Dear Readers,

The beginning of a new year is an opportunity to reflect on what was accomplished in the last 12 months. After a major revamp of CE News back in 2020, we continued our mission to curate relevant and timely information in 2021. We are fortunate to collaborate with dedicated individuals who share the same goal: to provide our readers with thought-provoking articles to inspire and enhance the work of SACME members. Below is a short summary of the work published by our precious contributors in 2021. All these articles can be found in the archive section of CE News on the SACME website.

Standing column editors

• William Rayburn (Publications & Scholarship)
• • This column aims to provide a list of insightful publications on topics of interest to teaching faculty and professionals in CME/CPD.
• Helena Prior Felipe (International CME/CPD)
• • CPD in Australia and New Zealand: An Evolution is Underway
  • CPD in Mexico:  The journey of Technologico de Monterrey, School of Medicine and Health Sciences to improve faculty scholarship and performance
• Vjeko Hlede (E-Learning & Technology)
• • Blended Learning Compared to Traditional Learning in Medical Education: Systematic Review and Meta-Analysis
  • Technology-Enhanced CPD After 1.5 Years of the COVID-19 Crisis: Where are We Now?

Spring 2021

• We published the most comprehensive issue of CE News with the publication of the proceedings of the 2021 annual meeting

Summer 2021

• Jann T. Balmer, Stepping In 4 Respect: Building a Culture of Respect and Inclusion
• Daphne Horn, Terri Rodak, and Sarah Bonato, The benefits of librarians participating in Project Extension for Community Healthcare Outcomes (Project ECHO™) programs

Fall 2021

• Mohammad Salhia Starting with Me, Myself and I – Reflecting on My Own Privilege
• Heather Clemons and Joenathan Rodriguez Determining Fair Market Value for CME
• Helen Mawdsley and Eleftherios K. Soleas Using a Common QI Method in a Health Professions Education Context
• Mila Kostic Back to the Future of the Virtual Journal Club

In this Winter issue, 2022, we offer two special reports and thought-provoking column articles, as well as a list of useful scholarly publications selected by Bill Rayburn, MD on an array of fascinating research topics with potential practical applications.  An interview with Gary Smith, PhD on ‘blended learning’ and his case study make up a two-part E-Learning and Technology column that you will not want to miss.

All this would not be possible without the efforts of our contributing authors and our production manager, Maggie Schultz. In 2022, we plan provide you with proceedings of the 2022 annual meeting and to enrich the content of CE News with multimedia content. We will pursue our mission with the goal to establish CE News as the leading CME/CPD newsletter.

We wish you all the best for the new year,

Martin and Robert

CE News Mission Statement The mission of CE News is to curate relevant and timely information that will inspire and enhance the work of SACME members and the broader CPD community by nurturing an open forum to share, highlight, and discuss emergent and best practices in teaching, learning, and education scholarship. Strategic Goals These strategies will be used to accomplish the mission: • Monitor and report on trends in the planning, design, delivery and evaluation of CPD activities via special interest features, standing column articles, podcasts and other formats. • Feature scholarly publications in health professions education practice and research. • Highlight key innovations and landscape changes in CPD. • Report on successful models for effective interprofessional CPD activities. • Announce upcoming funding opportunities in CPD. • Publish an Annual Meeting Proceedings Report as requested by the SACME leadership. • Nurture a network of content editors and contributing authors. • Utilize digital learning technology to optimize the readers’ experience as well as to access and search an historical archive.

The theme for the 2022 conference is “Work, Life, Learning: Navigating Through Uncertain Times." Plenary and workshop sessions will explore the context of well-being in our personal and professional lives, help to discover the keys to maintaining well-being, and provide actionable pearls to stop “surviving” and start “thriving” in our new normal. The conference will showcase evidence-based strategies for:

• building personal and professional resilience for clinicians, CPD providers, learners, and patients;
• increasing capacity for CME/CPD practitioners and educators to make a difference;
• decreasing burdens on our clinician-learners;
• using innovative approaches through the use of technology in continuing professional development programming; and
• increasing a culture of belonging and inclusion in our organizations and in our activities.

In addition, the SACME Planning Committee has confirmed an extraordinary and exciting line-up of experts as keynote and plenary speakers to expound upon conference themes and give us a deeper understanding of their importance as CME/CPD providers. They are:

Keynote and Plenary Session Speakers

Michele Harper, MD, emergency room physician and New York Times best-selling author
Black Butterfly Theorem: From Childhood Trauma to a Transcendent Healthful Self

Photo by: Nicole Mondestin

Michele Harper, MD has worked as an emergency room physician for more than a decade at various institutions, including as chief resident at Lincoln Hospital in the South Bronx and in the emergency department at the Veterans Affairs Medical Center in Philadelphia. She is a graduate of Harvard University and the Renaissance School of Medicine at Stony Brook University. The Beauty in Breaking is her first book. 

Stuart Slavin, MD, MEd, Senior Scholar for Well-Being at the Accreditation Council for Graduate Medical Education
Reclaiming Agency in an Out-of-Control World

Stuart Slavin, MD, MEd is Senior Scholar for Well-Being at the Accreditation Council for Graduate Medical Education (ACGME). A graduate of Saint Louis University School of Medicine, Dr. Slavin completed his residency training in pediatrics at UCLA and then served as a faculty member there for seventeen years before returning to Saint Louis University (SLU) as Associate Dean for Curriculum. While at SLU, Dr. Slavin led efforts to improve the mental health of medical students that produced dramatic decreases in rates of depression and anxiety in pre-clerkship students. He joined the ACGME in 2018 and is helping to lead efforts to improve the mental health of residents and faculty across the U.S.

 

Brenda Bursch, PhD, Professor of Psychiatry and Biobehavioral Sciences and Pediatrics, UCLA
Finding the Path Back to Meaning and Joy

Brenda Bursch, PhD is a professor in the UCLA departments of Psychiatry & Biobehavioral Sciences and Pediatrics, where she has been on faculty since 1994. Dr. Bursch is a hospital-based social and medical psychologist in Mattel Children’s Hospital. As a result of her decades of work in this setting, since 2015, she has been focused on health provider mental wellness, with the goal of applying science proven ways to minimize the impact of the stress and trauma of hospital work. She has developed resilience training modules, peer support training, and a mental wellness app for UCLA Health professionals. Over the past three years, her expertise has been sought to work in other high stress industries, including with firefighters and elite sports professionals. During the pandemic, she has served on the leadership team for the UCLA Health COVID-19 Wellness & Emotional Support Workgroup, training and coordinating the unit-based mental health support staff as well as providing direct support services for frontline health providers.

