whitepaper pri-med open education movement

How Will the Open Education Movement and Current Healthcare Trends Transform the Future of Professional Medical Education?

OCT‐11 www.pri‐med.com 1

Table of contents

• Introduction 1 • Setting the Stage: Understanding Physician Challenges 2 • The Future is Now: How Information Technology,

Open Education Movements and the Impending Tsunami of Healthcare Demand are Shaping Physician Behavior 3

• How “Open” Affects Physicians—and the Implications for Professional Medical Education 4

• Scenario Planning: How Might Trends Today Shape Professional Medical Education Tomorrow? 5

• How Will the Open Learning Movement and Other Current Healthcare Trends Transform Professional Medical Education and Development Activities for the Healthcare Professional in the Future? 6

• Scenario 1: Docs Take Control and Professional Medical Education Goes Social 7

• Scenario 2: New Funders Kick-In & Live Continuing Medical Education Prevails 8

• Conclusion 8

Perspective: How Will the Open Education Movement and Current Healthcare Trends Transform the Future of

Professional Medical Education?

Introduction An ever-changing mix of dynamic social, technological and political forces are converging on medicine and healthcare, driving change for providers as well as consumers. As clinical and patient care demands on healthcare practitioners—particularly primary care physicians (PCPs)—evolve, so do their requirements and consumption habits related to information, resources and education. While the challenges inherent in meeting these changing needs are clear, solutions are not. Given the pace of change in technology and new trends in higher education—most notably the “open education” movement—the question remains: what are the best models to provide physicians with the most current information? Most research and focus regarding educational innovation in medicine is focused on the medical school years. This is of vital importance, and significant resources are being deployed across scores of institutions and think tanks to define the blueprint for evolved teaching strategies. However, the need to

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transform how physicians learn beyond their medical school, internship, residency and fellowship training, and into their 30+ years of active practice between graduation and retirement, receives far less attention. While building the proper foundation through intensive training, self-assessment and evaluation as well as mentoring is essential to the practice of medicine, this clinical education gap and discrepancy for clinicians in practice needs to be addressed in order to maximize how patient care is truly managed in line with increasingly limited healthcare spending. Professional medical education is approaching an inflection point, and a dialogue regarding the future is urgently needed. We believe the jumping off point for these efforts will involve exploring multiple, varied questions around a central theme: “how will the open learning movement and other current healthcare trends transform professional medical education and development activities for the healthcare professional in the future.” Some of the plausible questions include: How will advances of the digital age impact professional medical education? Will clinical content become a commodity? How will interactive, social learning opportunities shape medical education consumption habits? How will pressures on physicians affect learning habits? Will industry funding of professional medical education be reduced or eliminated? Will education content become more personalized? Will physicians engage on a more frequent basis via social media avenues? Setting the Stage: Understanding Physician Challenges The importance of current trends in education to the evolution of professional medical education is intricately linked to the tide shift taking place in healthcare and how those changes are impacting PCPs. At the frontline of patient care, PCPs must contend with increasing patient and disease complexity, rising healthcare costs; nascent public health crises such as diabetes, obesity and heart disease; and a new influx of consumers due to aging boomers and healthcare reform. The average PCP sees 2,300 patients in the course of a year1—and that caseload is only expected to rise in the coming years. At the same time, given that many PCPs have their own stand-alone medical practices, they also are confronted by stringent fiscal and time constraints. PCPs are called upon to treat a vast range of diseases, disorders and therapeutic approaches and to regularly coordinate with specialists to provide patients with the most appropriate and comprehensive treatment options and approaches. Juxtaposed with an increasing demand for (and increasing demands on) these practitioners, our nation continues to face a serious shortage of PCPs, with no relief in sight. Additional challenges for PCPs include the transition to digital healthcare through electronic health records; and a shift in the doctor-patient relationship due to a new generation of informed and empowered “super consumers” who have access to specialized information and detailed research findings through the internet. There is also an increasing focus on tracking clinical outcomes to specific medical interventions—along with other potential changes in health policy and value-based reimbursement strategies, such as pay-for-performance and the introduction of accountable care organizations (ACOs). Certainly, to provide optimal care in this complex and fast-moving world, PCPs must have easy, nearly effortless, quick and specific frequent access to affordable, high quality, impactful information. They need to be able to retrieve the latest evidence-based and validated clinical research findings across a broad

