Despite recurring calls for reform and extensive literature on best practices, the field of CME/CPD has been slow to change. Lack of change despite stated intentions suggests this is what Heifetz calls an “adaptive challenge,” one requiring a change not in skillset, but in mindset.
Together we will address this adaptive challenge through the “Immunity to Change” (ITC) framework by education psychologists Kegan and Lahey. This process yields a map of the complex network of competing commitments and underlying assumptions that form the immunity to change. We will explore one possible map of the collective “immune system” of CME practitioners that generates powerful insights into our barriers to change: seemingly unresolvable tensions between learner autonomy and learning needs, feasibility and impact, innovation and acceptance, and more—all based in paralyzing “big assumptions.”
Map in hand, change in mindset then comes from implementing tests of these assumptions’ validity. We will use the ITC framework to integrate our individual experiences as CME leaders during the COVID-19 pandemic—an unanticipated but highly impactful test—into system-wide insights for positive change.
Miya Bernson-Leung, MD, EdM
Program Director, Child Neurology Residency Training Program
Department of Neurology, Harvard Medical School
Course Director, Michael J. Bresnan Child Neurology Course
Associate Medical Director, Continuing Medical Education
Boston Children's Hospital
Host & Facilitator
Mila Kostic, CHCP, FACEHP
Strategic Advisor, Center for Continuing Medical Education
Stanford University School of Medicine
Primary References and Pre-Work
Bowe CM, Lahey L, Armstrong E, Kegan R. Questioning the ‘big assumptions’. Part I: addressing personal contradictions that impede professional development. Medical Education. 2003;37(8):715-722. doi:10.1046/j.1365-2923.2003.01579.x
After reading Bowe et al 2003, please review the example ITC map (handout
Price DW, Campbell CM. Rapid Retooling, Acquiring New Skills, and Competencies in the Pandemic Era: Implications and Expectations for Physician Continuing Professional Development. J Contin Educ Health Prof. Spring 2020;40(2):74-75. doi:10.1097/CEH.0000000000000297
Kawczak S, Fernandez A, Frampton B, et al. Observations from Transforming a Continuing Education programme in the COVID-19 Era and Preparing for the Future. Journal of European CME. 2021;10(1)doi:10.1080/21614083.2021.1964315
Additional Optional References
Kegan R, Lahey LL. The real reason people won't change. Harvard Business Review. 2001;79(10):85.
Bowe CM, Lahey L, Kegan R, Armstrong E. Questioning the ‘big assumptions’. Part II: recognizing organizational contradictions that impede institutional change. Medical Education. 2003;37(8):723-733. doi:10.1046/j.1365-2923.2003.01580.x
Rowland P, Tavares W, Lowe M, et al. Rapid Knowledge Mobilization and Continuing Professional Development: Educational Responses to COVID-19. J Contin Educ Health Prof. Apr 2 2021;doi:10.1097/CEH.0000000000000348
Sklar D, Yilmaz Y, Chan TM. What the COVID-19 Pandemic Can Teach Health Professionals About Continuing Professional Development. Acad Med. Oct 1 2021;96(10):1379-1382. doi:10.1097/ACM.0000000000004245
Questions for Pre-VJC Reflection and Discussion
What are your observations about and reactions to the example ITC map? Are there pieces of it that stand out to you as particularly striking or true to your experience prior to the pandemic? Are there pieces missing?
What longstanding Big Assumptions about CME has the pandemic revealed, and perhaps called into question, in your office/institution?
What examples do you have of innovations or practice changes during the last two years, perhaps in response to the “questions and opportunities to explore” outlined by Price and Campbell? What do these experiences tell you about your/our Big Assumptions?