Dear Colleagues,

The purpose of this issue is to share with our collective readership, a snap-shot of the rich content and thought-provoking discussions which occurred throughout the 2021 Annual Meeting.  The 2021 Planning Committee under the leadership of Asha Maharaj, rose to the extraordinary challenges of designing a virtual meeting curriculum with distinction.  As Betsy Williams noted in the President’s opening remarks, “the program was designed intentionally to present best practices, discuss data, and define the curriculum as an educational quality improvement intervention opportunity”.  The Committee’s thoughtful and detailed planning process achieved many SACME “firsts” in terms of educational milestones, a few of which are highlighted here: 

• it was the first experience in offering a virtual event and as such, it allowed for new and effective innovations in the presentation of member abstracts, posters and exhibits in an asynchronous, pre-recorded format; 
• all meeting sessions were recorded and are available for future use as enduring materials;
• post-meeting, all registrants have been provided “on-demand” and unrestricted access to all recorded presentations and educational materials which will “live” on the official meeting site for the next 12 months;
• it was the first “longitudinal” annual meeting curriculum spanning weeks, not days, starting with a selection of 2 and 3 hour, intensive workshops; and most important,
• it offered a curriculum which promoted extensive interactive learner discussions, as well as online networking via discussion boards and attendee email threads, all from the convenience of one’s office or home. 

As a service to our members and others who were not able to participate in the Annual Meeting this year, the CE News editorial team has developed this dedicated annual meeting proceedings issue.  In this issue, we provide brief summaries and key lessons learned for the pre-conference workshops, keynote presentation, plenary panel discussions, and member-authored abstract presentations in CME/CPD Best Practices and Best Research categories.  We hope you find it useful as a reference guide to the extensive annual meeting curriculum and enjoy reading the captivating commentaries of our guest speakers, as well as the inspiring and creative initiatives conceived by the brightest minds in CME/CPD practice today—by you, our members who made this issue possible. 

Wishing you the very best,

Robert and Martin

In this section:

• Strategic Leadership
• Program Evaluation and Assessing for Change
• Creating a Faculty Development Program for CPD
• Diversity, Equity and Inclusion Toolkit for Planners & Presenters at the University of Wisconsin-Madison

Strategic Leadership

Presenters: Barbara Barnes, MD, MS, FSACME and Morris Blachman, PhD, FACEHP, FSACME

Summary - This workshop was designed to assist participants in developing and exercising leadership skills within their institution, SACME and the field of CPD.   Pre-work included review of several key articles on relevant issues of leadership, identification of their own personal challenges in becoming leaders, and a commitment to change with a 6 month follow-up.  Participants, from the U.S., Canada, and Australia, worked in various administrative and academic roles.  The session began with a discussion about how to exercise power and implement the value proposition for CPD in their own institutional context and included how to implement change through tools such as power mapping in the volatile, uncertain, complex, and ambiguous environments in which we operate.  The facilitators illustrated leadership challenges and opportunities by sharing some of their own experiences.  Participants broke into small groups to identify challenges to exerting their own leadership, including engagement of key stakeholders, institution hierarchies and silos, and addressing competing priorities.   Potential strategies addressed included defining, and knowing how to present, the CPD value proposition, building strategic relationships, rebranding CME, and more clearly defining unit objectives in strategic alignment with their institution.  Finally, participants were asked to refine their commitment to change statements, define strategies enhancing their leadership positions in their own institutions and the field, and be prepared to share results in six months.

Key lessons learned for CME/CPD practice - The group expressed significant interest in ongoing leadership development, but also recognized significant challenges to accomplishing this unit and institutional levels.  The workshop revealed significant interest and opportunities to define the academic CPD value proposition and support SACME members in becoming effective leaders.   Administrative structures, scopes of programming and responsibility, and institutional expectations for CPD units vary greatly among our institutions. As a result, leadership development within our field must be adapted to accommodate these variations, longitudinal, and multifaceted.  

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Health Professions at the Crossroads:
Building a Better Normal

Presenter: Julio Frenk, MD, MPH, PhD, President, University of Miami
Reported by: Robert D’Antuono, MHA

“We are facing a unique moment in time”, began Dr. Julio Frenk, the distinguished keynote speaker at the SACME 2021 Annual Meeting.  “As a result of COVID-19 we are experiencing what has been termed as the ‘Fauci Effect’, that is, an increased interest by students wanting to go into the health professions,” he continued.  We are at a threshold of a revolution in education.  A distinguished physician, epidemiologist, academic and government leader (Minister of Health of Mexico, 2000 to 2006), and the lead author of the Lancet report Health Professionals for a New Century (Frenk et al., 2010), Dr. Frenk presented a compelling keynote address on how technology, learning science, and the transformation of the healthcare labor market will shape the future of health education and CME/CPD. 

Dr. Frenk cited two mega trends which have emerged from the present pandemic:  COVID-19 has become an accelerator of change in the health professions and health education in particular, and the strong interest in ‘building a better normal’.  We should think about building a better normal and to learn lessons from this pandemic.  As this is the 10th anniversary of the Lancet report, it’s appropriate to revisit the changes needed to transform education in the health professions.  There are three fundamental drivers of change that are clearly charting our road to the future: first, advances in learning sciences (how humans learn); which has resulted in the second driver, i.e. the unprecedented advances in technology (the online environment), and third, changes to the labor market driven by new professions being created from advances in technology.  

In the 2010 Lancet report, two dimensions of a new strategy for change were discussed: the instructional change and the institutional change.  The instructional dimension strategy poses some key questions about instruction, strategic shifts, educational redesign principles, and the need for continuous leadership development.  The key questions are: what to teach ( the curriculum); how to teach (mode of delivery); when to teach (target portion of the life cycle); and whom to teach (access and diversity).  The strategic shifts include moving from a closed instructional system to an open architecture; from a standardized experience to a responsiveness to diverse needs; and lastly from a front-loaded education to an education for life. 

