Learning in the Workplace: Role of CME/CPD

SACME Fall Meeting 2015Baltimore, November 13, 2015

What does - workplace learning - mean to you?

PanelModerator:Mila Kostic, CHCP, FACEHPDirector of CMEPerelman School of Medicine at the University of Pennsylvania

Suzanne Ziemnik, MEdVice President of Continuing Professional DevelopmentThe American Society for Clinical Pathology

Jack Dolcourt, MD, MEdAssociate Dean for CME, Medical Graphics and PhotographyProfessor of Pediatrics,University of Utah School of Medicine

Betsy White Williams, PhD, MPH Professional Renewal Center®Department of PsychiatrySchool of Medicine, University of Kansas

Mindi McKenna, PhD, MBACME Division Director for American Academy of Family Physicians

Julie White, MS, CHCPDirector, Continuing Medical EducationBoston University School of Medicine

Learning as a process, not an outcome

Learning is a process whereby knowledge is created through a transformation of experience. (D. Kolb’s Experiential Learning Model)

- Formal Learning – defined goals and outcomes, usually in canonical occupational knowledge

- Informal Learning – largely learning from experience, no set expectation or outcome

- Incidental Learning – unplanned by learner or instructor, mostly workplace learning - Just-in-time or at the point-of-care learning

Workplace Learning Is the way in which individuals or groups

acquire, interpret, reorganize, change, or assimilate a related cluster of information, skills and feelings. It is also primary to the way in which people construct meaning in their personal and shared organizational lives. (Marsick, 1987)

(Davis DA, 2010 Lifelong Learning in Medicine and Nursing Report) Learning and change in the health professions

– Vision and Recommendations CE Methods, IPE, Lifelong Learning, Workplace

Learning, Learning at the point of care

Workplace Learning- Increasingly Important “The greatest proportion – perhaps as much as

90 % of learning occurs incidentally … including exposure to the opinions and practices of others also working in the same context”

Workplace Learning link to Quality, Safety and Team Work “To raise quality, health care managers will

reposition CPD from a developmental tool for individuals to a strategic tool for the care delivery unit”.

(Cervero RM, 2000)

Stephen Billett, Readiness and learning in health care education, THE CLINICAL TEACHER 2015; 12: 1–6

Learning as an experience

Readiness refers to an individual’s ability to learn from what they know, can do and value (i.e. their conceptual, procedural and dispositional capacities).

Conceptual knowledge

(what individuals know)

Procedural knowledge Dispositional knowledge

(what individuals can do) (what individuals value)Interdependence amongst conceptual, procedural and dispositional

knowledge

Aligning experience is critical

We must pay attention to assessing readiness to learn at all 3 levels

Is there a role for us to play in the workplace learning?

What are we already doing?

Jack Dolcourt, MD, MEdAssociate Dean for CME, Medical Graphics and Photography

Professor of Pediatrics

University of Utah School of Medicine

The Huddle

Society for Academic CMEPanel: Role of CME/CPD in the Workplace Learning

November 13, 2015

Daily Huddle – Census Rounds

• 10+ years in 3 Newborn ICU (NICU) in SLC

• Predictable start time & location– Expectation: drop everything and show up

• Evolution– Nursing: bed availability for new admissions– Administration: anticipated discharges and

staffing– Rounding strategy

Evolution to include Safety

• Q1 2014 Zero Harm Initiative• Culture change

– All meetings begin querying safety issues– Empowering

• Identifying safety issues beginning of NICU census rounds– Interdisciplinary team (physician, APRN,

dietician, pharmacist, discharge planner, social work, head nurse, team leaders etc)

Examples of Types of Issues

Mostly no physical harm resulted• Communication• System structure• Medication or feeding errors• Laboratory errors and mistiming• Staff safety• Parents inconvenienced by outside

vendors

Opportunity for certified CIPE

• Formal instruction component– Dynamic & relevant to workplace– Relatively consistent group of participants– Interprofessional learners and teachers

» Team function» Interaction and opportunity for reflection

– Track changes – PDSA cycle

About Credit? Is it in the way? Does it help?

