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© 2014 AAMC. May not be reproduced without permission.
Forty Years* in CME
Where’s it been? Where’s it going?
OR…………
© 2014 AAMC. May not be reproduced without permission.
CME at The End Of
The Universe
© 2014 AAMC. May not be reproduced without permission.
Disclaimers/disclosures:
I have no conflicts of interest in the presentation of
this talk (maybe commendable; clearly pitiful)
Well, come to think of it: senior consultant role –
AAMC, Mohammed Bin Rashid College of
Medicine, Dubai, UAE
I’ve had LOTS of help along the way
I'm retiring soon (i.e., informed but useless)
© 2014 AAMC. May not be reproduced without permission.
Objectives
1) To attend to your own pathway in CME and healthcare
2) Describe the differences between the ‘old’ CME and the new CME/CPD
3) Acquire cultural skills: know where Ontario is, learn how to say Toronto like a native
4) Learn to take selfies
5) Have a little fun
© 2014 AAMC. May not be reproduced without permission.
Background/Orientation: Where the heck is Ontario and what’s it done for me lately??
Hamilton
Toronto
POP
QUIZ:
how do
you say
‘Toronto’?
© 2014 AAMC. May not be reproduced without permission.
Orientation #2: The Journey, what it looks like*
Joseph Brant
Hospital
McMaster University
University of
Toronto
AAMC
The
Future
*NOT to scale
© 2014 AAMC. May not be reproduced without permission.
Orientation #3: what the journey feels like
Look kids,
Dave says
he’s “retiring”
About the
hell time,
don’t you
think, Billy?
© 2014 AAMC. May not be reproduced without permission.
Orientation #4: The Stories
McMaster
University
EBM, The
Question,
and the GI
Day
The University of
Toronto, SARS, the
continuum and
Rabbi Hillel’s
three questions
Jack Sibley,
Joseph Brant
Hospital
and the Wall
The AAMC and
the power of the
acronym
Where
did you
say the
CME
office is?
© 2014 AAMC. May not be reproduced without permission.
The McMaster Stories
McMaster University: EBM, the GI
Day and The Question
© 2014 AAMC. May not be reproduced without permission.
The World Famous GI Day
1977
Planning
• Brief ( 2minutes tops maybe) hallway
conversation between Lieutenant Major
Dr Fitzgerald Grunt, MD
• “I have money from Nipon-Nissan-
Phizzer. I’d like to do a GI Day.”
• I said, “Good”.
1978
The Day • 1 day ‘Advances in Ulcer Management’ 3-color brochure
• 6 lectures, each about 59.5 minutes in length; time for one
question
• Topics ranged from the biomolecular to the
pharmacoeconomic
• Target audience was family docs: 21 signed up. Some even
stayed past lunch. Lunch was good.
• Faculty outnumbered the participants by 2:1 (The Davis ratio:
2:1 is not a good number)
• Happiness index ratings were, well, not happy. They liked the
lunch though
• We broke even. Dr Grunt made a few bucks, brought his
buddies over from the UK, had a nice dinner for them.
© 2014 AAMC. May not be reproduced without permission.
Ye Olde CME versus What’s to come what’s wrong with this picture?
What’s wrong?
© 2014 AAMC. May not be reproduced without permission.
© 2014 AAMC. May not be reproduced without permission.
Referrals
revenue reputation
registrations
Does CME
work?
The (almost) world
famous Question
© 2014 AAMC. May not be reproduced without permission.
Does CME change
physician
behaviour? Does
it change patient
care outcomes?
© 2014 AAMC. May not be reproduced without permission.
It’s actually a complex question. It taught me two things:
1) What do we mean by CME?
© 2014 AAMC. May not be reproduced without permission.
Ye Olde CME
(like the GI Day)
The NEW CME/CPD
Needs Assessment None. More like the
planner’s needs.
Content Therapeutics for the most
part
Format Didactic. Can you say LEC-
ture?
Location Classroom/Holiday Inn
Audience Docs
Impact Happiness Index (they
weren’t)
Integration Zip
Where is the CME
office anyway?
Basement. Worse.
© 2014 AAMC. May not be reproduced without permission.
Where the *&^$@! Is the CME office?
#2: Basement:
in the MRI
concrete-walled
space
#1: Ward 4Y
Discharge
time 11AM
#3: Way the hell
and gone on
another
campus. Miles
away.
To Temporary
Bldg #26
Man.
© 2014 AAMC. May not be reproduced without permission.