To make these strategic shifts, we must embrace five educational redesign principles. The first is to offer a broad foundational knowledge that every graduate must achieve, along with cross-common competencies in critical thinking, ethical reasoning, communications (oral, written, visual), team work, and learning how to appreciate contrasting perspectives. 

The second redesign principle is to make education interdisciplinary and to assure a team approach. Third is a move into ‘engaged learning’ which is active, interactive among a community of learners, and personalized.  Fourth, a blended-learning format which is transformative, formative and informative.  Lastly, and most critical, we must strive to offer an integrated learning experience of online, onsite and in the field.  Throughout this new instructional strategy is leadership and continuous professional development opportunities for new and current leaders to move through the stages of leadership growth from the emerging to the mature leader.  

The second dimension of a new strategy is institutional reform.  Three changes are necessary:  Faculty resistance to change among colleagues must be eliminated making faculty development an imperative.  Our capacity must change and become more flexible, incorporate the use open learning spaces, and embrace more interactive technology.  Third, a culture of assessment and peer review which links outcomes to interventions in education must become the norm.  It is understood too that throughout this change process, we must recruit and retain minority faculty and students, and embrace diversity, equity and inclusion principles to higher education otherwise we will fail in our social mission.   

Building a new normal is likely to become the operational mantra of SACME members for at least the foreseeable future.  Dr. Frenk ended with a poignant quote from Albert Einstein: “You can’t solve a problem on the same level that it was created.  You have to rise above it to the next level.” 

In this section: 

• Communities of coping: Using the ‘Extension of Community Health Outcomes (ECHO)’ model to support health providers during COVID-19
• Creating spaces filled with grace – reflections on race, inclusion and belonging
• Engaging with music in self-care, healthcare and medical education
• Understanding our niche: The value proposition of CME/CPD
• The emergence of digital CPD: A new dawn, a new day

Communities of coping: Using the ‘Extension of Community Health Outcomes (ECHO)’ model to support health providers during COVID-19

Presenters: Javed Alloo, MD, CCFP, MPLc, Chantalle Clarkin, RN, PhD, Allison Crawford, MD, PhD, FRCPC, Andrea Furlan, MD, PhD, Anne Kirvan, Mona Loutfy, MD, Sanjeev Sockalingam, MD, MHPE, FRCPC and Betsy Williams, PhD, MPH

Institution: University of Toronto

Summary - The impact of the COVID-19 pandemic on frontline healthcare workers has resulted in psychological distress and the need to support mental health. Continuing professional development can have an important role in supporting individuals’ ability to cope with the distress of the pandemic and can help sustain and build resiliency. Drs. Sanjeev Sockalingam and Allison Crawford, Co-Directors of the program, discussed the use of an evidence-based CPD intervention, namely Project ECHO, a “hub and spoke” community of practice with a membership approaching 3000 individuals and over 750 organizations. In March 2020, Project ECHO launched its COVID-19 curriculum to support healthcare professionals’ ability to cope with COVID-19 and its mental health sequelae. The experiences of ECHO Ontario Mental Health Coping with COVID-19 illustrate how CPD can pivot to address emerging mental health needs in frontline workers within a broader system of mental health support during COVID-19.

ECHO COVID-19 was developed in one week using previously established ECHO implementation tools and processes based on the Consolidated Framework for Implementation Research.  It has had a significant impact on healthcare worker mental health causing issues with stress and moral distress.  The ECHO COVID-19 program currently has an interprofessional cohort of 831 participating healthcare providers and 339 health organizations, nationally.  ECHO uses virtual learning technology to leverage scarce community resources via teleconferencing.  ECHO COVID-19 is characterized by a sharing of best practices in the care of distressed healthcare workers; it utilizes a case-based learning format which is focused on improving and monitoring care outcomes while increasing access and referral to community providers in mental health, as well other specialists.  Education is self-directed and incorporates adult learning principles and strategies.  The ECHO curriculum is based on a participant needs assessment survey and literature review, and is focused on self-care topics to promote provider resilience, skills and shared resources, and strives to foster a robust community of practice.  Participants meet weekly for one hour sessions that consist of a mindfulness exercise, review of resources, Q & A, and sharing of personal experiences.  Within this community of practice, it was quickly recognized that participants were distressed, anxious and felt fearful of COVID risks.

Key lessons learned for CME/CPD practice -  Since implementation, program staff have turned their attention to reflecting and evaluating the model, collecting both quantitative and qualitative data, and using these data to make improvements accordingly.  Evaluation is iterative and ongoing.  Surveys reveal a very high satisfaction rate among  participants with improved confidence levels.  Key lessons learned are to be aware of the potential impact of COVID-19 on the mental health of providers and to carefully monitor the “distress curve” of our front-line healthcare workers.  In addition to the ECHO COVID-19 program, two other national EHCO programs have been established.  One is on Adult Intellectual and Developmental Disabilities, and another on Addiction Medicine and Psychosocial Interventions.

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Creating spaces filled with grace – reflections on race, inclusion and belonging

Presenters: Mohammad Salhia, HBSc, MEd, PhD, Nita Mosby Tyler, PhD, Will Ross, MD, MPH, and Ndidi Unaka, MD, MEd

Reported by: Mohammad Salhia, HBSc, MEd, PhD

Summary - Creating a Culture of Belonging and Inclusion was the second plenary at the 2021 SACME annual meeting.  It featured a panel discussion with Drs. Nita Mosby Tyler (Chief Catalyst and Founder, the Equity Project), Will Ross (Associate Professor and Dean, Diversity, Washington State University, St. Louis) and Ndidi Unaka (Pediatric Hospitalist, Cincinnati Children’s Hospital).  The session was facilitated in two parts. The first helped to level, set and create an understanding around issues of inclusion and belonging.  Next, we explored what it takes to move the dial, and how to enact meaningful change in organizations like SACME, and the broader healthcare community.  Conference attendees participated in a rich discussion online, sharing their own stories and perspectives, and, through online technology created a “word cloud” that showed us what was resonating most with them.