How AAFP’s Credit SystemSupports Workplace

Learningpanel presentation at the Society for Academic CME (SACME) fall meeting

Baltimore November 13, 2015

Mindi McKenna, PhD, MBA

CME Division Director for AAFP

Mindi McKenna, PhD, MBAContext for My Comments (Disclosure)

Previous Affiliations / Responsibilities:• Executive Director, Healthcare Leadership Group• Faculty, Rockhurst University, Health Care Leadership MBA Program• VP of Business Development & Marketing, Cerner Corporation (medical software)• Director, Marion Laboratories / Marion Merrell Dow (pharmaceutical research and

manufacturing)

CME Division DirectorAmerican Academy of Family Physicians

Disclosure: AAFP manages one of the USA’s 3 CME credit systems,which reviews and approves thousands of learning activities each year for AAFP

credit.

Author of 2 books: “High Tech Medicine” and “Physicians as Leaders” with P. Pugno, MD

Myths and misconceptions about CME credit(health care is changing … is CME?)

• MYTH: “Certified / accredited" CME must be costly and complex.

• FACT: Small, basic, practice-relevant activities can qualify for CME credit.

• MYTH: CME must be “formal.” • FACT: Some informal learning activities qualify for CME.

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Misconceptions and myths about CME credit(health care is changing … is CME?)

• MYTH: CME doesn’t align with workplace learning.

• FACT: Point of Care (POC-CME) credits HCPs for learning and improving in practice.

• FACT: CME credits “learning-from-teaching / scholarship.”

• FACT: Simulation activities often qualify for CME credit.

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Misconceptions and myths about CME credit(health care is changing … is CME?)

• MYTH: CME doesn’t align with QI or health system priorities.

• FACT: PI-CME credits HCPs for measuring patient care; for learning and changing; then re-measuring.

• FACT: PI-CME often meets MOC Part IV requirements.

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Misconceptions and myths about CME credit(health care is changing … is CME?)

• MYTH: CME doesn’t align with HCP’s other requirements. • FACT: AAFP tracks which ACGME/ABMS core

competencies are addressed by the many thousands of CME activities we certify each year.

• MYTH: CME hasn’t changed in decades. • FACT: AAFP is launching “t2p” which credits HCPs for

“Translating To Practice” what they are learning through commitment to change, barrier mitigation, reminders and support.

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What more could we be doing? Or differently?

A-B-C, Think – Pair - Share “A” How may that look like in academic CPD practice? “B” What skills, values and resources do we have that

can support us? “C” Is there anything we need from other CPD

stakeholders and how do we get it?

Silent Reflection (2 minutes)

Table Sharing (8 minutes)

Large Group Sharing (10 minutes)

Boston University School of Medicine | Continuing Medical Education

Julie White, MS, CHCPDirector, Continuing Medical EducationBoston University School of Medicine

Experience from 20 PI CME Programs

• Insert ourselves into the workflow

• Provide on-going project management

• Facilitate identification and implementation of interventions

• Assemble resources – clinicians from other departments, students, external services

• Offer CME/CNE credit and garner MOC IV approval

• Assistance with grant development and publications

• Making it meaningful to practice – encourage team participation

Experience from the Sim Lab and OSCEs

• Offer credit• Promote event• Educational design• Project management• Resource acquisition (space,

equipment, staffing, food)

Online Educational Resources

• Curriculum design• Application of adult education principles• Promotion/consumer behavior

consultation• Offer credit• LMS

Visionaries …

• Aligning MOC, OPPE, MOL, CLER, QI

• Bring in expertise from other fields – education, management, public health, …

• Overcome barriers, align resources, see beyond the silos

Workplace Learning (Virtually): Is there a role for CPD?