 

James Makokis, MD, a Plains Cree two-spirit family physician and winner of the Amazing Race Canada
A Conversation with Dr. James Makokis

James Makokis, MD, MHSc, CCFP is a Nehiyô (Plains Cree) two-spirit Family Physician from onihcikiskwapiwinihk (Saddle Lake Cree Nation) in Treaty Number Six Territory. He is the inaugural Medical Director of Shkaabe Makwa. He is an Adjunct Lecturer in the Dalla Lana School of Public Health, Associate Clinical Professor in the Department of Family Medicine at the University of Alberta. Dr. Makokis has interests in rebuilding the Indigenous health system and also has a transgender health focused practice. He is involved in several research projects including a Canadian Institutes of Health Research-funded project on developing transgender and two-spirit youth "Rites of Passage," on which he is a Co-Principal Investigator. In 2019, Dr. Makokis competed as one half of "Team Ahkameyimok" (never give up in the Plains Cree language) on Season 7 of The Amazing Race Canada and won. He is an avid ultra-endurance marathon trail runner, and lives with his husband Anthony and their dog Lucy.

Workshop sessions will reinforce SACME’s mission to promote the highest value in patient care and health of the public through the scholarship of continuing medical and interprofessional education and feature oral abstract presentations addressing research, best practices, and innovations across the continuum of CME/CPD from the wealth of quality abstracts that have been submitted for consideration.

Longitudinal programming will provide opportunities for experiential learning, professional networking, and social engagement in the weeks leading up to the three days of concentrated events in February and in the months following the Annual Meeting. 

Don’t miss the 2022 SACME Annual Meeting! For a full itinerary and to register go to www.sacme.org. 

In this section:

Medical Education in the Information Age

Stanford CME Reimagines the Future of Work with its Online Conference

Medical Education in the Information Age: Engaging learners and creating change across the continuum.
Reported by G. Robert D’Antuono, MHA

I had the good fortune to hear a presentation by Graham McMahon, MD, MMSC, President and CEO of the Accreditation Council for Continuing Medical Education (ACCME), on the emerging challenges in medical education during the virtual AHME Spring Institute last May, 2021.  Nearly everyone in medical education today is challenged to master new, more effective ways to train medical students and residents and to provide continuing professional development to teaching faculty.  Dr. McMahon, a skilled thought leader and clinician educator, has impressed us with his traditional and novel concepts and methods to teaching and learning.  An endocrinologist by training, he is a passionate educator with experience at every level across the continuum. 

The COVID pandemic has created opportunities and challenges in medical education: virtual learning has now become the standard method for learning and engagement.  We are now better situated to enable blended pre- and post-learning activities, and faculty can be more flexible in curriculum development and planning.  Dr. McMahon presented five concepts deemed to be innovative and effective educational practices: 

• Fundamentals of learning.  If you think about what distinguishes our learners, medical professionals are experienced learners, competent leaners, they can retain information well, and they are curious for more information.  They are motivated to achieve mastery yet challenged by a busy, stressful environment that may mitigate learning.  More importantly they suffer from a lack of feedback which leads learners to believe that they may be more competent than they actually are.  As a result, there is a tendency for learners to become complacent and have difficulty achieving mastery.  Mastery of learning can be achieved via carefully designed and managed curricula, as well as adopting assessments with actionable feedback and steps toward improvement.  Dr. McMahon stressed that clinicians are in fact motivated to achieve mastery and are especially responsive to comparative and constructive feedback.  Fatigue, cynicism, and burnout interfere with learning and must be mitigated. 
• Case-based learning.  Social learning can be used to explore cases.  It is a cognitive process that takes place in a social context.  It can occur purely through observation or direct instruction and in the absence of motto reproduction or direct reinforcement (Bandura).  Barriers to learner engagement can be significant.  For example, environmental distractions (noise, pagers, crowds), fatigue, low attention span of the learner, overconfidence, ambivalence or lack of motivation, and an overall group mentality regarding the case experience.  To mitigate these barriers, case selection is important.  It should be interesting, meaningful with an achievable goal.  Perhaps the case can be formatted to offer an individualized offering and build on prior learning. Offer hypotheticals. Making the case collaborative and a rewarding, positive and fun experience also help enhance learner engagement. 

In summary, the keys to case-based learning are: to clearly articulate the intent of the case; topic must be relevant to the learner; be of appropriate complexity; be discussed in a safe manner (e.g. “Which tests would you order?” rather than “What’s the correct test?”); and conclude with feedback and resolution from the faculty expert.

• Team-based learning.  A social construct for learning is important as we are in a different world with so many clinicians and staff involved in the care of one patient.  The care of patients is increasingly interdependent upon a different range of professionals. Each member of the team will remember different things about the patient.  Team-based learning is less efficient, however, the broader input from the team typically results in a better outcome due to the unique insights of each team member. Teams also reinforce and leverage human needs and when they are constructed to work well.  Such as our need for belonging, esteem, and safety.  We must move to an environment that is improvement focused rather than efficiency focused and is psychologically safe for team members to express themselves and accept feedback.  Teams fail due to inadequate communication, lack of team infrastructure, authoritarianism, hierarchies among the professions on the team, inadequate attention to people and their needs.  All these serve to create a negative learning environment for a team.  Ensuring team diversity is essential as well to gain different perspectives from different backgrounds. 
• Adaptive learning.  Adaptive learning leverages both sophisticated and simple education technology tools.  Educational technology means that you can be more efficient via individualized and adaptive learning plans.  You can connect and compare learner groups.  There is now evidence that online learning is more efficient.  Gains in knowledge, skills, and attitudes occur faster than through traditional instructor-led methods.  Online learning is more flexible and can accommodate diverse learning styles.  The best of all, online learners have demonstrated increased retention rates, better utilization of content and better achievement of knowledge, skills and attitudes as previously mentioned. 
• Faculty strategies.  Faculty must push learners into a new learning zone which assures psychological safety and accountability.  They must feel responsible for creating a learning environment that is positive.  Faculty must have administrative skills, leadership skills and know how to understand how a learning environment promotes learning and well-being.  The competency skills of learner feedback, scholarship, professionalism, assessment, program evaluation, remediation, clinical teaching and the science of learning are essential for all teaching faculty. 