Words create worlds - This is the constructionist principle of appreciative inquiry that tells us reality is created through language and conversation. Indeed, we heard about the criticality of being explicit in our use of language to call out the actions and behaviors that need to stop or change, and that we need to see more of. Saying racism, anti-racism, diversity, belonging – the list goes on – is, in part, how our organizations and societies demonstrate putting a stake in the ground and making a commitment to interrogate our current systems.  Saying these and other words will create a world where tackling the issues and planning for change are, as Dr. Julio Frenk described in his opening plenary, a better normal.

The session was underscored by the panelists’ authentic, vulnerable, and accessible approach to storytelling and narrative that facilitated a nuanced interpretation of the race dialogue in the context of continuing professional development.  We heard about the profound experiences of people of colour in healthcare, and also the multi-faceted emotional, mental, and social effort required to push past current norms of racial inequity and prejudice.  Compassion and patience are necessary to the process, with the panelist citing the battle against phenomena such as compassion fatigue and imposter syndrome whilst talking about race.

Our role as individual agents, professionals, educators, and human beings is to work together toward a better normal.  It is to foster respect, empathy and compassion for our colleagues, students, patients, and, yes, ourselves.  We learned from our guests that racism and other issues of equity manifest in different ways.  Internalized racism is part and parcel of a broader system of institutionalized or systemic racism that have deep and far reach impacts on individuals and communities of color.  Both may act differently, although the outcomes are often similar.

It is not lost on me, that I prepare this summary and reflect on our current geopolitical climate and race relations, that the EDI discussion is not new.  It has evolved and changed, with new ideas folding into our current, multi-pronged definition of the space.  We learned, in fact, that equity, diversity, and inclusion were each nearly a decade worth of work in their own right, ultimately influencing today’s dialogue on belonging.

The intention in this dialogue is historically different than in previous generations.  As Dr. Tyler so simply put it, “this is the first time in my history that I have seen people not opt out of the work…. We have a generation of people now that don’t see this as optional,” going on to say that she “can see the chipping away at systems that don’t work. This is the right time to keep going without opting out.”

This plenary session was a call to action. It was an open and honest conversation that, through the eyes of the experts engaged, put a finger on, and named, many of the issues we find discomfort in articulating, or perhaps even acknowledging outwardly.  It challenges us to live within, and eventually move beyond this discomfort. It implores us to focus on our commonalities. It calls for us to make the shift from being a bystander to an upstander; an ally to an accomplice.  It demands that we re-evaluate and recognize our social contract as health care providers, educators, and researchers.  We must be, as Dr. Unaka noted, “anchored to our purpose – to leave a mark as a generation to make a change for patients, families, learners and professional colleagues with whom we, and our systems of learning and care, will engage.”

We heard many poignant messages about belonging and how it can be achieved. Here is what we learned, and what we will be carrying forward as SACME embarks on its journey to create a culture of belonging.

We were left with a message of compassion to go deep within ourselves, and to find, encourage, and adopt the philosophy of spaces filled with grace. This is a more profound and nuanced message than the traditional safe space.  Dr. Tyler described it as the space where we can be wholly and fully who we are. The space at which we are learning and growing together that is free of judgment and critique. This is the essence of the social contract referenced by Dr. Ross, and the anchoring and north star of a generation touched on by Dr. Unaka.

As we embark on this journey wherever we stand, and in whatever agency as professionals and global citizens, these spaces filled with grace are the points at which we will achieve equity.  SACME is making the commitment to do this for our members through scholarship and professional development. Lastly, our hope is to enable meaningful and action-oriented dialogue to speak openly about these issues, and to create our better normal. Remember, after all, that words create worlds.

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Engaging with music in self-care, healthcare and medical education

Presenter:  Lisa Wong, MD
Institution:  Massachusetts General Hospital

Reported by:  Joyce Fried, BA, FSACME

Summary -  In keeping with the theme of the meeting, “The Art and Science of CPD,” Lisa Wong, MD, Assistant Professor of Pediatrics, Massachusetts General Hospital and Associate Co-Director of the Arts and Humanities Initiative at the Harvard Medical School, presented a session titled Engaging with Music in Self-Care, Healthcare, and Medical Education.  Dr. Wong began and ended the session by playing a piece by J.S. Bach on her viola.  She asked the audience to feel the music with all five senses and explained that music brings out emotions that might not be otherwise accessed.

Utilizing music in medicine can decrease loneliness, anxiety, isolation, and burnout, while increasing resilience, curiosity, and creativity both for healthcare providers and patients.  “Physicians spend years learning technique, but the point of the healing arts is to transcend that technique.  We transcend technique to seek out the truths in our world in a way that gives meaning and sustenance to patients, fellow physicians, and our wider community”, said Dr Wong.

Both the Association of American Medical Colleges and the National Academies of Sciences, Engineering, and Medicine are supporting initiatives to add and integrate arts and humanities into the curricula of science and medicine. COVID has required an important pivot in how music is utilized. The Longwood Symphony Orchestra, established in 1984 in Boston, is made up of musicians who are medical professionals.  Pre-COVID they played concerts.  During COVID, students and doctors from the orchestra played music for their colleagues during lunch breaks outdoors.   Other projects during the pandemic include the Boston Hope Music Project providing musical programming that can be accessed on tablets by homeless individuals with COVID at a temporary shelter. 