Quality of care
and CME/CPD
Clinical practice guidelines
Lessons from Toronto
(say T’rana)
The University of
Toronto, SARS,
the continuum
and a bunch of
other stuff
© 2014 AAMC. May not be reproduced without permission.
Another Toronto lesson about integration: CME is a part of the medical education continuum*
Premedical Medical
School
Residency
and
Fellowships Practice
Life-Long
Learning
*this is the med ed continuum, by the way
But, Dude….these
guys don’t always do
so well…!
© 2014 AAMC. May not be reproduced without permission.
Who’s at fault 1: Good
guy, CME, gets hauled
away…..
Who’s at fault #2
“It’s not our fault. They keep
throwing them in the river
upstream before they learn to
swim.” Colin Wolf, former associate dean, CME,
University of Toronto
Who’s at fault #3… Monette J Eval & Health Prof 1997
Tamblyn R et al, JAMA 2002
Wenghofer E et al, Med Educ, 2009
© 2014 AAMC. May not be reproduced without permission.
What are we missing in the continuum?
EBM, Numeracy
Quality Improvement, patient safety,
value-based medical care
Shared decision making
Decision science
Equity, LGBT health; diversity
Mindfulness, resilience
PBLI, SBP, ‘collective competency’
(Lingard)
Cost/Value
Others….
This is
only, like,
a partial
list…
© 2014 AAMC. May not be reproduced without permission.
© 2014 AAMC. May not be reproduced without permission.
The Stories
McMaster
University
EBM, The
Question,
and the GI
Day
The University of
Toronto, SARS, the
continuum and
Rabbi Hillel’s
three questions
Jack Sibley,
Joseph Brant
Hospital and
the Wall
THINGS I learned in
America: Forces for
change, the tipping
point and the power
of an acronym
Where
did you
say the
CME
office is?
© 2014 AAMC. May not be reproduced without permission.
Dartmouth Atlas 2010
The peculiar case
of American low
back pain
© 2014 AAMC. May not be reproduced without permission.
Country-country comparisons
© 2014 AAMC. May not be reproduced without permission.
Where does the US stand relative to other countries in health?
Source: OECD Health Data 2014, July 2014
U.S. Comparison to OECD Nations
Bottom Quarter 78.7 yrs compared to
Japan at 83.2 yrs
4th Highest Highest 6.1 deaths/1,000 births
compared to average 4.0
deaths per 1,000 births
35.3% obese compared
to average 22.7%
Life Expectancy Adult Obesity Infant Mortality
2012 2012 2012
© 2014 AAMC. May not be reproduced without permission.
The tipping point
Usual Care
Accre
dita
tion
© 2014 AAMC. May not be reproduced without permission.
The tipping point
No change Change
© 2014 AAMC. May not be reproduced without permission.
© 2014 AAMC. May not be reproduced without permission.
Ye Olde CME versus What’s to come
Ye Olde CME The NEW CME/CPD
Needs
Assessment
None. More like the
planner’s needs.
Subjective, objective,
triangulated
Content Therapeutics for the
most part
Holistic
Format Didactic. Can you say
LEC-ture?
Interactive
Location Classroom/Holiday Inn Educational and clinical
settings
Audience Docs The healthcare team
Impact Happiness Index (they
weren’t)
Patient care, even
population outcomes
Integration Zip More complete. See needs
assessment
Where is the CME
office anyway?
Basement. Worse. What CME office?
Interactivity*
THINK: what elements
form the new CME/CPD?
Think outside the box.
PAIR: Take 5 minutes,
talk to your seat-mate.
What does he/she think?
SHARE: tell us what
you’ve come up with.
What elements has this
little grid missed?
*courtesy of Ivan Silver, Linda
Snell, Yvonne Steinert, others
© 2014 AAMC. May not be reproduced without permission.
The Stories
McMaster
University
EBM, The
Question,
and the GI
Day
The University of
Toronto, SARS, the
continuum
Forces for
change and the
power of the
acronym
Where
did you
say the
CME
office is?
Jack Sibley,
Joseph Brant
Hospital and
the Wall
© 2014 AAMC. May not be reproduced without permission.
Dave’s Faves
(I had to do it.
Sorry)
ddavis@aamc.org
© 2014 AAMC. May not be reproduced without permission.
Hillel, adapted: the last story for now
If we in CME are not for it (the field, the science, the profession), who can be for us?
If we are only for CME, who are we?
If not us, who? If not now, when? If not in our home settings, where?
© 2014 AAMC. May not be reproduced without permission.
And, next steps on the journey
University of
Toronto
The
Future ddavis@aamc.org
drdavedavis@gmail.com
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