In summary, Dr. McMahon emphasized that powerful learning experiences can be engineered using available technology.  Knowing your learner; building trust; incorporating assessment, feedback, active learning and using a team as a learning unit, are key to the medical education process. 

Resource: For a copy of Dr. McMahon’s slides, click here.

G. Robert D’Antuono, MHA is emeritus Assistant Dean for CME, formerly the Winthrop University Hospital Campus for SUNY Stonybrook SOM, now NYU Long Island Medical School, Mineola, NY and Co-Editor-in-Chief, SACME CE News.

Stanford CME Reimagines the Future of Work with its Online Conference
By Marilyn Mejia

This past September 15, 2021, the Stanford Center for Continuing Medical Education held an online conference on the Future of Work that aimed to address the ever-changing landscape of continuing education and reimagine work as the world gradually returns to pre-pandemic normalcy. This meeting of the minds resulted in a highly attended, thought-provoking event that focused on three themes: workplace practices, education, and events.  Conference attendees had the opportunity to learn from experts and colleagues during the concurrent sessions, join social sessions such as a live tour of St. Petersburg, Russia and encounters with land and sea creatures, and participate in the conference scavenger hunt to win prizes.  However, the most talked about sessions were the conference plenaries.  The Stanford CME team worked diligently to organize an incredible plenary line that included notable future of work thought leaders: Nicholas Bloom, Arthur Markman, and Yvonne Wolfe, each of whom discussed different facets of hybrid work.

The conference kicked off with Arthur Markman, PhD, the Vice Provost for Continuing and Professional Education at the University of Texas at Austin, and Yvonne Wolf, a Senior Consultant at the Neuro-Leadership Institute, both of whom had interesting perspectives on the hybrid workplace.

In his talk, Markman highlighted the importance of connecting to culture, purpose, and collaboration in the hybrid workplace. His overall message revolved around being intentional in our communication with others. He pointed out that bumping into others, seeing your work results, and moments of joy tend to happen naturally in a face-to-face environment. These moments may not happen when working with others online and must be created explicitly by orchestrating them. 

Markman suggested that highlighting successes, joyous occasions, and purposeful communication must be woven into day-to-day operations. He spoke about making sure to ask beyond ‘yes and no’ questions to get a better idea of how employees are doing and what their needs might be. He also made it clear that assumptions on work culture are detrimental and that social cues are harder to pick up remotely so employees should be trained on this when being onboarded. 

Markman was followed by Wolf who shared information fostering an inclusive team culture in a hybrid or remote environment. She explained that people can never completely divest themselves of their biases, but we can create processes without bias. Wolf went over hiring practices that accept those different from current employees including those that live far from work locations when it comes to remote work. She pointed out how this inclusion can strengthen teams by opening job roles to those most qualified rather than the closest physically. 

Wolf highlighted the need to create a work environment with an "all belong" mindset that actively works towards equity. She extended that mindset to remote workers and their homes, asking that leadership recognize not everyone has access to the same tools at home including fast Internet and private home offices. Wolf also suggested that in the case of remote workers and on-site workers, leaders need to actively bring in remote workers to avoid creating in and out-groups among different modalities. 

The conference was closed by Nicholas Bloom, PhD, world-renowned researcher on remote and hybrid work and Professor of Economics at Stanford University, who overviewed the transformation of the workplace during the pandemic and forecasted the permanent effects of this world-changing event. During the pandemic, the number of employees working from home quickly escalated from approximately 5% to 50%, which had a ripple effect on how employees view the importance of work flexibility. Bloom, who spent years researching the effectiveness of remote work, restated increased productivity and enhanced quality of life for employees.  Bloom’s suggestion for employers is to integrate a hybrid work model in developing return to office plans as hybrid work is the best of both worlds. Workplaces that have remote work as an option have shown an increase in output at least partially because employees are more likely to transfer commuting time into work and their personal lives. While building community and networking is better in person, employers have had to make at least partial concessions as businesses that asked employees to return to the office full time have seen a mass exodus and demands for more flexibility. 

While having a hybrid model is trending for the near future, it does come with its unique challenges that need to be managed thoughtfully. Bloom discussed how it can be easy to isolate remote workers from those on location and had strategies to mitigate that issue. A best practice for equalizing meetings is to make sure that if any employee is joining via video conferencing, everyone else also joins the meeting online to dissuade conversations that only those joined together can hear. Another best practice Bloom discussed to equalize remote workers and on-site workers is to make sure that working from home is not optional but mandatory in a hybrid model. This strategy dissuades employees from being competitive in demonstrating their willingness to show up at the office and possibly pass remote workers on promotions due to less visibility. Bloom also strongly recommended that employees be evaluated by output, or the final result of a worker’s effort, rather than input, or the amount of time it took to get the final result. This helps equalize workers in that no one is being judged for how long they sit at their desks but instead just how much they are getting done.

The plenary speakers, emphasized further by various panelists throughout the day, made a point of stating that many of the challenges that arise in hybrid and remote work are not new but merely presenting themselves differently and therefore, leaders should address these issues accordingly. Stanford CME’s Future of Work online conference showcased presentations from plenary speakers to panelists discussing, debating, and delving into ideas and best practices for our evolving work landscape.  Attendees reported signing off from the conference with nuggets of information and recommended strategies, better preparing them to confront potential challenges and embrace the sea of opportunities that comes along with hybrid and remote work.  The exploration of the Future of Work via Stanford CME’s online conference facilitated the reimagination of business, education, and event practices by illuminating a vision of a productive and collaborative workplace for employees both hybrid and remote.

For anyone interested in purchasing access to the recordings of this online conference, please contact stanford_cmelive@stanford.edu to learn more.

Marilyn Mejia is the Education Design Coordinator, Stanford Center for Continuing Medical Education, Stanford University School of Medicine, Palo Alto, CA

Column Editor: William Rayburn, MD, MBA

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

Embedding Learning in a Learning Health Care System to Improve Clinical Practice.

