Thursday, May 25, 2017

The future of CME

A NEJM Perspective piece on this topic opened with:

The point at which a clinician takes ownership of his or her own learning agenda is a pivotal moment in professional growth.

That sentence drew me into the article. The author, Graham T. McMahon MD believes there is a point in professional development where the clinician takes ownership of his or her continuing education. Self evident as that may be there are those who oppose this view, believing that CME content should be determined by external authority. That, for example, is the basis for the arguments of those few who defend Maintenance of Certification (MOC).

McMahon went on to elaborate on the benefits of self guided learning as opposed to that driven by others from afar:

Now that information is ubiquitous, simple information exchange has relatively low value; in its place, shared wisdom and the opportunity to engage in problem solving in practice-relevant ways have become key. Physicians seeking professional development can recognize when they’re actively learning and tend to embrace activities that allow them to do so. Education that’s inadequate, inefficient, or ineffective, particularly when participation is driven by mandates, irritates physicians who are forced to revert to “box-checking” behavior that’s antithetical to durable, useful learning.

So what are we to do? Much of the solution, according to McMahon, lies in the attitude of the learner rather than the CME offering:

A key element is self-awareness: professionals who know their own strengths and weaknesses are most likely to have a productive experience when they identify the types of activities that help them grow and then actively participate in them. There are many ways to increase self-awareness, such as taking a self-assessment quiz…

To become self-aware, we have to step out of the protective cocoon of self-confidence and become humble and open enough to assess both how we can best maintain what’s working and how we can grow further.

CME offerings, according to the author, are most effective when they are interactive and learner-centric. While this is a challenge in the traditional didactic format, he does not argue for the elimination of the didactic as some have proposed over the last several years. [1] [2]

All in all, the piece is respectful of differences in learning needs among physicians and supportive of them being in charge of their own individual educational agendas. A  concern I have, though, is this statement in the middle of the piece:

The regulators, too, need to evolve. By relinquishing the fixed structural requirements for health education and instead focusing on educational outcomes (rather than process and time spent), regulators and accreditors can create the right conditions for maximizing educators’ flexibility and promoting innovation. By creating a diverse system that can address even superspecialized needs, we facilitate choice among formats, activity types, and locations. I envision a future in which educational expectations and professional competency obligations are aligned and integrated and in which all physicians have an educational “home” that helps them navigate their continuing growth — so that education is intertwined with practice throughout their careers.

That sounds a little too much like the MOC we loved to hate a couple of years ago.

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