Forty Years* in CME Where’s it been? Where’s it going? · I have no conflicts of interest in the presentation of this talk (maybe commendable; clearly pitiful) Well, come to think

© 2014 AAMC. May not be reproduced without permission.

Forty Years* in CME

Where’s it been? Where’s it going?

OR…………


CME at The End Of

The Universe


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)


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


Background/Orientation: Where the heck is Ontario and what’s it done for me lately??

Hamilton

Toronto

POP

QUIZ:

how do

you say

‘Toronto’?


Orientation #2: The Journey, what it looks like*

Joseph Brant

Hospital

McMaster University

University of

Toronto

AAMC

The

Future

*NOT to scale


Orientation #3: what the journey feels like

Look kids,

Dave says

he’s “retiring”

About the

hell time,

don’t you

think, Billy?


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?


The McMaster Stories

McMaster University: EBM, the GI

Day and The Question


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.


Ye Olde CME versus What’s to come what’s wrong with this picture?

What’s wrong?



Referrals

revenue reputation

registrations

Does CME

work?

The (almost) world

famous Question


Does CME change

physician

behaviour? Does

it change patient

care outcomes?


It’s actually a complex question. It taught me two things:

1) What do we mean by CME?


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.


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.


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


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…!


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


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…



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?


Dartmouth Atlas 2010

The peculiar case

of American low

back pain


Country-country comparisons


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


The tipping point

Usual Care

Accre

dita

tion


The tipping point

No change Change



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


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


Dave’s Faves

(I had to do it.

Sorry)

[email protected]


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?


And, next steps on the journey

University of

Toronto

The

Future [email protected]

[email protected]

mailto:[email protected]

mailto:[email protected]

Documents

Forty Years* in CME Where’s it been? Where’s it going? · I have no conflicts of interest in the presentation of this talk (maybe commendable; clearly pitiful) Well, come to think