1 http://www.nejm.org/doi/full/10.1056/NEJMp068155



spectrum of disease and therapeutic approaches, along with guidance on evaluating and assimilating those findings into clinical practice and behavior change. Professional medical education, including accredited Continuing Medical Education (CME), has shown to be an effective stop-gap to ensure practicing physicians’ education stays current. Going beyond this, today’s providers of professional medical education have a unique responsibility to lead the development of a new paradigm to meet the next generation of physician needs. The Future is Now: How Information Technology, Open Education Movements and the Impending Tsunami of Healthcare Demand are Shaping Physician Behavior Web and mobile technologies affect how clinically relevant information is accessed, consumed, analyzed and evaluated, resulting in both dramatic and subtle changes in our daily life—for both healthcare professionals and consumers. One trend that has emerged from the internet age is the demand for and expectation of openness and transparency—manifested in concepts such as open access (the free sharing of materials, including scholarly publications, via the internet for reuse to various extents), open licensing (a license which grants permission to access, re-use and re-distribute a work with few or no restrictions), and open government (a citizen’s right to access government documents and proceedings for effective oversight), and now open education. “Open education”—sometimes referred to as “Education 3.0”2—is a global movement that has spurred a departure from the traditional closed approach to education, characterized by intellectual supremacy of the educator, toward one that is distributive, collaborative and characterized by self-directed learning. In a large sense, education has become democratized; traditional barriers to access are evaporating as conventional teaching and learning models are crumbling in the face of this paradigm shift. Open education involves an assortment—and choice—of learning models from live to online, independent to group and everything in between. Content and curriculum may be “crowd sourced” from multiple experts—or the learners themselves—rather than flowing from a single authority. However, the question remains whether physicians will adopt a crowd sourcing type model as a way to adopt new medical practices and information into practice.

The expansion of virtual learning environments is prompting a transformation of the physical classroom model as well, resulting in enhanced live learning experiences that are more dynamic and interactive, as demanded by today’s sophisticated learners. And, as the internet provides a “two-way street” for individuals to access and contribute information, it is only natural that their appetite for on demand data and interactions will increase. As consumers themselves, healthcare providers’ desire for seamless access to data has grown commensurate with that of the general population. A growing majority of PCPs use a handheld device or smartphone apps for medical information, as the new generation of “Google docs” recognizes the power of mobile technology to support and inform decisions at the point of care.3 The shape of tomorrow’s professional medical education is being forged by the dynamics of physician supply and demand, emerging technology, and the need for transparency and crowd-sourcing that arose in parallel with the internet age. These forces may be manifested in a number of different ways, resulting

2 http://www.getideas.org/education 3 MobiHealthNews, June 2010



in vastly differing landscapes depending on which way the winds shift, and what actions leaders take today to shape the marketplace.

