Dear Readers,

All of us have been affected by the current COVID-19 pandemic and its subsequent attenuation measures. It has affected the health of many, and certainly how we work, learn, and teach.  

As mentioned by Albert Einstein “In the midst of every crisis, lies great opportunity”.

In his article “Technology-Enhanced CPD After 1.5 Years of the COVID-19 Crisis: Where are We”, Dr. Vjekoslav Hlede elegantly describes how the current crisis has affected our relationship with online learning. This made us remember a commentary recently written by a group of Canadian ophthalmologists.¹ The authors mentioned that the most important benefit to come from the rise in virtual CME during the pandemic is the “increased access to those who have historically been excluded from traditional CME activities”. The authors described that the “increased uptake of virtual delivery of CME provides an opportunity to reduce barriers to access to high-quality resources irrespective of local medical education resources or personal barriers to access.” The authors commented that this is particularly true for women who “participate less frequently at conferences, serve on fewer journal editorial boards, and are less commonly listed as primary authors in peer-reviewed journals.” Participation in CME activities is definitely a first step in closing the gender gap in medicine.

As editors, we would like to acknowledge the importance of diversity, equity and inclusion (DEI) in our discipline.  Dr. Jann Balmer discusses an innovative education and training program implemented at UVA entitled Stepping In 4 Respect in direct response to situations of discriminatory behavior on the UVA campus and in the community. To this cause, we are happy to announce the establishment of a new standing column on DEI in this newsletter. We are delighted that Dr. Mohammad Salhia, chair of the new DEI taskforce for SACME, has agreed to serve as the column editor.  We hope this column will promote discussion of DEI issues and their critical importance to the future of medical education among our SACME members and at their home institutions. Look for this column in the fall issue. 

Wishing you all a wonderful summer,

Martin and Robert

¹Can J Ophthalmol Volume 56, Number 1, February 2021 - click here to view.

In this section: 

• Stepping in 4 Respect: Building a Culture of Respect & Inclusion
• The benefits of librarians participating in Project Extension for Community Healthcare Outcomes (Project ECHO™) programs
  

Stepping In 4 Respect: Building a Culture of Respect and Inclusion

By Jann T. Balmer PhD RN FACEHP FAAN

One day after the presidential election of 2016, several of our residents reported significant discriminatory and disrespectful incidents in the hospital. The events of August 2017 in Charlottesville escalated the incidence of a pattern of discriminatory behavior in our health system and our community.  Some of the injuries of white supremacists required hospitalization so the Confederate flag, and other discriminatory wearables and tattoos were evident to our faculty, staff, residents, trainees, and students. Most of these clinicians and team members represented the cultures that were the targets of the conflict in our small city. 

In a proactive move, the Health System leadership created a task force of students, residents, nurses, attending physicians, chaplains, FEAP (faculty and employee assistance program), DIO, Deans, CMO, and CNO to review the situation. The group described the major problem as “failure to respond to acts of disrespect involving health professionals, trainees and students” and that a multi-pronged approach to addressing this challenge was needed. The approach includes education and training, policy, resources for reporting and support and setting expectations through messaging.

This case study focuses on the education and training initiative developed by the University of Virginia Health System (School of Medicine, Nursing, University Physicians Group and Medical Center). The curriculum, based in wisdom theory and associated evidence, serves as the foundation for the approaches that we use in this organizational change initiative.

Drs. Peg Plews-Ogan and Greg Townsend lead the Stepping In 4 Respect Collaborative with support from Dr. Susan Kools in the SON and Dr. Susan Pollart. The Office of Continuing Medical Education, with support from the SON CE office, serves as the educational design, logistic/commercialization and accreditation team. We have a large interprofessional planning committee who pulled together a two-day Train the Trainer Conference in November 2019.  This conference responded to the expressed interest from other academic institutions who wanted to use our framework, resources, and the IRB research study, etc. for their institutions.

The potential for assessing the impact of this approach on organizational change and culture in a number of academic medical centers and health systems, creates an opportunity for multi-institutional analysis of the model. The Office of CME worked with the UVA Licensing and Ventures Group to create licensing agreements and IRB reliance agreements for these institutions. Through collaboration with Micron Research, a UK-based specialist data company, a multi-functional web portal collects all of the pre/post and six-month survey data from all Train the Trainer conferences and two-hour workshops, and houses all of the educational materials that UVA created for this program.