To bridge the gap from generating actionable knowledge to applying that knowledge in clinical practice and improving outcomes, new information must be disseminated to and implemented by frontline clinicians. This manuscript describes a mechanism (Quiz Time) developed at Vanderbilt University for embedding workplace-based clinician learning in the learning health care system. Beginning in 2020, clinician-researchers and educators designed a randomized, controlled trial to test whether this learning system influenced clinician behavior. Using data currently being collected, these findings will inform future directions for developing and deploying learning approaches with the goal of closing evidence-to-practice gap. McEvoy M, Dear M, Buie R, et al. Acad Med 2021; 96: 1311-4. DOI: 10.1097/ACM.0000000000003969

An Examination of Self-Reported Assessment Activities Documented by Specialist Physicians for Maintenance of Certification.

Maintaining certification in a physician’s specialty is essential. This study examined data from five specialties to identify: variations in participation in assessment activities, differences in the learning, and the frequency and type of planned changes. A total of 2,854 pathologists, cardiologists, gastroenterologists, ophthalmologists, and orthopedists provided data about a variety of assessment activities. Although most activities resulted in learning, fewer resulted in plans for change. Selection of assessment activities should include the opportunity for discussions of data to stimulate practice change. Activities in which there was a discussion with a peer or supervisor were more likely to result in a change. Lockyer J, DiMillo S, Campbell C. JCEHP 2020; 40: 19-26. DOI: 10.1097/CEH.0000000000000283

Demonstrating the Value of Postgraduate Fellowships for Physicians in Quality Improvement (QI) and Patient Safety (PS).

Academic fellowships in QI and PS have emerged as one strategy to fill a need for physicians who desire this expertise. This report characterizes the impact of two programs at the University of Pennsylvania and Harvard Medical School on the value to the graduates and institutions in which they are housed. This qualitative study involved interviews and analyzed using themes of 296 fellows and 16 mentors at a median of 3 years postgraduation. The graduates’ effort distribution was 50% clinical care, 48% QIPS administration, 28% QIPS research and 15% education. Two-thirds of graduates were hired in the health system where they trained. Both graduates and mentors perceived programmatic benefits related to individual career goal attainment and institutional impact. Myers J, Lane-Fall M, Perfetti A, Humphrey K, et al. BMJ Qual Saf 2020; 29: 645-54. DOI: 10.1136/bmjqs-2019-010204

Digitalization and Physician Learning: Individual Practice, Organizational Context, and Social Norm.

Information and communication technology (ICT) is a growing feature of a physician’s work and learning. Although ICTs can strengthen continuous professional development and learning at work, more research is needed. This survey of Swedish physicians enrolled in a CPD course highlights the need for formal training and support for specific ICT systems and the need to understand the usefulness of digitalization integrated into practice. Medical communities are influencers of use, which suggests that an emphasis on collegial expectations for digital collaboration will enhance practitioner adaptation. Vallo Hult H, Hansson A, Gellerstedt M. JCEHP 2019; 40: 220-7 PMCID: PMC7707155 DOI: 10.1097/CEH.0000000000000303

Association of Simulation Training with Rates of Medical Malpractice Claims Among Obstetrician-Gynecologists.

The incidence of adverse events in obstetrics has been estimated at 2-16% of deliveries. Root causes underlying sentinel events found that the most common issues were communication problems and deficiencies in the organizational culture, including an inability to work as a team and a dysfunctional hierarchy. This retrospective analysis compared claim rates before and after simulation training among 292 obstetrician-gynecologists, all of whom were insured by the same malpractic3 insurer and attended one or more simulation from 2002 to 2019. Compared with pre-simulation training, malpractice claim rates were significantly lower post-simulation training for the full period (11.2 vs 5.7 claims per 100 physician coverage years) and the 2 years post simulation training (9.2 vs 5.3). Attending more than one simulation session was associated with a greater reduction in claim rates. Schaffer A, Babayan A, Einbinder J, Sato L, Gardner R. Obstet Gynecol 2021; 138-44. DOI: 10.1097/AOG.0000000000004464

Toward Practice-Based Continuing Education Protocols: Using Testing to Help Physicians Update Their Knowledge.

This study of 112 family physicians belonging to a practice-based learning program aimed to support maintenance of competence by exploring variables that influenced the value of web-based pretesting. Two educational modules were studied, mostly in small groups. Relative to those given a review article, physicians given a pretest reported less time completing the assigned task, performed better on outcome test questions that were repeated from the pretest, and made a greater proportion of practice changes to which they committed. The study concluded that formative quizzes, delivered with feedback, can influence the amount of material practicing physicians remember from an educational intervention on the topic. Armson H, Order S, Wakefield J, Eva K. JCEHP 2020; 40: 248-56. DOI:  10.1097/CEH.0000000000000316

Can the Recruitment of Senior Transitioning Clinician Educators Enhance the Number and Quality of Resident Observations? Thinking Outside the Box.

Despite the ACGME’s Next Accreditation System mandating direct observation by faculty of training performance, the literature suggests that institutional culture does not support trainee observation and faculty have limited time to observe in an efficient and effective manner. The author proposes senior clinician educators who in their full-time careers established themselves as playing a major role in teaching and might be interested in continuing their relationship with the academic health center. Recruitment of the increasing number of seniors transitioning to retirement could significantly increase the number and quality of resident observations, addressing a previously insoluble problem with a relatively significant return on investment to the academic health center. Greenberg L. Teach Learn Med 2020; 32: 569-74. DOI: 10.1080/10401334.2020.1801442

Curriculum Transition from Lecture-Based to Team-based Learning (TBL) is Associated with Improved Performance on Internal Medicine In-Training Examination.

At first, this article may not seem relevant to continuing education. However, it makes an important point that compared to lecture-based learning, TBL is associated with improved medical knowledge acquisition. With TBL, learners acquire knowledge through advance reading assignments and then learn to apply this knowledge through real-world problem-solving exercises. This prospective cohort study examined the association between these two educational methods and the performance on in-training examinations by 120 residents at Albany Medical College. The percent correct scores were higher with TBL than lecture formats, in a multivariable regression analysis. Schynol G, Perog J, Feustel P, Smith R. J Grad Med Ed 2021; 13: 691-8. DOI: 10.4300/JGME-D-20-01164.1

Theory in Quality Improvement and Patient Safety Education: A Scoping Review.