How “Open” Affects Physicians—and the Implications for Professional Medical Education The open education movement has—unsurprisingly—made its way into the world of professional medical education. In fact, PCPs are on the leading edge of adopting this new paradigm, perhaps because post-graduate professional medical education is flexible by design and, thus, predisposed to accommodate the busy schedule of today’s practicing clinician. This is concomitant with physicians’ rapid pace of technology adoption. Physicians have found smartphones and online resources and applications to be an ideal solution to obtain data and easily consult with experts to support their work. This, in turn, has changed the way education providers consider curriculum, and design and develop content. This more “open” approach is also particularly well-suited to physicians who actively pursue insights and information on the latest clinical findings and guidelines in order to enhance their delivery of care and to yield optimal patient outcomes. The ability to obtain data from a broader range of contributors is enabling clinical content development that is becoming less siloed and more integrated, even at the point of patient care. In addition, in this new model, content is easily shared and repurposed. This, in turn, allows education providers to create well-rounded curricula on a wide array of topics, providing up-to-date information not only on disease and therapeutic areas but also on practice management, healthcare reform, electronic health records and other relevant trends and technologies. Sidebar: Physician Smartphone Usage4 • 64% of physicians report owning a smartphone • 60% of primary care physicians (PCPs) use their smartphone to search for clinical information • 45% of PCPs use their smartphone to download clinical information • 55% are using a downloaded app such as a medical calculator, diagram, or other clinical tool • Those using their smartphone daily for clinical tasks are more likely to be active, peer influencers. In its Progressions 2010 report, Ernst & Young coined the term Pharma 3.0 – a collection of trends including health reform, health IT, comparative effectiveness, and the rising confidence in consumer power, that are signaling a new direction for the pharmaceutical industry and for the healthcare industry as a whole. 5 According to Pharma 3.0, which has gained traction as a “movement”, there is a transformation at hand whereby all participants in the healthcare ecosystem—patients, physicians, payers and pharmaceutical companies—are revisiting and realigning their practice and behaviors to improve health outcomes. Open education can be a catalyst for change in this new environment. It creates ways for physicians to share key learnings based on their clinical experience in near real-time, through online communities and exchanges that can complement more formal classroom experiences. As such, physicians now need not wait for medical conferences or publications to gain access to findings and information that may have implications for their patients—and may lead to improved health outcomes. And, not least important, funding for education is also becoming more open, shifting from a single stream originating from industry and associations to a multisource model. This new paradigm allows for all stakeholders—including payers, government and others—to contribute to the ongoing education of the

4 Pri‐Med 2010 Pri‐Med Access Attendee Survey, n = 726 5 http://www.ey.com/Publication/vwLUAssets/Progressions_2011_Building_Pharma/$File/Progressions_2011.pdf Progressions: Building Pharma 3.0: Global Pharmaceutical Industry Report 2011 (Ernst & Young).



medical profession. This migration is also reshaping disclosures and transparency practices across the industry for the better, helping to mitigate perceived and actual conflicts of interest. The opportunities represented by open education and the use of technology in professional medical education are not without risks. Content creation and sourcing become more important and more complex as a greater number of contributors enter the space. Not all content is created equally. When patient outcomes are at stake, systems and processes must be in place to ensure that physicians have access to quality information and possess a framework by which to provide tools to critically evaluate the source. The associated regulatory scrutiny under which the professional medical education world falls—with respect to both accredited and non-accredited medical education activities—adds an additional layer of complexity and potential future risk-mitigation. Additionally, while immeasurably valuable as an affordable and accessible source of information, digital learning experiences may lack some of the power that comes from face-to-face interactions with inspiring and energetic expert instructors, as well as face-to-face communications with peers. Incorporating open, web-based resources into the model for professional medical education also has ancillary benefits, including greater interaction and networking for physicians in smaller practices. Frequent interactions and community development between and among physicians can take place virtually, in between live events. Mobile access also means physicians can obtain information at the point of care, regardless of their location. Live meetings have also evolved to keep pace with the changing education landscape, adopting enhancements that add to the value of this educational format. Previously, PCPs incurred significant time away from patients and travel expenses to attend national medical meetings. The availability of more regional and local meetings translates to less time away from clinical practice as well as reduced travel costs. The integration of digital technologies into live meetings has spurred greater learner involvement and interaction (such as portable handsets for audience response systems and SMS texting for faculty question & answer sessions), as well as more independent learning opportunities (such as iPods for self navigated poster sessions). Many medical meetings now offer “edutainment” formats, such as clinical gaming, to deepen audience engagement and foster better retention of information. Scenario Planning: How Might Trends Today Shape Professional Medical Education Tomorrow? Scenario planning is a strategic, step-by-step process utilized by businesses and other organizations to make long-term plans and decisions. Scenario planning theorizes what the world might look like by exploring today’s polarizing factors that could be tomorrow’s reality. Decision makers or strategic planners often use this approach to understand the dynamics that are shaping the future and develop tactics that incorporate this understanding into strategic decisions that will impact an organization’s ability to survive and thrive in years to come. This exercise empowers decision makers with resources to forecast potential pitfalls and opportunities that certain actions, events or decisions may yield—without incurring real-time risk or loss. For example, scenario planning can help guide the investments an organization makes in new markets and product offerings, to maximize its ability to deliver content in the most popular and useful formats. Applying scenario planning to the professional medical education industry reveals a number of interesting and conceivable outcomes, particularly at this moment in time, with virtually every aspect of the medical education model in broad transition.