Suzanne ZiemnikVice President of Continuing Professional Development

SACMENovember 13, 2015

Workplace Learning

• “The way in which individuals or groups acquire, interpret, reorganize, change or assimilate a related cluster of information, skills and feelings, and a means by which health professionals construct meaning in their personal and organizational lives” (Marsick, 1987)

• Contextual learning• Not necessarily designated for credit in traditional CE

frameworks

Opportunities in Pathology

• Pathology is becoming digital• Full Slide Scans -3gb an image• Crowdsourcing & sharing have become mainstream

• Virtual Training• Shared Viewing• Image Annotations

• Machine Learning• Image Comparison• Clinical Decision Support

PathInsights GI: Tools for Creation, Content for Consumption

PathInsights GI includes dynamic learning and collaboration resources:

• Comprehensive information set with personalized curation tools

• Peer collaboration tool• Master class online microscope • Expert teaching collections• Related study materials• GI specific CME • Case studies in presentation mode

Peer Collaboration Tool

• Pathologists virtually share their diagnostic problems directly with each other

• Peer dialogue on problematic details of the patient case• Tool allows for the permanent capture and subsequent reuse

of the teachable moment

Communities of Practice

Communities of Practice

Workplace Learning: What is the Role of

CME/CPD

Betsy White Williams, Ph.D., M.P.H.Professional Renewal Center®

Department of PsychiatrySchool of Medicine, University of Kansas

University of Kansas

Social Cognitive Theory• Learning occurs in a social context with a dynamic and

reciprocal interaction between the person, the environment and behavior.

• There is an emphasis on social influence and its influence on external and internal reinforcement.

• Considers how people acquire and maintain behavior while considering the social environment in which the individual behaves.

• Recognizes past experiences which play a role in whether behavior will occur.

Bandura, 1986

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Workplace Learning

Workplace Learning

• In the research of each of the bases of performance:

• Cognitive• Behavioral, and• Environmental

• The whole cannot be fully understood without reference to the linkages among the three

CognitiveFactors

EnvironmentalFactors

Behavioral Factors

Organizational, Team, IndividualPerformance

Workplace Learning

• Basic dichotomy• Formal Learning

• Attendance at CPD event at workplace

• Completion of on-line training module

• Informal Learning• Happens through

experience and interactions

• Is indirectly judged as to outcome

FormalLearning

Informal Learning

Workplace Learning

• Learning organization (Sengue, 1990)…...”organizations where people continually expand their capacity to create the results they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspiration is set free, and where people are continually learning to see the whole together.”

…. “in situations of rapid change only those that are flexible, adaptive and productive will excel. For this to happen, it is argued, organizations need to ‘discover how to tap people’s commitment and capacity to learn at all levels’

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Workplace Learning

Workplace Learning

System

Team

InterpersonalSkills

Knowledge/ Procedure

• Each area of the organization has a place for, indeed should be a focus of, CME/CPD

• To date we have focused on personal mastery

• There has been increased focused on interprofessional/team learning

• More opportunity for CME/CPD exists at higher levels of the organization

In SummaryWhat does - workplace learning - mean to you?Some ideas about what we are already doing

Case conferences and quality rounds, huddles QI work, faculty development Danger of hidden curriculum Contributing in non-credited practice improvement

What we have to pay attention to Context of the workplace – learning environment Assessing readiness to learn (change) in all 3 domains of

knowledge Dispositional readiness is central to the quality of engagement

and learning through clinical practice to secure appropriation of healthcare knowledge (beyond superficial engagement)

To learn more - Valsiner J, van der Veer R. The social mind: The construction of an idea. Cambridge, UK: Cambridge University Press; 2000.- Cole M. The zone of proximal development where culture and cognition

create each other. In: Wertsch JV (ed.) Culture, communication and cognition: Vygotskian perspectives. Cambridge, UK: Cambridge University Press; 1985: pp. 146–161.

- M. W. J. van de Wiel et al. Exploring deliberate practice in medicine: how do physicians learn in the workplace? Adv in Health Sci Educ (2011) 16:81–95 DOI 10.1007/s10459-010-9246-3

- Davis DA, 2010 Lifelong learning in Medicine and Nursing report- Stephen Billett, Readiness and learning in health care education, THE

CLINICAL TEACHER 2015; 12: 1–6- John Parboosingh FRCSC, FRCOGJ, Workplace Learning, First Regional

Conference and 9th National Workshop on Continuing Professional Development (CPD) of Physicians

- E. Wenger, 1999 Communities of Practice- Ericsson KA, Deliberate Practice, 2004, 2006- Wertsch JV. Mind as action. New York: Oxford University Press; 1998.