The two-day Train the Trainer program prepares potential Collaborative institutions to build and train their leadership teams in an immersive organizational change strategy that addresses discriminatory and disrespectful interactions while adhering to their core mission of healthcare. Each institution can integrate and expand the Stepping In 4 Respect curriculum to align with their organizational priorities, structure and mission. Currently, six academic health institutions/health systems are implementing the Stepping In 4 Respect Workshop to their faculty, staff, and trainees and participating in the IRB study through reliance agreements. Three additional academic/health systems are joining the Collaborative.

The Stepping In 4 Respect Workshop is a highly interactive, two-hour session that provides faculty, staff, and trainees with information about how and why addressing discriminatory behavior is critical to meeting our mission here at UVA. Through the introduction of the B.E.G.I.N. framework (Breath, start with Empathy, set the Goal, Inquire, Engage), based on wisdom research, we provide the scaffolding for the “duty to act” and address these situations when they occur.  We provide participants with “back pocket” phrases for each of the 5 steps in the framework. The re-enacted video scenarios depict discriminatory behavior from patients, families, peers and supervisors that occurred over the past several years and reflect actual events at UVA. These scenarios serve as the foundation for building awareness and creating urgency for action. All of the Stepping In 4 Respect Collaborative institutions utilize this two-hour workshop as the primary vehicle for engaging clinicians, trainees and staff.

The video scenarios serve as the triggers for a group debrief. The facilitators guide the discussion of the scenario to help participants reflect on the emotions and frustrations that can result from these types of interactions. The discussion is followed by “improvisation” exercises in a “fishbowl” environment so that volunteers can respond with a follow-up conversation to the event and the entire group has an opportunity to respond with questions, comments, etc. In most sessions, the workshop can include three videos during the course of the two-hour session.

The other critical element of this project focuses on measuring of the impact of this initiative on our individuals, teams and organization. Through the design and utilization of the Stepping In web portal, with Micron Research, collection of all pre, post-workshop and 6-month survey data, as well as resources and CE credit information for learners, is accessible through this web portal. The web portal design has four levels:

1) IRB/research access, which is limited to the de-identified data for all of the survey questions by meeting/session.

2) Facilitator access, which provides access to all of the videos, resources, information and a list of the participants/session, but no access to the research data.

3) Administrator access, which uploads the names and email addresses for facilitators and participants per scheduled meeting/session. The administrator manages all of the enrollment and distribution of the invite/pre-workshop survey.  Subsequent surveys are pre-programmed to go out to the participants. The administrator deletes any no-show participants to keep the IRB data is accurate.

4) Participant/learner access, which provides entry to the pre, post and 6 month surveys, resources and information about CE credit.  Each of the Stepping In Collaborative Institutions has a unique version of the web portal for their institution. The institution can review all of their survey data as desired. The University of Virginia as the lead institution in the IRB study can have access to the aggregate data from all of the institutions participating in the Stepping In 4 Respect Initiative.  Additionally, a one-time student survey is scheduled annually as a “canary in the mine” assessment of organizational change at each of the Collaborative institutions.

Since the impact of COVID, we have been holding these sessions virtually. We are currently limiting each session to 20 people. Our AV vendor manages all of the technical and logistic elements of the workshop as the content; discussions, etc. require the full attention of the facilitators. Since July 2020, UVA has trained over one thousand (1,000) clinicians and staff members through over 66 Zoom sessions.

Preliminary Research Results

At UVA, the initial review of results (Feb 2021) from the Stepping In 4 Respect initiative are as follows:

• 54.4% of participants reported having witnessed examples of discriminatory behavior in the health care setting in the preceding six (6) months
• 21.7% speak directly to the perpetrator
• 30.1% speak to the target.

Workshop Impact

The workshop data shows that of all participants:

• 81.4%  Are likely/very likely to change responses to discriminatory behavior (n=194)
• 83.1     Have improved their response to incidents of discriminatory behavior (n-77)

The University of Virginia/UVA Health is pleased to share our lessons, insights and work with other leading academic health systems. We believe that the commitment of our healthcare professionals, support staff, trainees and students is focused on the delivery compassionate care while supporting our valued colleagues and team members.

Jann T. Balmer, PhD RN FACEHP FAAN, is the Director, Continuing Medical Education at the University of Virginia School of Medicine, jbalmer@virginia.edu.

