Big changes have come to continuing medical education, and more are on the way. Here is how CME will need to adapt to remain vital.
The end of the year is a natural time to reflect on the multitude of changes that have been affecting the continuing medical education (CME) industry. The past few years have been rife with revolutionary transformations in healthcare and education—driven, in part, by the dizzying pace of technological advancement. These trends all carry significant implications for every aspect of CME, from provider to faculty to learner to patient. These changes present challenges—and opportunities— for all CME stakeholders. It’s time for a thorough exploration of new models for creating, delivering, and funding CME that will ensure post-graduate medical education remains effective, impactful, meaningful, and relevant for today’s practicing physicians throughout their careers.
UNDERSTANDING THE UNIQUE DEMANDS ON TODAY’S PHYSICIANS
To understand the most effective models for bringing physicians the information they need to deliver the best possible patient care, we first must understand the environment in which they practice and the myriad changes affecting that environment. While all healthcare practitioners face increased demands, today’s primary care physicians (PCPs) confront unique challenges. They are at the front line of patient care (and are expected to be even more so with the implementation of healthcare reform and accountable care practices), responsible for diagnosing, treating and, as needed, triaging to specialists a broad range of diseases. They are contending with growing public health issues like obesity and diabetes, driving preventative healthcare, and battling rising costs. Even as demands are high and growing, the U.S. is facing dramatic PCP shortages: Recent studies show only a 4% increase in the number of PCPs between 1998 and 2006 1, yet we anticipate that an estimated 30 million new patients will very soon receive health insurance coverage through the Patient Protection and Affordable Care Act2. It’s clear that today’s PCPs have more responsibilities than ever before with fewer resources, including time, money and staff.
THE CHANGING PORTRAIT OF THE PHYSICIAN LEARNER
While the physicians’ environment undergoes radical changes, the portrait of the physician learner is also evolving. Recent medical school graduates are highly accustomed to using technology as part of the learning process and expect this to carry over into their postgraduate education. In addition, these so-called Google docs are avid technology users in both their professional and personal lives— regularly utilizing a number of formats to gather information and communicate with others. While using technology to directly communicate with patients is an evolving area, provisions of the Affordable Healthcare Act that relate to Meaningful Use, whereby patients must be given electronic access to their own healthcare files and data, may compel physicians to engage electronically with their patients.
WHERE WILL CONTINUING MEDICAL EDUCATION EVOLVE TO MEET PHYSICIAN NEEDS?
Currently, most educational innovation in medicine focuses on the medical school years, with limited attention paid to postgraduate medical education during the average physician’s 30+ years of active practice. The CME space needs a movement to keep current with the most clinically important and critical issues related to patient care in the years to come—something akin to the global open education or Education 3.0 3 movement (a departure from the traditional teacher-to-learner lecture format to an assortment and choice of learning models) and the Pharma 3.04 movement (a transformation of the healthcare ecosystem by which all participants realign their practices to improve health outcomes). Broadly, we need interdisciplinary healthcare professional education to support effective team management of patients. This raises the bar for CME effectiveness and efficiency. The changes in healthcare, technology and education present us with a unique opportunity—and stark need—to evolve CME to meet physicians’ needs. As we approach the new year with an understanding of some of the factors affecting CME, we predict four key factors that will have the biggest impact in the months and years to come.
TECHNOLOGY-ENHANCED LIVE MEETINGS
Live meetings have always played an important role in CME. The face-to-face exchange of ideas with other practitioners is an invaluable learning tool for fostering collaboration and intellectual stimulation. Research shows that 90% of physicians who attend live CME events intend to return the following year 5.
Live meetings will continue to play a key role in CME. Critical to this is the continuing evolution of formats and the content delivery platforms in which they are conducted to meet the various learning styles, preferences and demands of today’s physician base. It isn’t enough to expect that a faculty presenter, even with the best content, can be a driver for effective CME alone. As more physicians use technology to access clinical information, these models will be used to enhance the live meeting experience for both faculty presenter and learner.
Live meetings are already moving to a more open approach, incorporating increased peer-to-peer and peer-to-faculty interaction and offering different format options through digital and multimedia tools. For instance, attendees at live meetings are using portable handsets to respond to polling and send SMS texts to ask questions during presentations. Some medical meetings are starting to offer “edutainment.” In clinical gaming, for example, physicians compete against each other in virtual-patient simulations across a range of disease states. It is an engaging format that enhances critical-thinking and problem-solving skills while reinforcing key clinical practices.
