Continuing Medical Education: Looking Back, Planning Ahead

Introduction

1 David Price, Carol Havens, and Mary Jane Bell Introduction Continuing Professional Development and Improvement to Meet Current and Future Continuing Medical Education Needs of Physicians Friday evening, after a long day of patient care, a physician sits down to complete some paperwork before heading home for a quick dinner and going to see her children in a school play. She has seen several patients with complex medical problems , prompting several questions she is unable to answer. Rifling through her mail, she sees a letter from her hospital asking for verification of continuing medical education (CME) activities as part of her re-credentialing, an application from her state medical board requesting documentation of CME in several state-mandated content areas, and a reminder from her specialty board to complete her next set of maintenance of certification activities. She also sees her quality report card from a major insurance carrier, highlighting several areas for improvement. Scattered throughout the pile of mail are several journals and four di√erent post cards advertising CME meetings at various locations throughout the country. Feeling totally overwhelmed about addressing her patients’ unanswered needs, improving her quality report card, and meeting all of her CME requirements, she leaves for the evening , knowing that she will spend a good portion of her scheduled day o√ trying to catch up. What will CME look like in the future? We believe that the CME enterprise will evolve, guided by changing social and economic forces, to having greater value to physicians, other health-care providers, patients, and society. Emerging evidence demonstrates that CME is a vehicle for change. Done correctly, it can alter clinical practice behaviors and improve health-care delivery and patient outcomes. By advancing clinical practice among all health-care providers, CME can transform the health-care system to better meet the expectations of patients and society at large. CME professionals must continue to attend to the wants and needs of our main consumers, while engaging our physician colleagues in designing future CME. However, just as performance improvement CME (PICME) programs assess gaps in care and patient outcomes and not just physician self-expressed needs, we believe the CME enterprise must look beyond physician wants. It should be guided by the population health needs of communities, regions, states, and the nation. Thus, the future of CME will be determined not only by physician wants but by other forces and expectations. In addition to providers, stakeholders committed to creating healthy communities (i.e., citizens, payers, governments, and regulatory agencies) will shape the future directions of CME. The term continuing medical education is 2 introduction somewhat limiting. Continuing remains appropriate because it suggests a lifelong commitment to learning and performance improvement. Medical potentially constrains the content of CME to doctor-targeted, disease-specific updates at the expense of organizational as well as interprofessional education and practice learning opportunities . Medical also neglects the psychosocial and humanitarian aspects of the physician role and ignores the necessity for us to gain competencies in communication skills and cultural awareness. Education implies a learning process with an endpoint , just as one graduates from high school or college. Lifelong learning, another commonly proposed term for CME, may constrain the implied intent of our e√orts by suggesting that learning (knowledge), rather than doing, changing, or discovering , is the endpoint. Continuing professional development (CPD), a more inclusive term, better reflects where CME is going and will replace our outdated terminology. Even this term does not adequately reflect the scope of our future e√orts. No doubt, the terminology of what we call that which we do will evolve. We have chosen to use the term continuing professional development and improvement (CPDI) to describe the CME of the future. In this chapter, we will identify external trends in society, general education, and health care that define the future of CPDI. We will then hypothesize about what physicians will want and need from their CPDI activities, and we will discuss briefly the expectations of our colleagues of us, their future CPDI leaders. We will conclude with some predictions (or hopes) of what CPDI will look like 20 years from now. When the next CPDI retrospective occurs, we trust that the CPDI field will have progressed significantly and become an enterprise that aids physicians in personal and professional development and improvement, resulting in the transformation of the health-care system toward the delivery of patient-centered, humanistic, cost-e√ective health care...