Key lessons learned for CME/CPD practice -  Art in the curriculum can help to build empathy, communication, and teamwork. For example, music can teach comfort in silence, necessary to enhance listening skills.  In addition to benefiting students and physicians, this project also benefited frontline workers.  When the facility shut down, the musicians offered free private music lessons for healthcare workers and began playing virtual bedside concerts using Face Time for hospitalized COVID patients in isolation.  They also began playing live music for patients waiting in vaccine lines.   “Music heals”, Dr. Wong asserted.

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Understanding our niche:  The value proposition of CME/CPD

Presenters:  Annette Mallory Donawa, PhD, Morris J. Blachman, PhD, FACEHP, FSACME, Katasha N. Charleston, MPH,  J. Matthew Orr, PhD, Allison Rentfro, PhD, Kurt Snyder, JD, MBA

Reported by:  Helena Filipe, MD, MMEd, FSACME, AFAMEE

Summary -  While all involved were invited to reflect on one’s own experiences and share personal views on the strategic value of the CPD Unit and their leadership within the institutions they serve and encouraged an active exchange of professional experiences in a supportive and trustful learning environment, this engaging SACME workshop shined social learning principles as well as a significant component of personal and collective reflection.

The focus was on reflecting about the CPD value proposition, how it has been changing throughout the years and identify and assess the strengths, niches and value that CPD provides to organizations.

Topics approached were a) how to have meaningful and intentional conversations with leadership; b) aligning with the organization's ROI, financial goals, and health outcomes; c) writing an elevator speech; d) sharing lessons on rapid system collaborations during COVID-19 and finally e) building a value-added toolkit.

From CME to CPD -  The traditional CME office seen as a source of institutional revenue and funding needs linked with the regulation empowerment of accreditation and recertification and the paperwork shuffle involved has been progressing into the holistic and complex CPD conceptualization. Physicians lifelong learning current needs and preferential learning methods overflow the classic CME model in the multimodal formats and settings diversity where new learning can happen, with a clear preference for practice-based learning experiences and the wide variety of themes it should focus and embrace beyond the clinical.

As pointed out during the workshop and beyond any administrative role, physician’s leadership development is one of these needs to leverage the increasing complexity of quality healthcare delivery and what is increasingly expected from them.  Dr. Moss underlined the importance of the concept underpinning the acronym VUCA (volatility, uncertainty, complexity and ambiguity) as a catalyst recently boosted by the pandemic to advance and uphold how CPD should best support physicians lifelong learning and institutional CPD units should reinvent themselves as strategic allies for physicians, teams and the healthcare systems they work in, ultimately for better patients’ outcomes and the public health.

VUCA is holistic by highlighting four contemporary components of our daily life a) volatility: the fast and unpredictable changes without an immediate clear pattern or trend, b) uncertainty, frequent disruptive changes where the past is not a very good predictor of the future, c) complexity comprising the multiple, complex, intertwined technological, societal, geopolitical and ecological evolutions, and d) ambiguity shining little clarity on what is real or true and difficult to predict the impact of action or initiative. The Physician Executive Leadership Institute project led by Profs. Orr and Blachman was shared as one action example of knowledgeably and strategically progressing the CPD unit, by meeting physicians’ roles as leaders besides clinicians, educators and researchers. 

The future 21st century CPD office -  The CPD unit team should strive to a) assume a position of agent of change through communication, collaboration to innovate; b) provide system leadership by embracing change and adapt and by adapting transform analyzing what is possible to control, influence or more peripherally adapt/accept and strategize towards what can be further brought to influence or control; and c) develop cognitive and behavioral strategic management skills.  CPD educators and leaders should consider developing skills in a) providing expertise in learning; b) having needs assessment competency; and c) assessing multi-level needs (strategic alignment)- individual, unit and system.  CPD should incorporate goals as a) being an institutional strategic asset by enhancing provider and leadership capabilities; b) being a player by coaching, consulting, and providing direct support; c) to be a change agent by developing CPD engagement and learning activities able to meet strategic direction and future needs; and d) being a Thought Leader by developing office capacity to support CPD mission.

Key lessons learned for CME/CPD practice -  CPD has leapt from CME to meet the challenges of volatility, uncertainty, complexity and ambiguity (VUCA) of our times.  The CPD unit of the future is a new office of academic and professional development.  The CPD unit narrative should be C squared:  Collaboration and Communication are key drivers for strategic value creation in CPD and the CPD unit.  The CPD unit alignment with the institutional goals and needs is critical- the CPD Unit can strategically include well-being, mentorship and leadership in high quality education to impact innovation patient care and health outcomes.  Key performance indicators are important to center the elevator speech and develop the CPD unit leadership. Let us end with  quote:  “Lifelong learning supporting organizations with no CPD unit: a building without architects?” 

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The emergence of digital CPD:  A new dawn, a new day

Presenters:  Vernon Curran, DipAdEd, Med, PhD,  Heather MacNeill, MD, BSc(PT), MScCH (HPTE), FRCPC, Yuri Quintana, PhD, John Sandars, MBChB, MSc, MD, MRCP, MRCG, FAcadMEd, CertEd,

Reported by: Vjekoslav Hlede, PhD 

Summary -  The plenary session The Emergence of Digital CPD: A New Dawn, a New Day was the main technology focus session of the Annual Meeting with a panel of distinguished experts in digital learning.  Each offered different and useful perspectives on the digital revolution in medical education, the forces which brought about the current trends, and the strategies and methods to harness this massive redirection for the betterment of our learners across all levels of the continuum. 

