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Redesigning Redesigning Continuing Continuing Education for Education for the Health the Health ProfessionsProfessions
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Institute of MedicineInstitute of Medicine
Established in 1970 by National
Academy of Sciences to exam policy
matters pertaining to the health of
the public National Academy of
Sciences is a private, nonprofit
society that was established by
congresssional charter to advise the
federal government
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Historical Context for Historical Context for Continuing EducationContinuing Education
•Continuing Education not seen as
prestigious as undergraduate or graduate
education
•1960’s- most was provided by
pharmaceuticals
•Subject to criticism- Conflict of Interest
•CE industry has grown rapidly in last 10
years
•Increasing involvement of commercial
support and Medical Education and
Communications (MECC)
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Concerns about Continuing Concerns about Continuing EducationEducation
•Flexner report in 1910- concerned about
UG medical education and lack of
standardization
•These mirror the concerns we have today
about CE
•CE largely driven by state requirements,
certification requirements and regulatory
bodies
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RequirementsRequirements
•For MD’s- Michigan- 50 CME credits
per year
Alabama- 12 CME credits per
year Indiana- 0 CME credits per
year
•Nursing varies from 5-15 hours per
year
•Pharmacy varies from 10-60 hours per
year
•No evidence to support the number of
hours or the type of education
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MedicineMedicine•ACCME- Accreditation Council for Continuing
Medical Education-accredits the providers
•Medical Schools, Professional Societies and MECC
(for profit)
•On average ACCME providers report profits of
23.5%
•58% of CME is industry funded
•1.5 billion of CME from commercial entities
•Some effort to develop safeguards but not enough
•Reports of planted members in audience to ask
about a drug
•What would happen if withdrew all commercial
funding- cost each MD on average $3,500 each
year
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PharmacyPharmacy
•Pharmaceutical and medical device
companies have a leading role in CE for
Pharmacy and Medicine
•2006- 43% of CE programs for
pharmacists received commercial support
•Culture where pharmacists expect to
obtain CE at minimal cost and the CE
providers were dependent on industry to
cover their costs
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Other ConcernsOther Concerns
•2.5 billion in income in 2007
•1.5 billion commercial funds
•Concerns about quality, inconsistency
in number and type of hours, conflict of
interest and funding lead to the
convening of a conference funded by
the Macy Foundation
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Macy Foundation ReportMacy Foundation Report
•CE was more focused on number of
credits than on improvement in
performance or patient care
•Funded by organizations with conflicted
interests
•No incentives for Interprofessional Care
•They called for the appointment of an IOM
committee to consider the development of
a national Interprofessional Continuing
Education Institute
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Committee on Planning for a Continuing Committee on Planning for a Continuing Health Care Professional Education InstituteHealth Care Professional Education Institute
Jako S. Burgers Senior Researcher, Scientific Institute for Quality of Healthcare
Linda Burnes BoltonVice President and Chief Nursing Officer, Cedars-Sinai Medical Center
Catherine DeAngelisEditor-in-Chief and Senior Vice President, Scientific Publications and Multimedia Applications, JAMA
Robert D. FoxProfessor Emeritus of Adult and Higher Education, University of Oklahoma
Sherry A. GliedProfessor and Chair, Department of Health Policy and Management, Columbia University, Mailman School of Public Health
Kendall HoDirector, eHealth Strategy Office, Associate Professor, Division of Emergency Medicine, University of British Columbia
Edward F. LawlorDean and William E. Gordon Distinguished Professor, George Warren Brown School of Social Work, Washington University
David LeachFormer Executive Director, Accreditation Council for Graduate Medical Education
Lucinda MaineExecutive Vice President and Chief Executive Officer, American Association of Colleges of Pharmacy
Paul E. MazmanianAssociate Dean for Continuing Professional Development and Evaluation Studies, Virginia Commonwealth University
Michael W. PainterSenior Program Officer, Robert Wood Johnson Foundation
Wendy RheaultVice President, Academic Affairs, and Dean, College of Health Professions, Rosalind Franklin University of Medicine and Science
Marie E. SiniorisPresident and CEO, National Center for Healthcare Leadership
Gail L. Warden (chair)President Emeritus, Henry Ford Health System
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Charge to CommitteeCharge to Committee
Review issues in continuing
education (CE) of health care
professionals to consider the
establishment of a national
interprofessional CE institute to
advance the science of CE
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Committee ProcessCommittee Process