The benefits of librarians participating in Project Extension for Community Healthcare Outcomes (Project ECHO™) programs

By Daphne Horn, MI, Terri Rodak, MA, MISt and Sarah Bonato, MIS

For the past five years, Librarians at Centre for Addiction and Mental Health (CAMH) have been participating in multiple Project Extension for Community Healthcare Outcomes (Project ECHO™) programs, resulting in numerous benefits for staff, program participants, the library and librarians. 

ECHO is an innovative continuing education model that creates virtual communities of practice and builds healthcare capacity in underserved communities. The ECHO model leverages scarce healthcare expertise and resources by connecting “hubs” and “spokes” using tele-video-conferencing technology.  Practitioners in community settings (the spokes), and inter-professional specialists based at hospitals or academic centers (the hub) engage in multidirectional learning.

An ECHO session generally includes a didactic presentation from a hub member or guest, followed by a case presentation by a spoke participant.  Subsequent group discussion results in a list of recommendations for the case presenter (Babineau et al).

Librarians participate in seven of the nine ECHOs hosted by CAMH, either in embedded or consultative roles. As part of the inter-professional hub team, they work collaboratively to provide evidence-based information and tools for both the hubs and spokes.    

In the embedded model, a librarian is attached to a specific ECHO from the planning stage through to the final session. Before the cycle begins, the librarian might conduct literature searches to inform the curriculum and gather evidence to support didactic presentations (Rodak & Bonato).  The librarian then attends all sessions (approx. 16-32 weekly sessions) presenting at the start of each session the resources they gathered from the previous week’s questions, and posting them on the “library resources” section of the online participant portal.  Librarians provide resources that answer explicit questions that arise from the sessions and by attending the sessions they see gaps in knowledge and provide resources to help answer unspoken questions.

In the consultative model, the librarians do not attend the ECHO sessions.  Any questions that arise from the session are sent to the library and distributed to one of our three librarians based on their workload.

For the librarians, ECHO provides many unique opportunities including relationship-building with internal and external clinicians, learning the language and concepts used by different professional groups in mental healthcare, increasing the visibility of medical librarianship within the hospital and in the community, generating funds for the library, and providing valuable training for librarians new to the mental health and addiction field.

Benefits for ECHO participants include access to the expertise of medical librarians and curated collections of high-quality, evidence-based resources to supplement discussion topics, answer their specific questions, and enhance their clinical practice.   Resources are shared in a virtual Community of Practice Hub for continuous learning by ECHO participants.

While the benefits of participating in ECHOs are many, there have been some challenges.  The resources that the librarians gather must be open access to accommodate the spokes varying degrees of access to paid resources.  For similar reasons, grey literature is a common source of information, but it needs to be critically appraised.  It is important not to inundate the spokes with too much information so librarians must appraise similar resources to select the most suitable (Rodak & Bonato). Capacity is another challenge, as our small library has limited human resources to attach to ECHOs, and at times has strained to support multiple ECHO’s while maintaining other projects and work.  Lastly, hearing case presentations about patients can be mentally and emotionally taxing.  Recognizing that librarians do not have the same training or professional experience as their clinical colleagues, we are currently working with leadership to establish a skills development session for new non-clinical ECHO participants. 

With over 960 ECHO programs in 45 countries, your library is likely able to find opportunities to become involved in this impactful and rewarding initiative. 

The authors Daphne Horn, MI, Terri Rodak, MA, MISt and Sarah Bonato, MIS work at the Centre for Addiction and Mental Health, Toronto, Canada. Contact Daphne.Horn@camh.ca. 

References

Babineau, J., Zhao, J., Dubin, R., Taenzer, P., Flannery, J. F., & Furlan, A. D. (2018). The embedded librarian in a telehealth continuing medical education program. Journal of Hospital Librarianship, 18(1), 1-14.

Rodak, T., & Bonato, S.  (2021).  Coping with COVID: Supporting the Mental Health and Professional Practice of Healthcare Workers Through Embedded Librarianship.  Ontario Library Association SuperConference.  February 3, 2021.  Online.

By William Rayburn, MD

This column aims to provide a list of insightful publications on topics of interest to teaching faculty and professionals in CME/CPD. 