Dr. John Sandars, Professor of Medical Education, Edge Hill University, UK, began the session with a focus on the emerging trends in learning: personalization, transfer to practice, and active learning.  Simultaneously, parallel emerging trends in technology include user-generated/social media, machine learning, and learning analytics using artificial intelligence (AI).  A massive growth in medical education has been the result of an open-architecture educational platform, FOAMED, which stands for Free Open Access Medical Education.  FOAMED is characterized by its user-generated content that is a result of collaborative and curated processes.  Analysis and appraisal of FOAMED content indicates it is a reliable source for information.  The Cochran Review is an excellent example of FOAMED at its best. Dr. Sandars went on to characterize the mastery of learning using machine learning, that is, artificial intelligence (AI).  Learners go through various levels and work toward a mastery of knowledge. Machine learning is capable of capturing vast datasets of learning and performance analytics, that are used to assess and enhance learner achievement.  The future of CPD indicates that each learner becomes “center stage” supported by a robust set of tools, a network of peers, and data sources.  

Dr. Vernon Curran, Associate Dean for Educational Development, Memorial University of Newfoundland, continued with a discussion of digital CPD trends, strategies, and evidence-based, best practices for online learning.  “COVID-19”, he noted, has given us a unique opportunity to help demonstrate the evidence-informed effectiveness of online CPD”.  Online learning includes an array of multiple and similar terms: e-learning, web-based learning, digital, virtual learning.  Online is a growing collection of different systems and platforms by which to learn. Modes of online learning include:  synchronous (via Zoom, WebEx), asynchronous (discussion boards, recorded presentations), and blended-hybrid (a combination of online and live content delivery).  The many advantages of online learning include its convenience and flexibility in terms of both the time and location of learning; it is independent; readily available; offers economies of scale and lower cost; and can be updated frequently.  Some disadvantages are initial technology costs, internet access in remote areas, and learning curves for learners unfamiliar with digital literacy.  But the advantages seem to far out-way the disadvantages for most groups of learners.  This seems to be true if you review online learning data user data.  The trend we see is a substantial increase in physician participation in online CME activities from 2012 to 2020, while studies have found no significant difference in learning outcomes using distance learning vs. live, more classroom learning.  Digital CME/CPD is as effective as face-to-face traditional teaching, across topics and disciplines.  Dr. Curran ended by highlighting that learner satisfaction and retention are enhanced significantly if the online instructional methods are varied to include cognitive interactivity exercises, instructor-learner discussions, feedback, homework assignments, patient case study discussions, practice exercises and self-assessment questions, and intentional repetition of learning sessions.  In conclusion, Dr. Curran stressed that online learning makes it entirely possible to build-in both formative and summative assessment methodologies for a far more comprehensive evaluation of learner performance and retention.   

Dr. Heather MacNeill, Faculty Lead, Educational Technologies, University of Toronto, began by making the point that learning itself has not changed.  “We have many traditional and online tools in the educational toolbox to choose from”, she stated.  What matters is if the educational objectives are achieved.  It’s a combination of the right tool for the right purpose.  She agreed with Dr. Curran and Dr. Frenk that blended-hybrid learning formats are the best approach for the future as it offers the most tools.  Also, Dr. MacNeill stressed the importance of collaborative learning tools, such as “Chat”.  Her final message was that we must plan carefully about how best to integrate all these tools into online learning.  Faculty development is certainly going to be essential in the re-training of our activity directors to embrace the new environment of online learning. 

The 2021 Annual Meeting was marked by these and other great presentations focused on innovative technology-enhanced CPD. Most of them were labeled as "Education Technology Innovations." However, many presentations from other categories had significant technological elements. They could easily be categorized as "Education Technology Innovations" or "Technology-enhanced CPD." For example, Farrell, Bassom, and Stoklosa's (2021) abstract presentation on interprofessional training for human trafficking educators was a good example of work that could simultaneously be classified as work in (1) Enhancing Education in CME/CPD and (2) Education Technology Innovations.  Dr. Farrell et al. combined social cognitive, constructivist, and experiential learning theories with widely available technologies (WhatsApp and Zoom).  If you are revisiting the 2021 conference website and looking for presentations and discussions on technology-enhanced CPD, the session group labeled "Educational Technology Innovations" is a great starting point. However, please do not forget to check sessions in other categories.   

I will conclude with a reference from Dr.  Julio Frenk’s keynote message Health Professions Education at the Crossroads.  The Covid-19 crisis made a technological revolution in healthcare education inevitable. That revolution will require healthcare education providers to adopt an open architecture in which the educational system is not a closed system separated from practice, but a well-networked system neatly interwoven with our professional and private lives. That system should emphasize lifelong education focused on unique learners' needs, and deliver active, interactive, and personalized learning experiences.

Reference -

Farrell, S., Bassom, R., & Stoklosa, H. (2021). Using Theory And Technology To Cultivate An Interprofessional Community Of Human Trafficking Educators Paper presented at the SACME Annual Meeting 2021.

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Each year, four winners are selected from among the many abstract and poster submissions during the Annual Meeting. Their work is presented here in acknowledgement of the extraordinary achievement of these SACME authors. Congratulations!

Jump to: Best Research | Best Practice | Best Early Investigator | Best Poster

BEST RESEARCH

Commitment to change (CTC) and actual practice change after a continuing medical education (CME) intervention

Authors: Sharisse Arnold Rehring, MD, John Steiner, MD, MPH and Mathew Daley, MD

Institution: Colorado Permanente Medical Group

Problem/Intervention - Evidence linking commitments to change (CTC) to actual practice change is limited, yet a widespread practice is to utilize CTC on evaluations as a means to assess CME outcomes. Commitments to change are intended to promote learner reflection, serve as a proxy for actual behavior change and even motivate learners to implement the intended change in practice. CTC usually depends on self-report. They are often used to measure effectiveness of CME since actual practice changes are difficult to measure in most settings due to inadequate access to clinical data, logistical challenges in measuring the content of educational interventions and lack of organizational incentives to invest resources in evaluation. Important questions remain about whether CTC accurately translates into performance change.