This is not an exercise in prognostication—there is not attempting to divine, or even prescribe, the future. Rather, in an effort to stimulate idea generation and discussion around potential directions for the industry, the value of scenario planning is in posing provocative questions that delve into the core of the forces currently at work.

Sidebar: Scenario Planning Process Overview • Pose central questions, “what if” considerations • Delineate primary driving forces • Identify uncertainties/polarizing forces • Plot opposing forces as x/y axes • Focus on quadrants to ideate potential scenarios

How Will the Open Learning Movement and Other Current Healthcare Trends Transform Professional Medical Education and Development Activities for the Healthcare Professional in the Future?

Exploration of potential scenarios begins with identification of the forces at work and how they may act on the current model of professional medical education:

• How will advances of the digital age impact professional medical education? Will education eventually move to all digital vs. integration of digital with live forums? Will non-traditional technology players, such as Google or YouTube, become involved with the development and/or delivery of content? What role, if any, will other social-based mediums (Facebook, Twitter, Tumblr, Yelp, to name a few) play in the learning or physician engagement process?

• Will clinical content become a commodity? Will costs to develop content decline as the industry draws from broader, open sources? Will premium content continue to be recognized and valued by learners?

• How will interactive, social learning opportunities shape medical education consumption habits? Will clinicians rely on their peers for easier access to expert physicians and case-specific advice? What will be the role of gaming and other non-accredited forms of professional medical education as compared to certified, standardized education?

• How will pressures on physicians affect learning habits? Given increasing time constraints, will non-accredited education begin to take the place of accredited professional medical education? Will there be less time spent on medical humanities and more time spent on patient outcomes oriented information?

• Will industry funding of professional medical education be reduced or eliminated? Will physicians be required to pay more for post-graduate professional medical education, or will other stakeholders emerge to fill the gap? What will the government do to help make professional medical education available to practicing healthcare practitioners? How will the emergence of ACOs impact funding of education? Where do payors fit in?

• Will education content become more personalized? Will learning opportunities become more customized based on individual practice needs and the mining of patient population data through centralized electronic health record (EHR) systems? Will tools emerge that empower physicians to develop long-term personalized curriculums? How can education be better synchronized with individual physician education and practice needs?

• Will physicians engage on a more frequent basis via social media avenues? If so, what format will be the preferred choice of socialization and for what primary reasons will they socialize in e-communities (i.e., sharing clinical information, medical gaming, etc)?

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Ensuring forward momentum and “modernization” in professional medical education will require the heightened engagement of firms and partners from outside of our industry. This external insight and investment will complement and propel innovation originating from within the professional medical education industry.

This is a watershed moment for professional medical education. The future is yet to be written, and all stakeholders in professional medical education should have a role in guiding the future of professional medical education. Through insightful collaboration, all contributors can better prepare to continue meeting physicians’ post-graduate education needs. More discussion and exploring ideas about the future is needed and sought. Share your comments and opinions on the open education movement and the future of medical education through Pri-Med’s Twitter and Facebook page, or join the comment thread on the Pri-Med blog, Off the Chart.

About Pri-Med

Pri-Med, an M|C Communications LLC brand, is a trusted source for medical education and provider of professional learning environments for health care professionals across the nation. Pri-Med delivers a network of meetings and digital, multi-media content and online tools designed to meet the clinical education and information needs of actively practicing health care practitioners. The Pri-Med community of health care professionals relies on Pri-Med as their primary professional resource for opportunities to engage with their peers, expert faculty and world-class content. Utilizing our collaborations with leading institutions, associations, medical centers and education partners, Pri-Med helps its clinician community deliver higher-quality patient care. M|C Communications is a division of M|C Holding Corp. For more information about Pri-Med, visit www.pri-med.com

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Disclosure Pri-Med is an educational brand, and thus does have a stake on the ongoing evolution of professional medical education. The intent of this document is to raise questions so that we can learn and better serve physicians. This is not an attempt to promote any one product, good or service.

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