Hanging up the surgical cap: Assessing the competence of aging surgeons

Determining when a surgeon should retire includes continuing education and public safety considerations. This search of websites describing non-medical professions where cognitive and physical competency are necessary include airline pilots, air traffic controllers, firefighters, and state judges. Six objective testing methods for evaluation of surgeon technical skills were identified and validated for surgical trainees. Only Objective Structured Assessment of Technical Skills (OSATS) was capable of distinguishing between surgeons of different skill levels and showing a relation between skill level and postoperative outcomes.  (Frazer A, Tanzer M. World J Orthop 2021; 12: 234-45 doi:10.5312/wjo. v12.i4.234. PMID: 33959487)

Australian endocrinologists need more training in transgender health: A national survey

This anonymous 14-item survey was a national medical society to assess the level of training and confidence of Australian endocrinologists and trainees in the endocrine management of trans and gender diverse (TGD) individuals in a representative sample.  The 54.9% response rate of the 545 members highlighted the shortfall in training and showed that prior clinical experience is associated with higher levels of confidence.  This targeted area will require more focused continuing education to adapt to meet the increasing demand for quality TGD health services (Bretherton I, Grossmann M, Leemaqz S, Zajac J, Cheung A. Clin Endocrinol 2020; 92: 247-57. Doi: 10.1111/cen.14143. PMID: 31845345)

Measuring impacts of continuing professional development (CPD): The development of the CPD Impacts Survey (CPDIS)

Evaluating CPD programs is essential to demonstrate their value to participants and their institutions. This study developed a survey that can measure a broad range of impacts of CPD programs, not just those that are easily measured such as knowledge, skills, attitudes, and confidence.  The development of the CPDIS survey was using best practice guidelines. A systematic scoping review, qualitative interviews, and existing survey instruments were used to develop the initial survey items. Professionals in international health professions education completed the survey. A principal component analysis provided refinements into three components: 1) learnings and self-efficacy, 2) networking and building community, and 3) achievement and validation assessed this broader range for more efficiently and accurately evaluating value of CPD programs. (Allen L, Palermo C, Armstrong E, Hay M. Med Teach 2021 Feb 26: 1-23 doi: 10.1080/0142159X.2021.1887834 PMID: 33635733)

Videoconferencing: A Steep Learning Curve for Medical Educators

The COVID-19 pandemic led to medical educators watching their health care systems morph and their ability to deliver in-person curricula disappear due to limitations on group sizes. This tutorial to make the “virtual education jump” serves as a starting point for transitioning curriculum from face-to-face to a virtual platform.  Three curricular design principles to optimize teaching via webinar include: making it active, making it accessible, making it appealing. Hosting a webinar successfully involves knowing your platform, practicing, having a partner, establishing ground rules, creating a learning environment, and avoiding pitfalls. Best practices in videoconferencing (lights, camera, action) are described. (Smeraglio A, DiVeronica M, Terndrup C, McGhee B, Hunsaker S. J Grad Med Ed 2020; October: 553-6. Doi: 10.4300/JGME-D-20-00514.1)

Perception among ophthalmologists about webinars as a method of continued medical education during COVID-19 pandemic

More medical specialty societies are conducting virtual multi-day annual meetings. A 21-question survey that focused on the quality and usefulness of webinars based on the Bloom’s taxonomy was circulated using digital media to approximately 1,400 ophthalmologists in India.   Of the 28% who responded, the quality of the webinars was good or excellent, knowledge was gained, and webinars were important in clinical practice and to be continued. However, there are needs for improvising the volume of webinars, target-audience-based delivery, and participant interaction to add value to this new dimension of teaching-learning that will likely continue either alone or as a hybrid with in-person learning. (Rana R, Kumawat D, Sahay P, et al. Indian J Ophthalmol 2021; 69: 951-7. Doi: 10.4103/ijo.IJO_3136_20  PMID: 33727465

Reliability of simulation-based assessment for practicing physicians: Performance is context-specific

I often wonder whether all practicing physicians will be required to undertake some simulation-based assessments to assess their competencies.  Anesthesiologists likely undergo the best simulation training using standardized complex simulation scenarios developed and administration for their maintenance of certification.  In this study, a subset agreed to be assessed by trained raters on both teamwork/behavioral and technical performance measures.   Findings showed that realistic simulation-based assessment is resource-intensive and may be best-suited for individualized formative feedback. Skill and knowledge gaps can be used in training programs and continuing education programs. (Sinz E, Banerjee A, Steadman R, et al. BMC Med Educ 2021; 21:207. Doi: 10:1186/s12909-021-02617-8  PMID: 3385837)