Theory plays an important role in education programming and research. However, its use in quality improvement and patient safety education has yet to be fully characterized. The authors undertook a scoping review to examine the use of theory in quality improvement and patient safety education. Goldman, J., Smeraglio, A., Lo, L. et al. Perspectives in Med Educ (10); 319–326 (2021). https://doi.org/10.1007/s40037-021-00686-5.

Beyond Experiential Learning in Project-Based Quality Improvement Education: Questioning Assumptions and Identifying Future Directions.

Project-based experiential learning is a defining element of quality improvement (QI) education despite ongoing challenges and uncertainties. The authors examined stakeholders' perceptions and experiences of QI project-based learning to increase understanding of factors that influence learning and project experiences. Goldman JP, Kuper AMDD, Baker GRP, Bulmer BM, Coffey MMD, Jeffs LRNPF, et al. Academic Medicine 2020;95(11):1745-5. PMID: 32079957. DOI: 10.1097/ACM.0000000000003203

Jump-Starting Faculty Development in Quality Improvement and Patient Safety Education: A Team-Based Approach.

Quality improvement (QI) and patient safety (PS) are cornerstones of health care delivery. Accreditation organizations increasingly require that learners engage in QIPS. For many faculty, these are new domains. Additional faculty development is needed for them to teach and mentor trainees. The authors invited diverse stakeholders from across the University of California, San Francisco (UCSF) School of Medicine and related health systems to participate in a team-based adaptation of the AAMC’s Te4Q program. The teams completed 5 projects based on previously identified priority areas to increase local capacity for QIPS teaching: (1) online modules for faculty new to QIPS, (2) a tool kit for graduate medical education programs, (3) a module for medical school clerkship directors, (4) guidelines for faculty to integrate early learners into QI projects, and (5) a "Teach-for-UCSF" certificate program in teaching QIPS. Sandrijn M van Schaik 1, Anna Chang, Shannon Fogh, Melissa Haehn, Audrey Lyndon, Bridget O'Brien, Patricia O'Sullivan, Sumant Ranji, Glenn Rosenbluth, Niraj Sehgal, Jeffrey Tabas, Robert B Baron. PMID: 31663959. DOI: 10.1097/ACM.0000000000002784

“Systems-Integrated CME”: The Implementation and Outcomes Imperative for Continuing Medical Education in the Learning Health Care Enterprise.

Health care delivery has evolved from a variably connected collective of individually owned proprietorships and independent hospitals to an environment in which physicians increasingly contract with or are employed by health care enterprises. While continuing medical education (CME) that is focused on the dissemination and maintenance of medical knowledge and the development of skills plays a critical role in helping physicians keep up to date, the authors of this manuscript believe the structure and delivery of CME have not sufficiently evolved to be broadly viewed by health enterprise leaders as a strategic or integral asset to improving health care delivery. Therefore, an evolution and a reconceptualization of the structure and function of CME are necessary to enable collaboration between leaders and improvement experts in health care enterprises and CME. In this paper, the authors describe models that better reflect a more effective role of CME within learning health care delivery enterprises and the implications of such models for these enterprises and the CME profession. Price, D., Davis, D., Bin Rashid, M., Filerman, G., National Academy of Medicine Perspectives 2021, Vol 11 (10), DOI: 10.31478/202110a.

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 Editors: Eleftherios F. Soleas, PhD and Helen Mawdsley, EdD

This column speaks to practice innovations, emerging trends, and practical high-impact tools as well as what these mean for CME/CPD.

So, Change is Scary

This year the theme of our 2022 SACME Annual Meeting is ‘Navigating Through Uncertain Times’. Let’s set the stage here by discussing change and how we organize for change. As motivation researcher, I can tell you that change is to one extent or another scary. If you are nervous about the change afoot in the world of CPD, you’re not being a luddite or a laggard, you’re being human. I’ll be human too, I’ll use my circumstance at Queen’s as a case study.
 
Change, what change?
We like to group things together and this gives us comfort, so let’s talk about two groups of changes and act like they are terminally unique. There are changes occurring outside of CPD organizations and changes occurring within our CPD organizations. We are focusing in this article on the changes within CPD organizations. The fact is, these within organization changes may or may not be occurring to you, but I promise you they are true for either you or someone you know and perhaps like. Funnily enough, the changes occurring in CPD organizations are being driven by forces from within and from outside the CPD organization.
 
The call is coming from INSIDE the house
I like to think that I am a sensitive team lead for the CPD team of the office where I live. Even if I weren’t, I would be able to tell that people are stressed. That they are stressed is not surprising, WHY they are stressed is. Our staffs (and us) are feeling overworked, because they are working outside their comfort zone, and perhaps on topics and in ways where they do not feel expert, and it shows. We had people tobogganing, and now they are doing skeleton. You might end up at the bottom of the hill, but the way down is terrifying for folks whose livelihoods depend on appearing professional, poised, and one-step ahead of the folks who they serve. Simply put, the expertise of our pre-pandemic staff is being challenged as an integral part of the office. Much of the CPD provider crowd’s expertise was predicated on in-person programming that will NEVER be as common or as used as it was before (you heard that here 1^st or perhaps 51^st). Simply put, our hard-fought proficiency in skills for in-person no longer single-handedly qualify us as all-around experts in CPD. My team is still reeling from this, maybe yours is as well.
 
What got you here as a high-achieving, productive CPD creator, seemingly doesn’t matter as much as it used to. We’re not being hyperbolic if we call this a form of grief. It’s a type of grief where we miss the past, where what we were good at mattered and got us through the day and must accept that we have to wade into an uncertain present and future, where we are learning how to do what we need to do to survive. We are essentially learning the textbook the night before we take the stage and teach everyone else. 
 
