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Academia and the Profession |

Continuing Medical Education and Quality Improvement: A Match Made in Heaven?

Kaveh G. Shojania, MD; Ivan Silver, MD, MEd; and Wendy Levinson, MD
[+] Article and Author Information

Acknowledgment: The authors thank Drs. Eric Holmboe, Robert Wachter, and Dave Davis for their comments on earlier drafts of the manuscript.

Grant Support: Dr. Shojania receives salary support from the Government of Canada Research Chairs Program.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-2040.

Requests for Single Reprints: Wendy Levinson, MD, Department of Medicine, University of Toronto, Suite 3-805, R. Fraser Elliott Building, 190 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada; e-mail, mailto:wendy.levinson@utoronto.ca.

Current Author Addresses: Dr. Shojania: University of Toronto Centre for Patient Safety, Sunnybrook Health Sciences Centre, Room H468, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.

Dr. Silver: Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada.

Dr. Levinson: Department of Medicine, University of Toronto, Suite 3-805, R. Fraser Elliott Building, 190 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.

Author Contributions: Conception and design: K.G. Shojania, I. Silver, W. Levinson.

Analysis and interpretation of the data: I Silver.

Drafting of the article: K.G. Shojania, I. Silver, W. Levinson.

Critical revision of the article for important intellectual content: K.G. Shojania, I. Silver.

Final approval of the article: K.G. Shojania, I. Silver, W. Levinson.

Administrative, technical, or logistic support: W. Levinson.

Collection and assembly of data: I. Silver.


From Sunnybrook Health Sciences Centre, University of Toronto Centre for Patient Safety, and the Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.


Ann Intern Med. 2012;156(4):305-308. doi:10.7326/0003-4819-156-4-201202210-00008
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New models of continuing medical education (CME) seek not only to impart knowledge but to change physicians' behavior and even play a role in facilitating organizational improvement. These CME models thus share some of the same basic goals as the field of quality improvement (QI), namely behavioral change and systems redesign to improve patient outcomes.This article provides some practical ideas about how CME providers and QI experts may beneficially integrate these 2 fields. It outlines several models for harnessing the existing engagement in traditional CME to achieve the goal of equipping practitioners with knowledge and skills related to QI, while also addressing the widely recognized problems with traditional CME. The authors touch on possible incentives to make such integrated models of CME and QI attractive to practitioners.

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CME and Quality Improvement: Making the Match Successful
Posted on March 5, 2012
Alexander M.Djuricich, MD, Associate Dean for Continuing Medical Education, Program Director, Medicine-Pediatrics Residency
Indiana University School of Medicine
Conflict of Interest: None Declared

I applaud Shojania et al. [Reference 1] for providing a much-needed description of the importance of quality improvement (QI) within the Continuing Medical Education (CME) arena. It is absolutely true that clinicians need to understand not only the medical content necessary to care for patients, but also the science of improvement within the practice context, in order to optimize patient outcomes. CME is the perfect venue where physicians can learn this.

It is encouraging to see that the Accreditation Council for Graduate Medical Education sees the importance of quality improvement as a skill for all future physicians, and has required that residents, as part of the practice-based learning and improvement competency, learn and practice these skills while in training [Reference 2]. The American Board of Medical Specialties is now urging front-line clinicians to learn similar skills by way of including performance improvement methodologies in the maintenance of certification (MOC) process [Reference 3]. What I find interesting is that despite a robust debate about the effectiveness of MOC for front-line clinicians [References 4], graduate medical education (GME) QI instruction has demonstrated that residents can and do learn improvement activities in a positive manner, and can apply this knowledge experientially [Reference 5].

Isnt it time then to bite the bullet and necessitate QI education for practicing physicians as a part of the CME process? The CME community should take notice from the GME world: it's time to require experiential learning about QI, similar to how some states mandate education in patient safety. This stance may appear to some like yet another regulatory requirement. However, the medical community itself is best suited to help close the gap on what the optimal learning needs of physicians are, instead of outside agencies that may not fully comprehend the day-to-day challenges that physicians face in caring for patients within the current health care climate.

Alexander M. Djuricich, MD Associate Dean for Continuing Medical Education Program Director, Medicine-Pediatrics Residency Program Associate Professor of Clinical Medicine and Clinical Pediatrics Indiana University School of Medicine

References

1. Shojania KG, Silver I, Levinson W. Continuing medical education and quality improvement: a match made in heaven? Ann Intern Med 2012;156:305- 8.