In an intervention that combined live CME with changes to the electronic health record to promote judicious antibiotic use for children with urinary tract infections (UTIs), we evaluated CTC and subsequent prescribing behavior in Kaiser Permanente Colorado, an integrated health care system. CTC was assessed immediately after the session using closed-ended questions about session learning objectives and open-ended questions to elicit specific practice changes. Perceived barriers to implementing recommended changes were also assessed.

Methods - The components of the CME intervention used to study CTC on pediatric UTIs included a live, case-based 2-hour educational session with randomized flipped classroom. All participants were offered individualized and peer-comparison antibiotic prescribing data. Spaced repetition emails with online knowledge assessments were disseminated along with “take home points” after the CME activity. Local clinical practice guidelines were published within the Clinical Library, which is available within the electronic health record (EHR) on the same day as the CME activity. New condition-specific order sets within the EHR addressing antibiotic prescribing in pediatric UTIs were developed and became available to family medicine and pediatric clinicians on the day of the CME activity.

Results - Among 179 participants, 80 (45%) completed post-session evaluations and treated one or more child with a UTI in the subsequent 17 months (856 UTIs total). In closed-ended responses to session learning objectives, 45 clinicians (56%) committed to changing practice for antibiotic choice and duration, while 37 (46%) committed to implementing guidelines. When asked open-ended questions to identify specific practice changes, 32 (40%) committed to antibiotic choice change and 29 (36%) committed to treatment duration change. Participants who made specific CTC statements had greater improvement in antibiotic choice (relative rate ratio [RRR] 1.56, 95% CI 1.16, 2.09) and duration (RRR 1.59, 95% CI 1.05, 2.41) than participants who did not make specific commitments. Few perceived barriers affected subsequent prescribing.

Key lessons learned for CME/CPD practice - The key lessons learned included the following:

• Commitment to changing specific clinical behaviors after a CME activity were significantly associated with sustained changes in prescribing for children with UTIs. At the end of the CME, some attendees were ready to change, made a commitment, and sustained the intended prescribing practices without ongoing audit and feedback. This is unique in the behavior change literature around antibiotic prescribing.
• Commitment to change in open-ended response evaluations of CME interventions may be associated with change in practice; and open-ended responses may be a better indicator of change in practice than responses to closed-ended evaluation questions.
• CME participants who self-identify as unlikely to make a change in practice may benefit from alternate educational interventions and strategies. Further studies on how to design educational interventions while maintaining the confidential integrity of the evaluation process are needed.
• Perceived barriers did not adversely impact the likelihood of practice change. Clinicians are not always able to predict whether perceived barriers will impact actual practice.
• This was a well-designed CME that met all the criteria defined in the literature for CME effectiveness. Further research is needed to replicate this finding.

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BEST PRACTICE

Accelerating the appropriate adoption of AI in healthcare through building new knowledge, skills, and capacities in the Canadian healthcare professions

Authors: Mohammad Salhia, HBSc, MEd, Rebecca Charow MSc, Tharshini Jeyakumar MHI, Azra Dhalla MBA, Caitlin Gillan Med, Dalia Al-Mouaswas BHS, Elham Dolatabadi PhD, Ethan Jackson PhD, Jane Mattson MLT, Jacqueline Waldorf EMBA, Manal Siddiqui MBA, Sarah Younus MPH, Wanda Peteanu MHSc, Walter Tavares PhD, and David Wiljer, PhD

Institution: University of Toronto

Problem/Intervention. There is a lack of capacity in healthcare systems to optimize the use of artificial intelligence (AI) to improve patient care, despite calls for AI integration as part of the National Academy of Medicine’s Quintuple Aim model. The proposed program will be designed to transform the mindset, skillset and toolsets of health care providers and organizational leaders across Canada.

Methods - To prepare a health care organization, its staff, its partners, learners, and its other stakeholders to have the knowledge skills and attitudes to harness AI tools effectively, a concurrent, multi-stepped approach is suggested to accelerate the rate of organizational change across Canada and ensure that AI not only automates but also enhances and optimizes health care delivery. This project consists of developing four education programs: basic AI awareness; two certificate-based programs to educate health care providers and leaders about AI; and a mentoring and coaching innovation hub.

Results - Framed by the Knowledge-to-Action framework, we are currently in the knowledge creation stage to inform the curricula for each deliverable. An environmental scan and a scoping review were conducted to understand the current state of artificial intelligence education programs as reported in academic literature. The environmental scan identified 13 AI accredited programs specific to health professionals where 4 were from the US, 4 from the UK, 3 from Canada, and 2 from Asian countries. The most common curriculum topics across the environmental scan and scoping review included AI fundamentals, AI in healthcare, ethics, data science, and challenges and opportunities of AI. There is a need for nationwide education standards, competency-based frameworks, and evaluation approaches.

Key lessons learned for CME/CPD practice - In order to participate in the shaping of AI practices, healthcare professionals must have the competencies and capabilities to implement and shape the future of their discipline and practices for advancing high-quality care within the digital ecosystem.

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BEST EARLY INVESTIGATOR

Leading and influencing change in continuing professional development: A work in progress

Authors: Morag Paton, MEd, Suzan Schneeweiss, MD, MEd, FRCPC, Jane Tipping, MADEd, Marta Guzik-Eldridge, BA, Rowland, PhD, Walter Tavares, PhD,
 David Wiljer, PhD. With special acknowledgement of Kaitlin Fuller, MLIS.

Institution: University of Toronto

Problem/Intervention - CPD remains underappreciated in the landscape and not well integrated into leadership structures (Vinas et al., 2020) in practice. While leading effective CPD requires competence across multiple domains, there is no requirement for CPD leaders to have completed professional development themselves (FMEC-CPD, 2019) and limited understanding of what educational leadership means or what it does in health organizations (Onyura 2019).

