CME 2012: making change happen
Dr Alisa Pearlstone and Dr Jamil Bacha
Alisa Pearlstone and Jamil Bacha talk about the brave new world of CME, where a new-found focus on effectiveness rather than just knowledge gain is bringing about real change in clinical practice.
Do you sometimes find the status quo just that little bit irresistible? Are you drawn toward the hypnotic “how-things-are-generally-done-round-here” of life? And once it has you in its sight, do you find yourself bewitched and unable to break free? To follow the path of least resistance is, of course, The Human Condition. It makes us efficient and streamlined. But we also know it’s not always a good state of affairs: as esteemed educator and writer, Dr Lawrence J Peter once wrote: “Bureaucracy defends the status quo long past the time when the quo has lost its status.”
A quo that lost its status long ago is the CME activity whose outcome is a satisfaction score, the educational event whose impact is measured by the number of participants that attended.
Amid growing disillusion in healthcare standards, our friends across the pond feared that CME would be thrown out as a relevant medium for preserving or enhancing standards in healthcare. Continuing to plan and measure CME as has always been done before was not an option if the field were to prove itself a reliable vehicle for driving improved outcomes. Indeed, Einstein’s famous definition of insanity was to do the same thing over and over again, expecting a different result. This dawning realisation contributed to the nascent change in the direction of North American CME. However, back on the European stage, it seems that some key actors may well still feel a little trapped in the status-free zone.
Resistance on the ground
The good CME practice group (gCMEp) is a collective of CME providers that are committed to preserving the best of European CME and helping to deter the worst. When we founding members of the group decided to have a bash at setting out some standards for European CME providers, we circulated our four proposed gCMEp principles to around 100 stakeholders for consultation.
“Of course, doing CME the right way is more costly and resource intensive.”
Three of the four principles – transparency, balance and appropriateness – were enthusiastically and universally endorsed with a faintly audible murmur of approval across the ether. What was interesting to us was the problem child: “effectiveness”. Sure, it was endorsed by the majority. Nevertheless, the lower level of endorsement and higher level of critique relative to all the other principles revealed a surprising level of wariness toward the pressure to measure outcomes. Where does this resistance hark from?
Money, money, money
Of course doing CME the right way is more costly and resource intensive. It involves carrying out research to truly understand the clinical issue that needs intervention, rather than second guessing based on the experience, interests and instincts of individuals involved. It involves identifying creative ways to bring about teaching moments that are appropriate to the clinical deficit and the audience – and rarely relies on the pure didactic approaches still most commonly used. It involves joined-up thinking that takes the clinical practice gap identified and ties it to a robust and relevant process for gathering evidence of changed practice. All of these things take much more money and time. And that has to come from somewhere.
The time has come for a brave new world in which ‘making change happen’ becomes a mantra for European CME: from accreditors to funders, from providers to learners. Only then can we possibly hope to create real traction for, and the will to invest in, outcome-oriented medical education.
“The time has come for a brave new world in which ‘making change happen’ becomes a mantra for European CME…”
What to change, what to measure
Dr Donald Moore, an expert in the CME field, developed an outcomes framework to help guide those setting up CME interventions. Measuring attendance or satisfaction lie at the very bottom of his pyramid, while scaling the summit of improved patient and community health demands a real change in what doctors do every day. According to Moore, creating and demonstrating practice change should be the minimum ambition of CME interventions.
Figure 1: Moore’s mountain of CME outcomes
Knowing different is not doing different
It’s easy to assume that simply explaining why things need to change is enough to make that change happen. Yet the journey from newfound knowledge to practice change is far from direct. Getting there takes not just declarative knowledge (understanding the science) or procedural knowledge (understanding the strategy), but educational approaches that address attitude, confidence and competence (level 4 on Moore’s Mountain). Just as you can’t learn to skydive by reading a book about it, the best way to learn is to do.
Can you imagine the Olympic athlete’s coach who trained their team by assessing only whether they showed up or how happy they were with their training, but never actually measured their performance to see if they were getting better? If we want to go for gold in healthcare, then the time has come to take a long, hard look at how we assess our doctors’ performances, design education and evaluate outcomes.
About the authors:
Dr Alisa Pearlstone
Alisa is a passionate advocate of the power of high quality CME to truly change clinical practice. She is a founding director of PCM Healthcare, an outcomes-focused med comms agency, and heads up PCM Scientific, the change-making CME division. She is also a founding member of the Good CME Practice Group. Alisa started her career in psychology, where her interest in adult learning began, completing her MSc and her doctoral research in neuroscience at the Institute of Neurology, Queen Square. She maintained her interest in science education in parallel as honorary lecturer and tutor at University of London. Since then, she has spent over 12 years in medical communications and education, rapidly rising to senior management positions, delivering global communications strategies and impactful educational initiatives with blue chip pharmaceutical companies.
She can be contacted at email@example.com.
Dr Jamil Bacha
Jamil Bacha is a Senior Medical Writer at PCM Healthcare, having joined their CME division in 2009. He has played a major role in supporting a number of international CME programmes, leading the development of a library of interactive teaching resources. He has long been passionate about science education, studying science communication within his degree, presenting extensively to lay audiences on topical science subjects and instilling enthusiasm in children under the auspices of science education outreach programmes run by the University of Cambridge. He holds a PhD in genetics from the University of Cambridge and was a first class graduate in biochemistry from Imperial College London.
He can be contacted at firstname.lastname@example.org.
What does the future of European CME look like?