Circumstances of the pandemic have required CPD organization to [synonym for pivot] (because I’m sick of that word) as demonstrated through the change of modalities for programs, as well as some CPD organizations accepting that they must become unwillingly leaner versus becoming leaner by choice. There are also COVID restrictions that have changed the social nature of in-person programming, depriving many of necessary human interactions. There has certainly been a loss of funding, which drives other losses. We also have changed retraining needs to contend with. Oh, and we have to deliver engaging programs virtually, and determine the best way to evaluate all of these changes to ensure we are meeting the spirit of accreditation standards
 
Organization and re-organization
At Queen’s, (Kingston, Ontario; it’s beautiful, come visit), we are a staff-heavy office which means that the vast majority of the leadership and function of the office is performed by staff rather than faculty. In fact, the only conventional faculty member in the whole building runs the joint. I can see pros and cons of this build. We have tons of doers, but exceptionally few clinicians on retainer. We are almost entirely reliant on our planning committees for the healthcare knowledge and proficiency. That said, a staff-heavy build benefits from stability and consistency that you can only really get from CPD being your full-time job. For clinician-faculty, CPD is more often than not, their SECOND job. Is this consultation-reliant build of office more agile and able to respond to the changing needs of CPD learners through partnerships? Maybe. If the CPD office (or pieces of it) went ‘poof’ and disappeared because of restructuring or insufficient cost-recovery, staff lose their livelihoods. This will probably matter more to staff reading this than it would to faculty. If the Faculty member lost their CPD hat would say ‘drat’ and I suppose see more patients. We’re talking about two different scales of calamity. This is why, in my perspective, staff, in the aggregate, feel and fear the changes more that faculty who have the security of knowing that there is a safety net for their gainful employment, treating patients. Agree with me or not, for CPD staff, there is much more for them at stake. Trust me, I’m one of them.
 
As I have slowly learned, not all CPD organizations have the same core funding. At Queen’s, we have university responsibilities in teaching, service, program organization which means we have a tranche of core funding that essentially pays for our building, our dean, and 2.75 full-time-equivalency of our admin staff members. The rest is on a cost-recovery mandate. Some organizations will have more, and some will have less depending on their circumstances. The pandemic did not magically increase our funding, yet it increased our expenses. We have a job to do and mostly our favourite tool (in-person) was conspicuously unavailable. We had to move on, willingly and unwillingly to try to do things differently.
 
This reality underpins the decision making on the types of program topics that a provider can offer. An office that needs more financial lift from cost-recovery to stay afloat simply doesn’t have the same resources to cover equally important, but less audience-garnering topics like Equity, Diversity, Inclusion, and Indigeneity (EDII).For this to change, funding structures needs to change. Perhaps, offering baseline funding for these under-discussed topics is a way to revamp the system and make sure that learning about these topics is consistently accessible, consistently encouraged, and consistently reinforced.
 
Tips, Recommendations, and Next Steps

• Think about how you are interacting with change. Are you processing, developing a response, refusing to engage, and/or embracing change? How are you meeting this change?
• With so much uncertainty, this is an excellent time to do some soul-searching. Decide what type of organization your organization wants to be. How would you find out?
• Unity of the CPD profession. We’re uncertain if there is a right response to the changes we are facing, but we’re positive a wrong answer is to try and respond alone. High-impact practices are meant to be shared and SACME is almost certainly a great place to do it.

To this end, I recognize this woefully short treatise on change in CPD is incomplete. Here are our emails (eks3@queensu.ca and helen.mawdsley@umanitoba.ca)  where you can tell us how much you (dis)liked this perspective and every perceived and unperceived factor that we missed. We’ll read every single response and listen.
 
Yours in Solidarity,
Terry & Helen
 

Eleftherios F. Soleas, PhD is Director of Continuing Professional Development, Professional Development & Educational Scholarship, Faculty of Health Sciences, Queen's University and Adjunct Professor, Faculty of Education, Queen’s University, Kingston, Ontario

Helen Mawdsley, EdD is Director of Research, Office of Continuing Competency and Assessment , Assistant Professor, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada

Case Study in Blended Learning and Interview with Gary Smith, PhD
Column Editor: Vjeko 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. 

Blending Learning Formats – A Story on how Baking a Cookie and Impactful Learning Interrelate                                                                An interview with Gary A. Smith, PhD by Vjeko Hlede, PhD

For anybody interested in CPD enhanced by implementation science, Gary Smith barely needs an introduction. As a Professor in Organization, Information, and Learning Sciences and Associate Dean for Continuous Professional Learning at the UNM’s School of Medicine, Gary co-authored a chapter in the latest “CME/CPD bible” Continuing Professional Development in Medicine and Health Care: Better Education, Better Patient (Rayburn, Davis, & Turco, 2017). He is the author of many papers focused on the interaction between faculty development, learning research and theory, and how to blend various learning formats to deliver successful practice change. Professor Smith also serves on the Academy Committee on Faculty Development.

Blended learning comes with many well-documented opportunities for improvement. With each of these opportunities comes the chance to make an error. In this article, Gary discusses ideas that may help us blend the CPD formats better with Vjeko Hlede. The second part of the article contains a UNM case study of how flipped classrooms—a blended learning modality—can deliver engaging, impactful CPD.

Vjeko Hlede: Thank you very much for sharing your case study and agreeing to this CE News interview, Professor Smith. Please allow me to start by reflecting on how I got familiar with your work. I became interested in your work in 2017 when the book CPD in medicine and healthcare (Rayburn et al., 2017) was published. I was impressed by your chapter (Smith & Stark, 2017) in the book. I was doing a Ph.D. at that time, and the chapter was foundational for my research. It is great to meet the author of that work. My favorite paper of yours is the essay where you use the metaphor for baking a cookie (Smith, 2015). Can you tell me more about the baking a cookie metaphor and how it can explain the challenges we face in CME/CPD offices?

Gary Smith: The essay where I use the cookie-baking metaphor refers to casual bakers who follow a recipe provided by someone else but maybe do not have much baking knowledge or skills. And so, if the recipe fails to create tasty cookies, perhaps because of some inappropriate adaptation of the recipe or lack of tacit baking knowledge, there's little opportunity for correction and improvement.

A more capable baker understands all of the ingredients and the steps in the process. He can learn from mistakes, innovate that recipe, and develop something very positive and different. The metaphor explains what faculty needed to know to teach well. It was written for faculty developers to think more about how they need to help teachers. Teachers need more than just lists of learning formats and activities. They need to understand how to use them, why they exist, and how various learning formats interact. The metaphor is equally valid in the CPD context. CPD staff can also benefit from thinking deeply about what they know about learning research.  Are they just following recipes and selecting from lists of learning formats? If you don't know why the recipe works or fails or how to adjust but still get that tasty outcome, you are just a line cook and not a chef.

Vjeko: Your paper argues that all faculty should be scholarly teachers. I wonder how we can implement that. And what about CPD professionals? Do CPD professionals need to be scholarly?