Faculty development for milestones and Clinical Competency Committees (CCC)

The goal of postgraduate training is the development of competency necessary for independent practice. This perspective article provides guidance for specific areas of faculty development for CCC members, including strategies for novel approaches to professional development for the committee. This includes the purpose and structure of the CCCs strategies, strength, and weaknesses of the assessments employed by the program, development of a shared mental model of the milestones of the relevant specialty, and the best practices of an effective group discussion. Optimal functioning of a CCC requires dedicated faculty time, education, and investment in faculty development across levels of experience and unique training needs of interprofessional members.  (Heath J, Davis J, Dine C, Padmore J. J Grad Med Ed 2012; 13 (April 2021 supplement): 127-31. Doi: 10.4300/JGME-D-20-00851.1)

Developing leaders and scholars in health care improvement: The VA Quality Scholars (VAQS) program competencies

Health care improvement leaders fill multiple roles within organizations and promote interprofessional improvement practice. The authors describe the VAQS program, an interprofessional postdoctoral training program whose mission is to develop leaders and scholars to improve health care. The final version included 22 competencies spanning 5 domains: interprofessional collaboration and teamwork, improvement and implementation science, organization and system leadership, methodological skills and analytic techniques for improvement and research, and teaching and coaching. Once attained, the VAQS competencies will guide the skill development that interprofessional health care improvement leaders need to participate in and lead health care improvement. (Horstman M, Miltner R, Wallhagen M, et al. Acad Med 2021; 96: 68-74. Doi: 10.1097/ACM.0000000000003658   PMID: 32769476)

Developing Physican gender as a source of implicit bias affecting clinical decision-making process: A scoping review

While medical education may not differ by gender, studies have shown that physician practice outcomes vary by provider gender.  This scoping review of 177 records found that gender-based implicit bias may be inadvertently acquired from culture and education. Although implicit bias is highly researched, much of the current literature focuses on the gender of the patient. This study found important gaps in the available literature regarding race and gender of the physician. Further studies could explore outcome differences between recent graduates and those in practice, for both female and male physicians. (Champagne-Langabeer T, Hedges A. BMC Med Educ 2021; 21: 171. Doi: 10.1186/s12909-021-02601-2. PMID: 33740973)

Developing Leadership Cirricula and Assessment in Australian and New Zealand Medical Schools

There is a significant research gap and no national consensus in these two countries on how to educate, assess, and evaluate leadership skills in medical professional entry degree/programs. A self-administered cross-sectional survey was distributed to senior academics and/or head of Australasian medical schools.  There is a variety of leadership competencies taught, with strength being communication, evidence-based practice, critical reflective practice, self-management, ethical decision-making, critical thinking and decisions making. Major gaps in teaching were financial management, strategic planning, and workforce planning. There appears to be no continuous quality improvement process for leadership education, and there is much more to do to shape professional development of academics to teach medial leadership and the required leadership skills for learners. (Jacquelyn Ross S, Sen Gupta T, Johnson P. BMC Med Educ 2021; 21: 28. Doi: 10.1186/s12909-020-02456-z    PMID: 33413349)

William Rayburn, MD, MBA is an emeritus distinguished professor, chair of obstetrics and gynecology, and associate dean at the University of New Mexico School of Medicine, Albuquerque, NM and a clinical professor of obstetrics and gynecology and graduate studies at the Medical University of South Carolina, Charleston, SC.

Column Editor: Helena Prior Filipe, MD, MMEd

CPD in Mexico:  The journey of Tecnologico de Monterrey, School of Medicine and Health Sciences to improve faculty scholarship and performance

By Mildred Lopez, MD 

Dr. Lopez is the Director of Educational Innovation Tecnologico de Monterrey, School of Medicine and Health Sciences in México. She shares her particular perspective, experiences, challenges and aspirations regarding the implementation of the CPD Office she leads.

The journey of the School of Medicine and Health Sciences in Tecnologico de Monterrey has been exciting. We are a young institution, a couple of years ago, we celebrated our 40th anniversary. The school started with only one program and 27 students. As time has gone by, it has become one of the 25 best schools in Latin America and has trained health professionals that practice worldwide. 