12 month study
3 face-to-face meetings
2 public workshops with 17 speakers
Extensive literature review
16 external reviewers
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Conclusions about CEConclusions about CE
•Purpose of CE is to enable health professionals
to keep their knowledge and skills up to date,
with the ultimate goal of improving
performance and patient outcomes
•CE should be interprofessional and include a
broad variety of professionals (e.g., dentists,
dieticians, nurses, physical and occupational
therapists (etc)
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Key messagesKey messages
There are major flaws in the way CE is conducted, financed, regulated, and evaluated
-Focus on meeting regulatory requirements rather than identifying personal knowledge gaps -Concerns about conflicts of interest in CE activities-Regulations that vary widely by profession, specialty, and state, leading to inconsistent learning
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Key messages (continued)Key messages (continued)
•The science underpinning CE is fragmented
and underdeveloped
-Often characterized by didactic learning methods (e.g.,
lectures) in traditional settings (e.g., auditoriums)
-Little specific information about how to best support
learning
-Health professionals lack a dependable basis for
choosing among CE programs
-Leaves the larger value of continuing education for
health professionals uncertain
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Key messages (continued)Key messages (continued)
• CE should be interprofessional in
nature
• A new, comprehensive vision for CE
is needed that prepares all health
professionals to perform to their
highest potential
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Toward a system of continuing Toward a system of continuing professional developmentprofessional development
•In CPD, learning opportunities:
-Stretch from the classroom to the
point of care
-Shift control of learning to
individual practitioners
-Adapt to individuals’ learning needs
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Toward a system of continuing Toward a system of continuing professional developmentprofessional development
•CPD system offers promise to:
-Advance evidence-based, interprofessional, team-based
learning
-Strengthen the research workforce, particularly
through academic institutions
-Engender coordination and collaboration among the
professions
-Provide higher quality for a given amount of resources
-Lead to improvements in patient health and safety
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Alternatives consideredAlternatives considered
•Status quo
•Program within a federal agency
(AHRQ or HRSA)
•Purely private structure consisting of
professional societies
•Coalition that includes the quality
improvement community
•Public-private structure
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Recommendation 1 Recommendation 1 Commission planning of an Commission planning of an instituteinstitute
The Secretary of the Department of
Health and Human Services should
commission a planning committee to
develop a public-private institute for
continuing health professional
development
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Recommendation 2Recommendation 2Envisioning a CPD systemEnvisioning a CPD system
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Recommendation 3Recommendation 3Improve quality and safetyImprove quality and safety
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Recommendation 4Recommendation 4Improve scientific foundation of Improve scientific foundation of CPDCPD
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Recommendation 5Recommendation 5Enhance data collectionEnhance data collection
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Recommendation 6 Recommendation 6 Develop national regulatory Develop national regulatory standards standards
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Recommendation 7Recommendation 7Strengthen financial supportStrengthen financial support
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Recommendation 8Recommendation 8Foster development of Foster development of interprofessional modelsinterprofessional models
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Recommendation 9Recommendation 9Support research Support research
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Recommendation 10Recommendation 10Evaluate progressEvaluate progress
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Planning committee for the Planning committee for the CPDICPDI
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Structure of CPDIStructure of CPDI
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Structure of CPDI (continued)Structure of CPDI (continued)
Managed by competency-based board
Initial oversight and coordination by
federal government as a central
convener
Board should determine whether the
government’s responsibilities should be
transferred back to CPD stakeholders.
Unless the board determines otherwise,
the Secretary will eventually have no
formal role in the institute
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For more information about the report and to
download the summary:
www.iom.edu/continuinged
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Thank YouThank You