Gary: I feel that the CPD professionals involved in the design and implementation of the learning activities or who consult with the physicians and others who come to the office to create those activities should be taking a scholarly approach.  I draw that definition from higher education, where scholarly teaching refers to using research-based practice when designing, implementing, and assessing learning. As with any field, that means constantly updating knowledge and competence.

“Scholarly” and “scholarship” sometimes get confused. Scholarship involves disseminating what is learned, which is an important element of CPD. If we say that CPD professionals should take a scholarly approach, they consume what is disseminated about learning and transfer it into their practice. That's where I think this idea of scholarly teaching could be translated toward CPD in terms of scholarly approaches to the design, implementation and assessment of learning in our activities.

Vjeko: I wonder whether we could use the metaphor to tackle complexity better. The complexity of CPD seems to be a big elephant in the room. Our world is made of complex systems. Healthcare is probably the most complex system we have ever created. The tricky thing with complex systems is Donella Meadows (2002) explained that we can never fully understand them or control them. However, we can learn how to dance with them better. Can the cookie-baking metaphor help us learn how to dance? 

Gary: Yes. If we go back to the cookie-baking metaphor, we sometimes assume that we understand all the variables that determine the baking outcome. However, there may be variables we're overlooking or ones that are entirely outside our control, at least at the moment. So there's a certain amount of vulnerability and humility that goes into what we do. We must be aware that many circumstances aren't just complicated, but they're complex, and we may not have our hands around all the issues that will lead to success or failure. That points out how we in the education world tend to focus on learning designs and our interactions with learners, and we may lose the sense of the system in which everything is taking place.

That is a considerable opportunity. The system often has more control over the outcome than the learning we design. Therefore, better alignment with the complexity of the system may improve impact of the learning we support.

Vjeko:  So we have to think about systems and how to extend our reach. I'm wondering if we can use networked learning as a tool to build community and reach some of the things that have been traditionally out of our control. Networked learning is collaborative technology-enhanced learning where learners are situated in their unique local context and connected with resources, teachers, and other learners. Networked learning is often blended with face-to-face learning.

Gary:  Networks are important. Technology can enhance them, but they do not necessarily relate to the use of technology. Networking is what communities of practice are about. It's about people who have shared interests and are facing shared challenges and problems, who say, “We need to stay in touch. We need to share our ideas.” When we find something that works, we share that. When we find relevant information, we have a place to collect and curate that for everyone's mutual benefit. Those fit into normal ways people work and learn in their working environment. It is through the networks of people that they establish.

Vjeko: And, in that context, I wonder what SACME can do to support the change?

Gary: One thing is to encourage CPD providers to pay attention to what's going on in the broader realm of professional learning and development outside of educational institutions. Education is not the same as learning.

Education refers to formal scheduled experiences based on objectives created by the presenters and facilitators responsible for assessing the outcomes. That's very much the CME tradition. It fits into many of the ACCME activity types. In educational institutions, we tend to immediately think that, if there is some gap in performance or knowledge, all we need is a lecture on that topic, a webinar, or a conference.

Decades of research focused on learning in general and learning in a variety of workplaces show that professional development and learning mainly occur through learning on the job. Learning often takes much more informal approaches. That often includes communities of practice. This is why the non-academic learning and development community talks about this as creating resources rather than courses. And that rhyme speaks to the idea of supporting those dominant informal learning approaches. The focus is more on microlearning and performance support modalities than courses and enduring materials.

And here's where I think SACME could potentially take the lead and the scholarly support of learning by saying, “You know we're just a subset of professional learning and professions in general.” If we take a more holistic view and check what the nonacademic world and other professions are doing, we learn that it's not about signing up for webinars and sitting in conferences. We've been trying to do that here in the UNM. We've been focusing on on-demand, just-in-time-learning resources and smartphone-accessible web apps that support learning and performance in the flow of work and at the point of care.

Vjeko: When you talk about solutions, is it just about resources or about resources and networks? And, if we need both, how can we combine them?

Gary:  Relationship between professional development and networking is an exciting topic. Networks are arising in two different ways. There are networks and communities of practice that evolve utterly independent of anything the professional-development office does because they naturally and organically grow in the workplace.

They also do arise through professional-development activities. We see this associated with some faculty development or research-focused events. For example, we see that in situations when you draw people together for learning events, particularly folks who otherwise might not interact very much because they're from different specialties or separate locations. When they come together to learn around a similar topic and develop connections, they form a community, a network that evolves out of those events and can persist.

They can continue to create and curate information within the network and generate resources that the CPD program is trying to make accessible to everyone. In that sense, those networks can develop resources and feed them back into the CPD office to help disseminate more broadly, rather than to see the CPD offices as a single hub with all the spokes coming out.

Vjeko:  When we talk about the benefits CPD offices and programs can gain from networks, can we use technology or a specific process to better support that? For example, as the SACME technology group, we contemplate which technologies/processes we can use to support SACME as a community of practice.

Gary: Networks and communities of practice create and curate information. Therefore, having central resource locations would be excellent. For example, a type of MedEd portal equivalent for CPD could be very helpful, even if it wasn't intended to have a rigorous peer review and so forth, as the MedEd portal has.

Vjeko: COVID has provided a strong push from traditional face-to-face teaching toward technology-enhanced learning modalities. I'm wondering, in your opinion, did we make sufficient change? To use the cookie metaphor, are we using the technology to improve our recipes, or are we using new tools (technology) for cooking the old recipes? 

Gary: I think it will be beneficial to research what CPD providers and SACME as an organization did do during the pandemic lockdown and how they see that persisting. I do not know what all the CPD providers did during that lockdown and what will stick for the future. However, we can recognize one underlining mechanism.

When you have to shift gears as quickly as we did, it is natural to try to reproduce the in-person experience with a similar virtual experience. You respond to an emergency. So you are not in a position to think about how to completely redesign the learning experience using the technology or thinking about the differences of having participants remotely. You're just trying to take what you've become comfortable with. Those are things that you've already organized, you have an agenda for, and you want to create a similar experience virtually.

To use the cookie analogy, we have been using the new tools intensively. We have become proficient with the new tools. However, we are still cooking quite traditional recipes.

Vjeko: So there is an opportunity to extend our cooking repertoire.

Gary: No doubt. We have the technology. Educators and learners got used to technology-enhanced learning, and we have an obvious need. That creates a good environment to blend the ingredients in a new way and innovate. 

