide quality patient care.
Continuous medical education credits (CME Credits) asses knowledge needs but do not necessarily measure patient outcomes. Integration of CME credits with health care outcomes will provide a long needed solution of meeting the needs of physicians and providers by increasing the relevance of the material being studied.
In order to incorporate knowledge attained at CME into practice, doctors need to understand basic management paradigms on how change can be instituted and measured.
The following is a method to incorporate CME activity with improved health care outcomes using the Institute of Health Care Improvement’s methodology.
The Surgical Care Improvement Project (SCIP) protocols for infection control in surgery has been adopted by third party payors as a core measure for incentive payments. These protocols represent a shift in traditional treatment methods and adherence to a standard protocol. The SCIP protocols for reducing wound infections in Colon Cancer Surgery calls for
1) Standard Antibiotic choice for prophylaxis
2) Duration of antibiotic prophylaxis to be for 24 hours only
3) Antibiotic administration to enable antibiotic in blood stream at time of skin incision
The following is a plan to improve health care outcomes, provide for CME activity while using the Institute of Health Care Improvement
What are we trying to accomplish?
1) Compliance with SCIP protocols for antibiotic use in Colon and Rectum Surgery
2) Decrease in rates of wound infection and improved health care outcomes
How will we know if that the change is an improvement?
1) Decrease in wound infection rates over a period of one year when compared with previous year
What changes can we make that will result in the improvement?
1) Institute a protocol for infusion of appropriate antibiotic at the appropriate time before surgery
Implementation - Plan, Do, Study, Act
Plan: A protocol will be developed indicating appropriate antibiotic use. The committee to develop this protocol will be multi-disciplinary with nursing, pharmacist, surgeon and anesthetists participating.
Do: A CME event will be held to educate all surgeons on the new protocols and its benefits. The CME activity will involve workshops by
1) Surgeon leaders on the improved health care outcomes from following this protocol
2) Infectious disease specialists on appropriate antibiotic use
3) Administrators on financial benefits from third party payors on compliance with protocols
Study: After a period of 6 months the following will be measured
1) Appropriate antibiotic use prior to surgery
2) Antibiotic in blood at time of incision
3) Discontinuance of antibiotics in 24 hours after surgery
4) Infection rates
Act: In 6 months outliers will be identified. Surgeon leaders will discuss the protocol with non-compliant colleagues. Reinforcement of the data and adherence to the protocol will be emphasized.
In one year annual infection rates (improved health care outcome) will be presented to the group. Administration will share data on incentive payments received for compliance with this protocol.
Conclusion:
Current CME activity does not address the issue of health care outcome. The present CME model involves giving credit for time spent listening to a lecture without taking into consideration implementation of what is learnt.
The CME topic should be relevant to the audience. Relevance can be identified with a needs assessment or in this case by an audit of patient care data. In this patient population it will be the appropriate use of antibiotics. Once a topic is identified the willingness of the learners to change should be assessed. Most current CME activity is to fulfill licensing requirements. The incentive for this program is to provide a meaningful change in patient outcomes and a financial incentive from compliance with SCIP protocols.
Most CME activity does not “close the loop”. CME activity does not identify if meaningful change has occurred. There has to be a commitment from agencies providing CME to evaluate change in outcomes. The problem in most cases is that changes in outcomes are incremental and may be too small to measure. A follow up questionnaire can be used to assess retention of learning at the least. A recent trend towards creating categories of CME is a step in this direction. Categories of CME that require the participant to pass a test fit into the superior category.
In conclusion, CME activity has to be relevant and aim to improve health care outcomes. Measurement of change in outcomes should be done to follow up CME activity. If such measurement is not possible, retention of learning should be evaluated.
Comments (2)
Bev Wood said
at 8:28 am on Oct 23, 2011
I hope you are right and that all health professionals assume responsibility for learning, keeping up to date, and delivering appropriate care. This requires good self assessment and reflection skills and also decisions about what our deficiencies are. Maybe this is what we should really train people to do. Business has been doing it for a long time, and now successfully. Medicine is getting on board, but maybe a little late.
CME is indeed very concerned with health outcomes to iindicate that education was appropriate, fit the target audience need, and answered an established deficit. However, noone seems to really know how to understand and measure the outcomes in terms of effect on health of a population. I notice you get it and put it into a QI plan, and that is a very appropriate way to address the need for good protocols and physician and health professional dedication and cooperation to see that it works.
David Disbrow said
at 12:00 pm on Oct 25, 2011
I fully agree that relevancy is an important issue when addressing CME issues. Although I have never attended a CME activity, I can easily relate to the desire of ensuring that time is well spent and that outcomes are a vital part of the conversation. “Closing the loop” by thoroughly revisiting meaningful commitments made by members of an activity is an excellent idea. Perhaps this should be part of the process re: licensing requirements. I recently read an article which gave an example of a company that let their employees do whatever they wanted to do for one day a month, but the next day each person reported the work that they did to a large group. The innovations produced in the company that arose from their “freedom” was incredible, and of course knowing that they had to report on their work was key. It seems to me that CME activities could involve reporting relevant change, including outcomes if appropriate. A given activity can involve pre-determined short-term or long-term findings that are reported to adequately document closing the loop and create more momentum with lifelong learning.
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