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 2 Conflict of Interest Declaration

3 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 in the Continuing Education of Physicians

6 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

9 Individual Physician Practice Context Data with Feedback Education Support Learning Resources 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. 10 A Description of Values

Competencies Required for Practice

12 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. 13 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. 14 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” 16 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

19 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

20 Persistent Gaps in Quality of Care Adherence to recommended health care indicators provided to adults (in the USA) Content Areas Preventative care54.9% Acute care53.5% Chronic care56.1% 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 22

23 less about learning from patients in clinics

24 or in acute care contexts

25 or during team interactions

or from assessing team performance here… 26

27 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. Published2007 Funding: American College of Chest Physicians 28

Continuing Medical Education Forsetlund, Bjorndal, Rashidian Continuing Education Meetings and Workshops: Effects on Professional Practice and Health Care Outcomes. Cochrane Systematic Review First published references Update trials More than 11,000 health professionals 29

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: Research Question. To determine how accurately physicians self-assess compared with external observations of their competence. 30

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) 31

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 32

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. 33

New MOC Framework Section 1 Group Learning Section 2 Self-Learning Section 3 Assessment Accredited Group Learning Planned Learning Knowledge Assessment Unaccredited Group Learning Scanning Activities Performance Assessment Systems Learning

CPD Strategies within the MOC Program 35 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 Management Strategy 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 change Fosters 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.

44 Looking Forward to Your Comments and Questions