References: 

Meadows, D. (2002). Dancing with systems. The Systems Thinker, 13, 2-6. Retrieved from https://thesystemsthinker.com/dancing-with-systems/

Rayburn, W. F., Davis, D. A., & Turco, M. G. (2017). Continuing Professional Development in Medicine and Health Care: Better Education, Better Patient Outcomes: Lippincott Williams & Wilkins.

Smith, G. A. (2015). Why college faculty need to know the research about learning. InSight: A Journal of Scholarly Teaching, 10, 9-18.

Smith, G. A., & Stark, A. (2017). Enhancing continuing professional development with insights from implementation science. In W. Rayburn, D. Davis, & M. Turco (Eds.), Continuing Professional Development in Medicine and Healthcare: Better Education, Improved Outcomes, Best Care. Philadelphia, PA: Wolters Kluwer.

Case Study in Blended Learning at the University of New Mexico, School of Medicine, Continuous Professional Learning Office (CPL)

By Gary A. Smith, PhD

Blended learning activities.   Since 2018, CPL (the CME/CPD office of the school of medicine at University of New Mexico), has offered the majority of its faculty development-in-education workshops (CME courses) in a blended format.  Topics include:

• Research‐Based Practices to Improve Your Didactic Presentations
• Learning in Small Groups: How to Make It Work
• Using Feedback to Take Our Learners (and Ourselves) from Good to Great
• Up Your Teaching Game: Use Evidence Based Learning Principles to Build Success and Satisfaction into Your Teaching
• A Toolbox for Effective Clinical Teaching
• Integrating In-Person and Online Teaching and Learning

Each of these courses is offered at least twice per year as a separate CME activity.  We adopt the use of the term “blended” as it has been widely established in higher education and recently reviewed by: Saichaie, K. (2020). Blended, Flipped, and Hybrid Learning: Definitions, Developments and Directions. New Directions for Teaching and Learning, (164), 95–104. https://doi.org/10.1002/tl.20428.

Learning format.  Participants complete approximately one hour of self-paced, on-demand learning through online multimedia and assignments that include completing an online assessment.  Completion of the online assessment is the required “ticket in the door” at the scheduled in-person learning event.  The in-person components range in duration from 1 to 2 hours.  The interactive multimedia elements provide foundational knowledge that is utilized during highly interactive in-person sessions.  Therefore, the general approach compares to the flipped classroom model.

The multimedia elements and assessments are accessed through the Moodle learning management system in the CPL site called Just in Time Learning (JiTL).  Each JiTL page is an on-demand performance-support and microlearning resource that educators can access at any time, any place.  Selected elements of applicable JiTL pages are explicitly assigned as the online component of each blended course.  (To review a sample of JiTL, see text box below.)

HSC Moodle: Continuous Professional Learning Just-in-Time Learning. Informational webpages, videos, take-away resources, and more for medical educators. Click on the blue title, above left, and then select "Self-Enrollment" to access the web pages. hscmoodle.health.unm.edu

Target audience.  Most participants in the blended courses are School of Medicine faculty who teach in the UME, GME, and health-professions curricula.  Additional enrollees include faculty in nursing, pharmacy, biomedical sciences graduate program, residents/fellows, and biomedical sciences PhD students and post-doctoral fellows.  A few participants each year are designers of CME activities and/or training and development functions within the health system.

Advantages and challenges.  Event evaluations show that participants like the blended format mostly because they can schedule a shorter time commitment for the in-person learning and pursue the online learning at their pace and as they find the time.  From a learning-design standpoint, the blended format supports the spaced-learning and testing-effect principles advocated from cognitive science research.  Facilitators can use the assessment results to tailor the in-person session to focus on specific learning challenges among the learners.  As the facilitator for many of these courses, I can attest to a much higher level of engagement and interactivity that is generated when participants arrive primed with both leveling knowledge and questions.  The only challenge has been to continually remind participants to complete the online learning prior to the in-person session.  Nonetheless, we have turned away only about 6 registrants among 200-250 enrollees per year over the past 4 years because they did not meet the preparation requirement. 

Some planners may view the time involved in creating the online modules to also be a challenge but we don’t at UNM.  Following best practices in learning and development, we know that most people learn not during scheduled courses and other events, but by consulting concise knowledge sources and performance supports in the flow of work.  Therefore, we put a high priority on developing the JiTL’s and then leverage them for the blended workshops.  This approach maximizes the impact of the effort expended to develop online multimedia and resources.

Evaluation.  We use the same evaluation forms for the blended courses as we do for fully in-person faculty development courses.  These evaluations include retrospective pre/post surveys and commitment-to-change queries (we also send email follow ups on commitment-to-change responses).  Results for blended and fully in-person courses are comparable.  Learning in either format has led to observe changed in teaching performance, but there is higher attendance in the blended events, probably because of greater access through reduced in-person scheduled learning.

Lessons for CPD practice.  Research on blended (flipped) learning in higher education should be broadly applicable to CPD practice.  The ability for learners to engage with foundational knowledge at their pace and then engage interactively when in person has clear advantages for advancing competency and performance.  We increasingly encourage our CME-activity planners to adopt similar approaches for healthcare-provider education.  We will likely deliver blended courses in quality improvement and patient safety in late 2022.

Gary A. Smith, PhD is Associate Dean for Continuous Professional Learning, the CME/CPD office for the University of New Mexico, and a SACME member. 

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

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.

January

ACEHP Annual Conference, Jan 12-15, 2022, Aurora, Colorado.  To register go to www.acehp.org/Annual-Conference

February

SACME Virtual Annual Meeting, Work, Life, Learning. Navigating through uncertain times., Feb 21-23, 2022. Keynote and plenary speakers include: Michele Harper, MD, James Makokis, MD, Stuart Slavin, MD and Brenda Bursch, MD.  Register at www.sacme.org

AAMC GEA/GIR/GSA Collaborative Webinar, February 16 3:00 pm - 4:00 pm ES. Topic: Approaching Tensions around the New Era of Pass/Fail USMLE Step 1 across the Continuum. To register, click here.

April

ACCME 2022 Annual Meeting, April 26-28, 2022. Details go to: https://accme.org/events/accme-2022-annual-meeting-april-26-28-2022

May

AHME Virtual Annual Spring Institute, May 10-13, 2022.  To register go to www.ahme.org