Methods - This study, presented as a work in progress at SACME 2021, has two main components. The first is an evaluation project of an existing CPD leadership program: Leading and Influencing Change in CPD (LAIC) which is in its fourth iteration and its first fully online delivery after substantial revision in content and format. We will use multiple data points including participant data, evaluations, assignments, and commitment to change statements evaluate the program based on levels 1-5 of Moore’s Framework (2009).

The second component is to describe what CPD (physician) leadership means, its competencies, and impact on practice change. This goal will be explored through a qualitative narrative study, first by conducting a scoping review of literature and complementing this, through interviews of CPD leaders and LAIC participants to better understand their lived experiences with leadership in CPD. We will use thematic template analysis (Brooks et al. 2015) to organize interview data.

Results - Early reflections from LAIC’s leaders on the transition to the online program indicate positive experiences with the integration of learning material, and improved involvement of and access to international CPD experts. Challenges include building a sense of community and balancing content delivery and interactivity.

Following Arksey and O’Malley’s methodology (2015) we piloted our search strategy with 5% of the 656 references (n=33) identified in MEDLINE. Title and abstract screening by two reviewers indicated that 33% (n=11) would be suitable to move forward to full text review.

Key lessons learned for CME/CPD Practice - At this early stage, we recommend working with a librarian to determine scoping review search strategies. We anticipate that this study will harness valuable data for new and developing CPD leadership programs and contribute to the growing literature about leadership in CPD.

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BEST POSTER

Educating correctional officers to better meet the mental health needs of inmates

Authors: Shaheen A. Darani, MD, FRCPC, Kiran Patel, MBBS, FRCPC, Laura Hayos, OT, Tanya Connors, MSW, Faisal Islam, PhD, Anika Saiva, HBSc., MPH, Sandy Simpson, MBBS, FRCPC

Institution: University of Toronto

Problem/Intervention - In Canada, there has been an increase in the rate of incarceration of individuals with mental health diagnoses. Over-representation of individuals with psychiatric diagnoses in correctional settings is well-established. Front-line officers play a central role in dealing with the mental health struggles of inmates. Nonetheless, the training that officers receive is often considered less than adequate.

Methods - A needs assessment was undertaken among officers at the Toronto South Detention Centre (TSDC) in Toronto, Canada. In response to needs identified, a one-day course was delivered to officers (n = 57) at the TSDC and Vanier Centre for Women (n = 41). The curriculum included mental health awareness; assessment of risk; communicating with inmates in distress; and self-care. Live simulations provided the opportunity for participants to identify signs of mental illness, assess risk, and respond strategically to de-escalate situations. Participants’ knowledge and confidence in their ability to identify and assist individuals with these problems was established using pre and post measures. Participant satisfaction was also measured via a survey. A three-month follow-up administration was used to determine maintenance of training gains. Focus groups at nine months were conducted to understand participants’ needs, learning, and impact of training.

Results - The results were promising, with 92% and 88% of participants at TSDC and Vanier Centre for Women respectively expressing satisfaction and 62% and 68% at TSDC and Vanier Centre for Women respectively stating they intended to change practices. Analyses of change in knowledge and confidence scores pre to post-training showed statistically significant improvement in all areas measured. Three-month follow-up at TSDC showed 75% of respondents have applied what they learned from the training to a “moderate or great extent”. Focus group themes showed improved attitudes and ability to identify behaviors related to inmate mental health struggles and interest in further training to support officers’ mental health. This study shows that training informed by officer learning needs can help them better meet the mental health needs of inmates. Training can improve attitudes toward inmates presenting with mental health issues.

Key lessons learned for CME/CPD practice - This study can guide the creation and delivery of future training programs. Training that is interactive and provides skills practice can have sustained impact on practice. Further training should integrate self-care to support officers' mental health. These findings could contribute toward best practice guidelines for future inmate mental health training programs.

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In this section:
I. Enhancing Education
II. Team-based Learning
III. Education Technology Innovations
IV. Equity, Diversity & Inclusion
V. Healthy & Inclusive Workplace
VI. Practice Change
VII. Post-COVID Implications

I. Enhancing Education in CME/CPD (16)

• Impact of PI-CME activity design characteristics on learner outcomes and sustained improvements in a regional healthcare system: 2015-2019 retrospective analysis
• Competency-based continuing professional development
  
• Using theory and technology to cultivate an interprofessional community of human trafficking
• In learning about a new medication: how patients can contribute in translating knowledge into better-informed practice
• White boards: The future of patient education?
• Educator, judge, public defender: Conflicting roles for remediators of practicing physicians 
• Continuing professional development in Canada: Preliminary findings from a scoping review of the Grey literature
• Moving towards mastery: A needs assessment for preparing CPD leaders to develop programs using educational technology
• Creation of just in time videos for healthcare educators on using synchronous technologies (Zoom)
• Physician learning from a summative, longitudinal assessment activity
• Using accredited CE and implementation science to build an academic healthcare system in an under-resourced community
• Promoting resilience and mental well-being during the Covid-19 pandemic: Using the echo model to provide system support to frontline healthcare professionals
  
• Turning COVID lemons into virtual exhibit hall lemonade: Successfully maintaining compliance while integrating virtual exhibit halls into accredited CME
• Evaluation of health care provider training in tobacco dependence treatment: Moore’s levels 5 and 6 
• Educating the educator: A novel model for change and quality education
• Active learning in continuing education: A Delphi study of in-person and virtual techniques

II. Team-based Learning (2)

• Joint accreditation: Now what?