The dream that started in 1978 now articulates the TecSalud Health System, integrated by the Academic medical centers of San José and Zambrano Hellion Hospital and the TecSalud Foundation. As years have gone by, also have our conception of the needs of the organization. There are five undergraduate programs, 16 medical residency programs, and four scientific programs (two masters and two PhD). Our faculty members and collaborators are involved in creating innovative solutions and proposals with a patient-centered focus. 

This vision on transforming Mexican healthcare, and becoming leaders in the region, has guided how we define our continuous professional development (CPD) activities and assessment methods.  A few years ago, we were aligned with a highly traditional CPD paradigm where the clinician’s assessment was knowledge-based.  This method was limited to observing the quantity and level of academic scholarship, the prestige of the universities where faculty have completed their training, the results of their English examination, and the letters of recommendations of peers in their disciplines.  As experience has shown, this evidence does not guarantee the professionals’ outcomes with learners or patients. More information was needed on their involvement with quality of care or student involvement in the hospital setting.

In 2012, we started the first version of a new faculty development program for clinical educators, which in 2018 evolved into a competency-based model for continuous performance improvement of clinical educators. The objective was to create a new paradigm whereby medical practitioners could develop the leadership and educational competencies needed in clinical settings. This model embraced six essential competencies: 1) apply basic instructional skills, 2) foster learning in the clinical setting, 3) assess and debrief performance, 4) manage healthcare educational technology, 5) educate on bioethics and citizenship, and 6) promote quality and patient safety management.

As evidence of the development of clinicians’ competence, learners design a performance improvement project to implement within their own practice environment and measure the outcomes. The projects vary in their magnitude and topics, some describe initiatives in their practice, and others involve innovative teaching methods with medical residents. These interdisciplinary projects show the participants’ commitment to scholarship, as they have presented their projects and findings at many regional and international conferences.  Since its implementation, the results and successes of our faculty development program have been shared in different forums. To this date, the school has received several awards for this program: Qs Stars Award 2016, Ted Freedman Award for Innovation in Education of the Canadian Association for Health Services and Policy Research (CAHSPR) in 2016, and as a finalist project in Reimagine Education 2017.

As a consequence of this new CPD program, clinician habits have changed. We have become a community of lifelong learners eager to do more.  Now, our leaders are involved in different CPD organizations and committees where they have received formal and informal training in quality and performance improvement techniques. They are now familiar with concepts and practices that before were deemed as optional.  In turn, this has translated into new policies and support for greater faculty involvement in the quality and performance improvement initiatives of the institution. 

One of these new initiatives is our Educational Innovation Groups, where on average, 64 clinicians participate every semester in designing educational innovation projects. These groups also foster interprofessional development where health professionals from all domains collaborate.  Students from health and other disciplines help to identify the improvement issues that need to be studied. To date, 76 scholarly papers have been published by these groups. It can be seen that in the first couple of years, one or two papers were published.  In 2020, these groups published 19 papers describing innovation projects focused on the professional development of health specialists.

When we witness a profound transformation and, in a short time such as this one, genuinely focused on improving the quality of medical practice, one can only look forward with hope. I hope that our journey can inspire other schools to dream of the impossible. In times such as the ones we are facing today, where hope is nowhere to be seen, a community such as the one we are helping to build is everything. There is still much to be done, but we have worked on a solid foundation to map, plan and grow together.

Helena Prior Filipe, MD, MMEd, is a consultant in the College of Ophthalmology of the Portuguese Medical Association International Council of Ophthalmology, University of Lisbon, Portugal.

By Vjekoslav Hlede, PhD

This column aims to provide insight and practical information on the impact of e-learning on CME/CPD and the latest trends in technology available to enhance the online learning experience.

Technology-Enhanced CPD After 1.5 Years of the COVID-19 Crisis: Where are We Now?

Necessity is the mother of innovation

It has been 1.5 years since coronavirus disease 2019 (COVID-19) was recognized in China, and over a year since the first American COVID case was reported on January 20, 2020. It has been a time of crisis, changes, and innovation—especially in technology-enhanced CPD.

Twenty-three centuries ago, Plato wrote that invention is fueled by our need (Plato & Scharffenberger, 2005). "Necessity is the mother of invention" is a contemporary proverb rooted in the same thought.

The COVID-19 crisis is an example of such an emerging, innovation-generating need. We had to innovate how we commute, socialize, heal—and yes, we had to (re)invent how we learn. The CPD we know today is different than the CPD from 2 years ago. 

