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Facilitating a Culture of Lifelong Learning and
Self-Improvement
A Focus on Learning and Change
Author: Dr. Craig Campbell
Date: May 3, 2012
I am a full-time Director with the Royal College
I have no financial relationships with members of pharmaceutical or medical supply companies
I do not hold any research grants funded by industry
I do not serve on any advisory board of any “for-profit” industry
I have numerous biases about CPD and Lifelong Learning
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Conflict of Interest Declaration
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Learning Objectives
At the end of this session you will be able to:
1.Discuss the factors that influence or enable culture change.
2.Explain some of the elements the Royal College is pursuing to enable lifelong learning and self-improvement among specialists.
Cultural Shift inthe ContinuingEducation of
Physicians
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Cultural Shifts are typically characterized by…
Change in Values
Change in Beliefs
Change in Behaviors
Cultural shift in CME is more evolution than revolution!
An Anatomy of Cultural Shifts
Facilitating Cultural Shifts
Factor 1:
Cultural change requires an explicit description of values & educational principles.
Educational Values and Principles
• Define the philosophy of CPD systems• Guide strategic decisions• Promote consistency and enable flexibility
Answers the Why Questions!!!
Continuing Professional Development – a focus on learning…
1.Across each dimension of professional practice and every CanMEDS Role.
2.Relevant to multiple practice contexts
3.Responsive to the practice needs of the profession.
4.Focused on outcomes!8
A Description of Values
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A Description of Values
IndividualPhysician
Practice
Context
Data with Feedback
Education Support
LearningResources
Strategies & Tools
Role for Learners
1.Design and implement a personal continuing professional development plan.
2.Use learning activities to build evidence-informed practices.
3.Identify and document the learning activities and outcomes that enhanced their practice.
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A Description of Values
Competencies Required for Practice
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Individual Learning
Group/Team Learning
New View of Life Long Learning
Guided By• Assessment
Informed By Data• Performance
• Health Outcomes
Defining Educational Principles
Maintenance of Certification Program
1.Personal: learning must be relevant to one’s scope of practice.
2.Needs-based: learning addresses perceived and unperceived needs.
3.Reflection: think critically about and learn from practice experiences.
4.Continuous Improvement: learning that demonstrates continuous improvement.
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Facilitating Cultural Shifts
Defining Educational Principles
5.Competency-based: learning that enhances the competencies required for practice.
6.Choice: choose the activities to address identified needs.
7.Inter-professional: learning within teams.
8.Evidence-informed: conclusions are based on best evidence.
9.Systems-based: learning that enhances the quality and safety of our health system.
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Facilitating Cultural Shifts
Facilitating Cultural Shifts
Factor 2:
Cultural shifts are facilitated by establishing a clear set of goals or outcomes.
Educational Goals or Outcomes
• Defines what success ‘looks like’ • How success will be measured?
Answers the ‘What’ Questions!
Explicit Expression of Goals
MOC Program: A CPD System that…
1.Enhances the learning (process and skills) of the profession
2.Advances the care of the public
Our Tag Line
“Enhancing Learning, Advancing Care”
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Facilitating Cultural Shifts
Facilitating Cultural Shifts
Factor 3:
Cultural shifts must be founded on or based on evidence.
Scientific evidence for the impact of learning on
• Behavior change, • Performance improvement• Health outcomes.
Evidence About What Works!
Importance of Evidence
Growing Expectations for
Engaging in Effective CME:
Medicine is a knowledge and technology intensive profession
Scientific evidence that informs our practices is doubling every 6-8 years!
Expectations practices reflect evidence-informed care
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Persistent Gap in Performance
Consistent evidence of failure to translate research findings into clinical practice
• 30-40% patients do not get treatments of proven effectiveness.
• 20–25% patients get care that is not needed or potentially harmful.
Grol R (2001). Med Care
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Persistent Gaps in Quality of Care
Adherence to recommended health care indicators provided to adults (in the USA)
Content Areas
Preventative care 54.9%
Acute care 53.5%
Chronic care 56.1%
McGlynn A (2003). NEJM
Persistent Gaps in Patient Safety
Quality of care concerns in hospitals
Adverse events occur in 2.5 – 16.6% of all hospital admissions
At the Ottawa Hospital adverse event rate was 12.7% with 38% deemed preventable*
o 61% of the events occurred prior to hospital
Forster et al CMAJ April 13, 2004
Traditional View of CME
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less about learning from patients in clinics
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or in acute care contexts
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or during team interactions
or from assessing team performance here…
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Impact of Group Learning on Performance / Health Outcomes
Continuing Medical Education
Marinopoulos, Dorman T, Ratanawongsa N
Effectiveness of Continuing Medical Education
Agency for Healthcare Research & Quality Evidence Report / Technology Assessment.