• Improving UW-Madison ICEP global evaluation survey

III. Education Technology Innovations (10)

• Enhancing high risk procedural skills training through active learning, emerging technology and simulation
• Advancing continuing professional development in quality improvement using workshops and an online project registry – In Progress
• Technology and academic medical leadership education: An evaluation of learner feedback of a hybrid leadership module for “learning in an academic health system”
• 10 Tips for transitioning to a synchronous online CPD environment
• Real time virtual support: Bringing medical education and clinical support to the point-of-care
• Innovative use of technology to enhance point of care ultrasound education
  
• Virtual learning about community engagement in clinical research
• Evaluating the future of faculty development: An actor network theory-based analysis of a virtual conference
  
• Just-in-time faculty development: A scoping review
• Designing Comprehensive Online CE Courses for Healthcare Professionals Targeting Practice Change and Patient Care Improvement
  

IV. Equity, Diversity and Inclusion (5)

• The potential influence of gender in framing reason for referral to a remediation program
• The role of practitioners in indigenous wellness – participant experience with cultural responsiveness training
  
• Beyond “mini-me” and #MeToo?: An environmental scan of physician leadership programs that include concepts of diversity, gender and race
  
• Findings from the implementation of r2c2 model of feedback for psychiatry residents within a competency-based medical education framework
  
• The potential of implicit bias in physicians referred for communication issues

V. Healthy and Inclusive Workplaces (2)

• Creating a culture of humility: Equity, diversity and inclusion
• The Oregon Wellness Program

VI. Practice Change (5)

• “Change talk” in small group learning communities – an ethnographic study
• Teaching trauma tools: Two novel approaches to continuing professional development for healthcare providers in developmental trauma
  
• Mental health training for correctional officers: A systematic review
  
• Evaluations of continuing health provider education for opioid prescribing: A systematic scoping review
• A conceptual model of continuing medical education for population health

VII. Post-COVID Implications (7)

• Leveraging technology: 5 Steps for effectively selecting and implementing new platforms
• Mental health interventions and supports during COVID-19 and other medical pandemics: A rapid systematic review of the evidence and implications for CME/CPD
  
• UBC CPD’s rapid COVID-19 CPD response: A story of unprecedented impact and lessons learned
  
• From the front lines of a pandemic: Interviews with the experts—a six part CME/CPD series created in response to the crisis
  
• Research integrity southeast ’21: In the wake of a global pandemic-crisis response in the form of an interprofessional CPD conference
  
• The COVID CPD landscape: Market research and insights for planning programmatic offerings
  
• Effects of COVID-19 Pandemic on Continuing Medical Education Activities

The transformative learner: How are you handling CPD in 2021?

Presenters/Moderators: Helena Prior Filipe, MD, MMEd and Ellen Seaback, CHCP 

When the COVID-19 crisis hit, educators across the globe had to make an abrupt switch to virtual educational strategies, and educational leaders had to lead and manage change in a world where change occurred daily. In this unsettling and changing pandemic time, Continuing Professional Development (CPD) educators need to develop a global perspective in educational strategies and lead change. 

Moderator Questions & Learner Discussion

What challenges have arisen for you and your team?

The pandemic has briskly spread a unique worldwide urgency for developing adaptive leadership skills. Kotter’s leadership model could helpfully apply. The pandemic triggered a sense of urgency for a change to keep ongoing communities of learning. Isolation, anxiety brought by lockdown and uncertainty were suddenly dominating. Learners mentioned these challenges: loss of CME office staff, cancellations of live activities, learning new technology, faculty resistance and loss of the learner face to face, in-person experience.

What strategies have you devised to overcome them? How have you adapted?

More than ever there was an urgent need for collective and innovative work through constructive, supportive and trustful relationships to maintain continuing learning environments. Digital was the keyword to keep in touch and ongoing learning.  The already consistent evidence on the benefits of technology savviness in the academic environment has grown by the various robust publications reporting successful learning experiences in night-to-day adaptions of earlier face-to-face curricula or creating them from the scratch.  All these had in common well theoretical grounded scholar teaching incorporating interactivity techniques and space for human interaction and togetherness.

Scepticism and over-enthusiasm on technology applied in educational activities had been reduced with a positive yield for the community of learning. Learning environments could be held online, with positive and effective interaction strategies learners- content and also learners -learners and faculty in a supportive human transaction. Role shifting became more real as faculty could as well learn from learners in what concerns to technology and learners’ preferences as well as by showing their vulnerability as human beings before the pandemic tsunami, they could teach others about the value of leading by embracing uncertainty, listening to the community and keep learning from each other. From safe to brave, learning environments multiplied opportunities to develop leadership skills and build collective knowledge.

Some specific strategies mentioned by learners were: CME Office staff serve as consultants to activity directors regarding the selection of learning formats, an amplified role of the moderator in synchronous virtual activities, and adapting hybrid meeting formats. 

Which from those do you intend to carry with you beyond and above the pandemic?

Looking at the pandemic beyond a huge problem and more as a source of opportunities encouraging for change, communicating this vision and positively looking at the obstacles ahead with a consistent perspective built on previous online educational good practice and experience, keeping communication channels open will hopefully allow to anchor changes in a corporate culture.  Embracing technology as a tool and vehicle that combined with scholarly teaching, constructive relationship building in supportive, rich and inclusive continuing learning spaces will most certainly be reachable for more with reduce cost, highlight the effective translation of social, constructive, connectivism learning theories into practice. Developing hybrid formats and mastering technology tools and environments to effectively teach and evaluate learning and programs declarative and procedural learning.  Highlight feedback and debriefing as critical for effective learning and creating learning environments nesting engaged and engaging communities of practice.  This pandemic has been an incubator for developing competencies in tackling complexity and uncertainty spaces and subjects and address one’s and others around vulnerabilities with kindness, with a positive individual and collective learning yield for the community of learning.

What will you leave behind?

Absolute skepticism and over-enthusiasm about online education and a realistic and scholarly approach developing ongoing teaching for scholarship using technology.  Being in absolute control and showing our back to embracing uncertainty and count on the community support and wisdom we engage with to learn and grow.