2. Armstrong G, Headrick L, Madigosky W, Ogrinc G. Designing education to improve care. Jt Comm J Qual Patient Saf 2012;38(1):5-14.

3. Hawkins RE, Weiss KB. Building the evidence base in support of the American Board of Medical Specialties Maintenance of Certification Program. Acad Med 2011;86(1):6-7.

4. Dubravec MS. The burdensome maintenance of certification process. Ann Allergy Asthma Immunol 2011;107(2):103.

5. Patow CA, Karpovich K, Riesenberg LA, et al. Residents' engagement in quality improvement: a systematic review of the literature. Acad Med 2009;84(12):1757-64.

Conflict of Interest:

None declared

Continuing Medical Education and Quality Improvement: A Match Made in Heaven?
Posted on March 5, 2012
MurrayKopelow MD, MS(Comm), FRCPC, Chief Executive and Secretary
Accreditation Council for Continuing Medical Education (ACCME)
Conflict of Interest: None Declared
We applaud Drs. Shojania, Silver, and Levinson (1) for their recognition that the integration of CME and QI offers the opportunity to improve health care quality. Their examples describe meaningful ways for CME providers to deliberately incorporate QI in their partnerships. We appreciate the recognition of best practices and the opportunity to learn and share effective strategies. In the US, CME providers have been recognizing this correlation. In 2006, the Accreditation Council for Continuing Medical Education (ACCME) released new accreditation requirements (2) in order to reposition accredited CME as a strategic asset to US health care quality and safety imperatives. In accordance with these requirements, CME providers are collaborating with their institutions, health systems, and communities to achieve common goals for quality improvement. We have completed accreditation reviews based on the 2006 Accreditation Criteria for 567 (82%) of ACCME-accredited providers. Our data shows that providers are raising CME to a higher level of effectiveness and relevancy. CME activities are based on professional practice gaps and are designed to change physicians competence, or physicians performance, or patient outcomes. As Drs. Shojania, Silver, and Levinson observed, providers are required to evaluate their programs' effectiveness in achieving these goals. Further, providers are expected to demonstrate that they have planned and implemented improvements in their program. The 2006 Accreditation Criteria foster CME's engagement with the health care environment by awarding providers Accreditation with Commendation, if, among other requirements, they act as strategic partners in quality initiatives through collaborative alliances. Overall, 20% of providers have achieved Accreditation with Commendation. The percentage is increasing: 25% of providers in the July 2011 cohort (3) and 37% in December 2011 (4) achieved this status. To foster the integration of CME and quality improvement, we have built an online video library featuring examples of innovative collaborations (4), including a statewide quality improvement partnership, a hospital-based CME program that worked with quality improvement to address cardiovascular issues, and a National Committee for Quality Assurance performance improvement-based CME initiative to address national performance measures. The federal government has recognized CME as a strategic asset to public health initiatives. The Office of National Drug Control Policy, Food and Drug Administration, Centers for Disease Control and Prevention, National Coordinator for Health Information Technology, and Agency for Healthcare Research and Quality have incorporated accredited CME into their public health strategies. Accredited CME providers are successfully demonstrating that CME is a Bridge to Quality.

References

1. Shojania KG,Silver I, Levinson W; Continuing Medical Education and Quality Improvement: A Match Made in Heaven? Ann Intern Med February 21, 2012 156:305-308.

2. The ACCME Accreditation Criteria. Accessed at http://www.accme.org/requirements/accreditation-requirements-cme-providers/accreditation-criteria on 29 February 2012.

3. Executive summary of the July 2011 Meetings of the Board of Directors of the Accreditation Council For Continuing Medical Education (ACCME). Accessed at http://www.accme.org/sites/default/files/null/602_2011_07_Board_Executive_Summary_20110809.pdf on 29 February 2012.

4. Executive summary of the December 2011 Meetings of the Board of Directors of the Accreditation Council For Continuing Medical Education (ACCME). Accessed at http://www.accme.org/sites/default/files/null/000_2011_12_Board_Executive_Summary_201101122012.pdf on 29 February 2012.

5. Interviews. Accessed at http://www.accme.org/education-and-support/video/interviews on 29 February 2012.

Conflict of Interest:

None declared

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