The best way to raise standards and quality for continuing health education would be for the Department of Health and Human Services to launch a public-private institution, according to a report issued by the Institute of Medicine.
There are serious flaws in the way in which continuing education for physicians and other health professionals is “conducted, financed, regulated, and evaluated,” concluded the authors of the report. “The science underpinning continuing education for health professionals is fragmented and underdeveloped,” they added.
Because of that, “establishing a national interprofessional continuing education institute is a promising way to foster improvements in how health professionals carry out their responsibilities,” they said. The 200-page report, “Redesigning Continuing Education in the Health Professions,” was sponsored by the Josiah Macy, Jr. Foundation.
The 14-member Institute of Medicine committee that produced the report proposed the creation of a public-private entity that would involve the full spectrum of stakeholders in health care delivery and continuing education.
That new entity, which would be called the Continuing Professional Development Institute (CPDI), would look at new financing mechanisms to help avoid potential conflicts of interest. It also would develop priorities for research in continuing health education and recognize effective education models.
The medical community must move from a culture of continuing education to one of “continuing professional development … stretching from the classroom to the point of care, shifting control of learning to individual practitioners, and [adapting] to the individual's learning needs,” said committee chair, Dr. Gail Warden, president emeritus of the Henry Ford Health System, Detroit, said during a teleconference.
“We believe academic institutions need to be much more engaged than they have been in continuing education. The system should engender coordination and collaboration among professions that should provide higher quality for a given amount of resources and lead to improvements in patient health and safety,” she noted.
Old CME Model?
Continuing medical education (CME) vendors had mixed reactions to the committee's report.
Rick Kennison, D.P.M., president and general manager of PeerPoint Medical Education Institute, said that he agreed with the committee's recommendations in the area of traditional CME. Those types of programs, such as live meetings and society annual meetings, “are didactic in nature [and] don't meet the needs of participants as learners, and there is conflict and bias associated with them.”
But a large problem with the report is that the committee reviewed continuing medical education as it used to be, Dr. Kennison said. “They wanted to evaluate a model of a car, but instead of using a 2010 model, they used a 2006 model. There have been a lot of changes in CME in the course of the last few years that were completely overlooked by the committee.”
For example, Dr. Kennison said that his organization has already moved to performance-improvement CME, which is a goal outlined in the report. Performance-improvement CME, he explained, involves “direct learning by the participant—self-directed learning—in which the participant uses metrics and supplies data to help determine change and improvement in patient care.
“We've been doing this for more than 2 years now,” he noted. “Because the group didn't evaluate performance-improvement CME, I think they missed a major stepping stone associated with the current status of CME.”
Dr. Kennison said his company's CME programs are sponsored by the pharmaceutical industry. But the funding is in the form of general grants related to diseases and conditions, he noted, and does not involve sponsoring education initiatives that highlight specific drugs or classes of drugs.
Dr. Edmond Cleeman, a New York orthopedic surgeon and founder of TRIARQ, a medical education organization for orthopedists, physical therapists, and other health professionals in the orthopedic field, agreed with the committee's recommendation that continuing health education needs to be team based and multidisciplinary. In the TRIARQ program, which is still being developed, students taking the courses will pay the costs themselves.
“For us as orthopedic surgeons, we deal with physical therapists all the time,” he said. “We felt strongly about developing a community that is really across disciplines. Doctors have things that we can learn from physical therapists, too.”
Leery of a Government Committee
Several of the recommendations gave Dr. Cleeman pause.
“To form another government committee and force a single type of a mold, and add additional regulations on all medical subspecialties and on CME—that's not the right approach,” he said. “Each discipline is very different, and the needs for each should be determined by its own governing body … I think you're going to scare away innovation.” Instead, “it's a good idea to have a private organization, maybe like the American Medical Association,” said Dr. Cleeman. “Their goal would be to assist in developing goals for continuing education.”