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.