When the epidemic is over, we may go back to many old practices. Still, we will have a shared understanding that there are valid alternatives to face-to-face learning, and multiple ways to enhance the traditional learning formats with technology. We will be (more) familiar with different pedagogies we can use, and aware of the value technology-enhanced social learning and autonomous networked learning can deliver.

Many changes have been developing during the last decade or two. Therefore, we have had plenty of materials to use for innovations. The crisis has accelerated these changes. More importantly, it has catalyzed us, the people. We, as learners, CPD providers, and faculty, have gotten comfortable with technology-enhanced pedagogies. We have become accustomed to optimizing technology-enhanced CPD or finding innovative ways to address the limitations of technology.

One great example of an innovative way to address commonly mentioned limitations of technology-enhanced meetings was the SACME Annual Meeting session "What Connects Us: Meet Our Young Co-Workers (i.e., your kids)." During that session, conference participants joined with their kids, creating a unique, memorable, social, and friendly atmosphere. Imagine that—a chance to meet your peers and their kids, hear kids' perspectives on parents working from home, and see toddlers attempting to use keyboards. How awesome is that?! That kind of social interaction is not possible during traditional face-to-face meetings. Therefore, while replicating the rich, friendly atmosphere from live annual meetings in an online context can be a challenging task, there are a wealth of opportunities to innovate in adding meaningful social interaction to online meetings. 

For CPD providers, technological change is a big task that requires additional resources and new know-how. So, providers may be hesitant to take further steps in that direction. On the other hand, learners find it easier to say: "Yes, that is the way to go. "

For example, Swiatek et al. (2021) surveyed 902 spine surgeons from 91 countries and seven continents, and found that virtual medicine practices are being adopted very rapidly and that surgeons love them. Online education platforms have become the primary sources for spine education and physician-to-physician communication. In the same manner, telehealth, which was "once considered technologically cumbersome, financially unproductive, and difficult from a medico-legal perspective, has now become part of clinical spine surgery" (p. 9). Surgeons are happy with that direction.

Improved access to CME/CPD and access to high-profile experts in CME/CPD conference programming are additional benefits. It may be hard to expect busy, well-known experts to be ready to spend two or more days traveling (time, cost of travel and accommodation) to deliver one presentation at your conference. Yet, if they can join the conference from the comfort of their own office, they will be more prone to say, "Yes, I will be happy to present." For example, the SACME 2021 virtual annual meeting highlights were the sessions delivered by a few globally recognized experts. That is a benefit we cannot afford during purely face-to-face live meetings.

Kisilevsky et al. (2021) report that the COVID crisis has helped us improve collaboration between various CME/CPD stakeholders and has increased access to CME/CPD. Improved access to high-quality resources benefits all learners, especially those from groups that have traditionally had limited access to CME/CPD events (participants from remote areas, those with limited funding, or women with young kids, for example). Furthermore, virtual CME/CPD may be an equalizer that helps us reduce the gender gap in medicine. Virtual CME/CPD provides an opportunity for female faculty to increase involvement in CME/CPD. That is, as Kisilevsky et al. (2021) explain, an important step toward an equal gender balance on journal editorial boards and women being better represented as primary authors in peer-reviewed journals.

So, what will happen after the epidemic is over?

Based on previous technology adoption cycles among healthcare professionals—smartphone adoption, for example—it is fair to say the genie is out of the bottle. There is no way back. Physicians are very busy, highly trained, and well-regulated professionals, sharply focused on patients' health. Therefore, they do not have time to play with emerging technologies. On the other hand, if there is proof that a mature technology can help us improve patient care, and appropriate policies and regulations are in place, clinicians will adopt it very quickly. We can recall that clinicians were not early adopters of smartphones. There were many concerns about how a smartphone could negatively impact healthcare practices (Gill et al., 2012). And then, during the first few years of the last decade, that changed fast (Putzer & Park, 2012).

Now when we know the direction and the quite permanent nature of recent changes, we may ask ourselves, are there additional opportunities and gaps? The scoping review by Daniel et al. (2021) on developments in medical education in response to the COVID-19 pandemic reveals that there was quite a lot of research focused on pivoting to online learning, simulation, and assessment. On the other hand, they found only two articles focused on faculty development. Faculty skilled in supporting and leading engaging technology-enhanced CPD are critical for effective technology-enhanced CPD. Therefore, faculty development seems to be a gap and opportunity that requires additional attention.