The changes afoot in the live meeting format must continue to evolve and expand—and exert tremendous positive impact on the learning experience. This will require providers, faculty, learners and funders to re-think the educational experience. Integrating digital technologies into live meetings can spur deeper audience engagement and foster better retention of information. By incorporating the technologies that today’s physicians use every day and establishing models that focus on interactive learning, live meetings will remain important for physicians and afford multiple opportunities for educators.
USER-GENERATED CONTENT AND ACCREDITATION
To complement live-meeting attendance, we believe physicians will increasingly leverage time- and cost-effective digital platforms to access information and connect with peers. It is already happening, and we expect demand will increase, especially as learners become more sophisticated consumers of new educational formats.
Anytime, anywhere learning will help PCPs stay current with the latest prevention, diagnosis, and treatment strategies. Learners will be able to map education to their knowledge gaps and clinical-care areas and engage in ongoing peer-to- peer and peer-to-faculty information exchanges. According to another recent study, physicians value social networking sites that enable engagement and interaction with fellow physicians around common patient care goals 6. As this user-generated (or crowd-sourced) content becomes a common learning tool amongst physicians, we envision it will play an important role in accredited CME programs.
When patient outcomes are at stake, systems and processes must be in place to guarantee that physicians have access to high-quality information and possess a framework by which to critically evaluate the source. Given that user-generated content will play an increasingly important role in physicians’ practices, it will be critical to formalize and accredit these processes to ensure physicians and patients benefit from this information exchange. However, all contributors need to operate in the same professional framework, providing evidence-based, objective, rigorous and independent content. The professional community’s demand for this type of content will help the community self-modulate and filter out inappropriate or substandard content. And that is one of the most valuable aspects of community: reaching out and connecting with others, elevating the group to achieve more than one could achieve alone.
CAPITALIZING ON SOCIAL MEDIA
Physicians have kept pace with other users of social media technology: 75% of physicians visit social networking sites, and 60% use combinations of consumer- and physician-oriented sites 6. The pharmaceutical industry, of course, remains a critical source of information on the latest treatment strategies but has no clear regulatory guidance as it considers how best to use social media tools to communicate with providers. Until that guidance emerges (if it ever does), some companies understandably hesitate to enter the field, though they may miss out on opportunities to bring important information to healthcare providers. As we incorporate more social media-related technologies and platforms into educational programs, industry has an opportunity to deploy these tools to communicate with their audience, with limited associated risk.
EXPANDING FUNDING MODELS
As physicians continue to navigate the new normal—increased patient loads, limited staff, rising healthcare costs, working in multi-disciplinary teams—we believe they will rely more heavily on CME to ensure they have the latest information and guidelines to provide optimal patient care. Given the current economic environment, traditional funding models may not be adequate to keep up with demands.
While the pharmaceutical industry will always play a key role in supporting CME programs—it is, after all, the source of new medical treatments, an important driver of patient care, and a logical partner for related education programs— we are beginning to see an expansion of multi-source funding paradigms and models. There will be, for example, an increasing role for all stakeholders in the postgraduate medical education process—including payers, government and organizations beyond the pharmaceutical industry—to contribute to the ongoing education of the medical profession. We expect that this migration to broader funding sources will also reshape disclosures and transparency practices across the industry, helping to mitigate perceived and actual conflicts of interest.
THE YEAR AHEAD
As we look ahead to 2012 and beyond, we can’t predict exactly what the future may hold. We have a good understanding of current factors affecting the CME space, but these forces may play out in a number of different ways—in part based on what actions we take today, resulting in vastly differing future outcomes. The convergence of changes in healthcare, technology, and education make this a tremendously exciting time for the CME industry, creating opportunities in professional medical education that will benefit physicians in ways not previously imagined.
1. American Medical News. “Nearly Half of Office-based Physicians Work with NPs and PAs.” September 12, 2011. (http://www.ama-assn.org/amednews/2011/09/12/bisb0912.htm)
2. Sources: American Medical Colleges, Association Press, And Bureau of Labor Statistics: Denise Mick: “Midlevel Healthcare Providers: An Untapped Prescribing Force.” PharmaVOICE
4. Ernst & Young Progressions 2010 Report
5. Pri-Med Onsite Attendee Survey Research, August 2011
6. 2011 Pri-Med Research Study on Social Computing Behaviors