Published 2007
Funding: American College of Chest Physicians
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Continuing Medical Education
Forsetlund, Bjorndal, Rashidian
Continuing Education Meetings and Workshops: Effects on Professional Practice
and Health Care Outcomes.
Cochrane Systematic Review
First published 2001221 references
Update 2009 + 81 trials
More than 11,000 health professionals
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Accuracy of Self-Assessment
Davis DA, Mazmanian PE, Fordis M, Van HR, Thorpe KE, Perrier L.
Accuracy of physician self-assessment compared with observed measures of competence: a systematic review.
JAMA 2006: 296:1094-1102.
Research Question. To determine how accurately physicians self-assess compared with external observations of their competence.
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Audit and Feedback
Jamtvedt G, Young JM, Kristoffersen DT, O'Brien MA, Oxman AD.
Audit and feedback: effects on professional practice and health care outcomes.
Cochrane Database of Systematic Reviews
First publication 2003: 88 trials
Update in 2006: 118 trials (30 new trials)
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Some Conclusions
CPD Research Literature on Performance
Mean impact of most interventions is typically between 5-10%
Several important “lessons” and “findings”
1.Importance of measuring baseline performance (needs assessment)
2.Need to identify measureable outcomes
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Some Conclusions
CPD Research Literature on Performance
Effectiveness of educational interventions
1.Multiple more than single
2.Sequenced
3.Repetitive
4.Frequent measurements over time.
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New MOC Framework
Section 1 Group Learning
Section 2 Self-Learning
Section 3 Assessment
Accredited Group
Learning
Planned Learning
Knowledge Assessment
Unaccredited Group
Learning
ScanningActivities
Performance Assessment
Systems Learning
CPD Strategies within the MOC Program
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Group Learning
Self-Learning
Assessment
Intentional Integration of….
Facilitating Cultural Shifts
Factor 4:
Cultural shifts are enabled by technology that informs and supports:
• System development and innovations• Learning and documentation strategies• Data integration and management
Learning ManagementStrategy before System
Facilitating Cultural Shifts
Role of Technology
Transformational in enabling us to ….
1. Create a learning management system,
2. Link CPD resources to practice needs
3. Support the development of communities of practice
4. Integrate and leverage practice data
Facilitating Cultural Shifts
Role of Technology
1. From e-Learning to m-learning
2. Inform learning by data on….
• Performance of individuals or teams
• Health outcomes of patients
• Health status of communities
3. Virtual simulation
4. Communities or Networks of Practice
Facilitating Cultural Shifts
Factor 5
Cultural shifts are enabled by effective strategic partnerships.
• Change is a process that requires time and multiple levels of support
• Continuous involvement of stakeholders!
Must have organizational commitment and support!
Facilitating Cultural Shifts
Factor 6:
Cultural shifts are enabled by effective educational support strategies.
For the Royal College this meant…• Creating a regional educational support program• Recruiting and enabling a cohort of CPD educators
who practice in each province!
Education about CPD, the MOC system, and the competencies of learning
Facilitating Cultural Shifts
Factor 7:
Cultural shifts are enabled by the development and implementation of rigorous program evaluation
• Provides evidence against the goals• Ensures regular feedback • Promotes organizational commitment to
changeFosters a Culture of Continuous
Improvement
My Reflections
Factor 8:
Cultural shifts require a leadership team that is credible, committed, consistent, and consultative.
• Change will be resisted and challenged• Not every decision will be ‘right’• Expect unintended consequences!
Transformations take time One can’t get discouraged!!
Our Collective Imperative….
Cultural Shift in the Continuing Education of Physicians
Remains incomplete due to:
1. Limited strategies and tools to facilitate the planning and documentation of learning activities and outcomes.
2. Accessibility of formative assessment options to identify gaps in knowledge, competence and performance.
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Looking Forward to Your Comments and Questions