The COVID-19 crisis has initiated many changes and innovations. Though the crisis is coming to an end, many of those changes and innovations are here to stay. We can use them to fuel new innovations and new improvements. The necessity in the near future will not be to react to the epidemic; the necessity will be to continue improving. While we do so, Kitto (2021) convincingly explains, our focus should not be on technology, but on how to use the technology to deliver human-centered improvements to the increasingly complex socio-technical systems we live in.

Vjekoslav Hlede, PhD is a Senior Learning Management Specialist with the American Society of Anesthesiologists, Chicago. 

References

Daniel, M., Gordon, M., Patricio, M., Hider, A., Pawlik, C., Bhagdev, R., Ahmad, S., Alston, S., Park, S., Pawlikowska, T., Rees, E., Doyle, A. J., Pammi, M., Thammasitboon, S., Haas, M., Peterson, W., Lew, M., Khamees, D., Spadafore, M., Clarke, N., & Stojan, J. (2021). An update on developments in medical education in response to the COVID-19 pandemic: A BEME scoping review: BEME Guide No. 64. Med Teach, 43(3), 253-271. https://doi.org/10.1080/0142159x.2020.1864310

Gill, P. S., Kamath, A., & Gill, T. S. (2012). Distraction: an assessment of smartphone usage in health care work settings. Risk management and healthcare policy, 5, 105-114. https://doi.org/10.2147/RMHP.S34813

Kisilevsky, E., Margolin, E., & Kohly, R. P. (2021). Access, an unintended consequence of virtual continuing medical education during COVID-19: a department's experience at the University of Toronto. Canadian Journal of Ophthalmology, 56(1), e18-e19. https://doi.org/10.1016/j.jcjo.2020.10.002

Kitto, S. (2021). The Importance of Proactive and Strategic Technology-Enhanced Continuing Professional Development. Journal of Continuing Education in the Health Professions, 41(1), 3-4. https://doi.org/10.1097/ceh.0000000000000343

Plato, & Scharffenberger, E. W. (2005). Republic (B. Jowett, Trans.). Barnes & Noble, Incorporated. https://books.google.hr/books?id=9FLdTCiaI_MC

Putzer, G. J., & Park, Y. (2012). Are physicians likely to adopt emerging mobile technologies? Attitudes and innovation factors affecting smartphone use in the Southeastern United States. Perspectives in Health Information Management/AHIMA, American Health Information Management Association, 9(Spring).

Swiatek, P. R., Weiner, J. A., Johnson, D. J., Louie, P. K., McCarthy, M. H., Harada, G. K., Germscheid, N., Cheung, J. P. Y., Neva, M. H., El-Sharkawi, M., Valacco, M., Sciubba, D. M., Chutkan, N. B., An, H. S., & Samartzis, D. (2021). COVID-19 and the rise of virtual medicine in spine surgery: a worldwide study. European Spine Journal. https://doi.org/10.1007/s00586-020-06714-y

Patient-centered Outcomes Research Institute (PCORI) Upcoming Funding Opportunities. Check for research areas and upcoming application deadlines.

Royal College of Physicians and Surgeons of Canada (RCPSC) offers a variety of grants to support medical educators, clinicians and researchers. Find more information here.

June

AMEE Live Webinar:  Creating Shared Online Medical Education for the World

Wednesday, June 23, 2021, Time: 1600 hrs UK., To register: Please register here

July

AAMC.  Telehealth Competencies to Train the Current and Future Physician Workforce – July 15, 1:00pm (EST)

 Includes a Live Web Event on 07/15/2021 at 12:00 PM (CDT)

Telehealth, defined as the use of technology to deliver health care at a distance, has become an increasingly important and commonly used tool for delivering care to patients. 

https://aamc.elevate.commpartners.com/products/telehealth-competencies-to-train-the-current-and-future-physician-workforce-july-15

August

AMEE 2021 Annual Meeting 

Redefining Healthcare Professions Together, A Virtual Conference, 27-30th of August 2021. www.amee.org

September/October

AHME/AAMC.  Teaching 4 Quality Certificate Course, September 22 – October 27. 

An all virtual, longitudinal curriculum, Te4Q is a faculty development course that aims to enhance the teaching skills of clinical faculty in a quality improvement/patient safety context. Teams are encouraged. An optional QIPS project is offered to earn a course certificate.  More information available in the next few weeks. Check www.ahme.org or www.aamc.org for complete details.