1.  While we are waiting to begin, with the help of the person sitting next to you, try and solve these word puzzles.
i.e = TRIPOD

2. NES CPD Knowledge Market CPD: the journey from credit to quality
THANKS
HONORED to be here as your guest…
Though there was the SNOW and PLANE DELAY (and springlifed MO)
OUR MANTRA: once you’ve seen one medical school, you’ve seen them all. This is clearl true here: SIU is a ntional leader in medical education. Talk about coals to Newcastle….SIU has a wonderful, McMaster-like culture and gestalt, innovations, so – if there is ANYwhere to give this talk, it’s here….
Had a long time to think about this….
Changed slightly
Dave Davis, MD Senior Director, Continuing Education & Performance Improvement

3. Outline
The clinical care gap: is something wrong with CPD? With med education?
Forces for Change
Towards a more effective future for CPD:
The iLearner
“It’s about the outcomes, Stupid!”
Osler, Berwick and the work of medicine
New roles for us……
CPD at the end of the universe: supporting the change: AAMC, GIN, and your initiatives
Four major chunks here…knowing when to nap..room for interaction

4. I think we would all agree, the any discussion of the care gap begins here, with the patient
We define the care gap in any number of ways but truly it’s about the patient
The clinical care gap

5. Ideal, evidence-based practice
The clinical care gap
Ideal, evidence-based practice
clinical care gap
We can also define it graphically in this manner –
The first of three mind exercises
Current practice

6. Examples of the gap…

7. Forces for Change: 1) The Reports
In the face of the care gap, there have been strong forces for change

8. Good guy, CPD, gets hauled away
Film at 11

9. 2) Other forces for change
Regulatory, Accreditation req’ts
Research about effective CPD, QI, implementation
QI initiatives, PI
The New CPD
Continuum studies (eg Tamblyn)
Competency-based learning & assessment, recertification, MOC
Information explosion
HIT, data feedback and reporting; transparency
New diseases, prevention, screening
Bias, COI and Commercial support issues
PCOR-Comparative effectiveness
The implementation research agenda

10. “There’s a crack in it – that’s how the light gets in”
Towards a more effective future for CPD….
“There’s a crack in it – that’s how the light gets in”
Leonard Cohen

11. Theory, research lessons
Cost
unbiased info
evidence, evidence, evidence
the iLearner
the collaborative team-member
the faculty member
Theory, research lessons
The clinician-learner
The
‘content’ of CPD
from lecture to learning: effective CPD tools, interventions
alignment, silos, quality and safety
’It’s all about the outcomes, Stupid’
workplace learning
Health Care
System issues
Patient
Team members
These don’t quite fit..but this helps…
This is the third mind experiment – care gaps, causes and futures…
Here are some elements, all with the notion of the continuum behind them..let’s just touch on a few
The CPD system

12. What will the future look like?
Fox’s theory of learning & change
the iLearner
the collaborative team-member
the faculty member, the leader
The clinician-learner
The
‘content’ of CPD
Health Care
System issues
Patient
Team members
These don’t quite fit..but this helps…
This is the third mind experiment – care gaps, causes and futures…
Here are some elements, all with the notion of the continuum behind them..let’s just touch on a few
The CPD system

13. Fox’s theory of learning & change
environmental forces
Inter-personal forces
Intra-personal forces
NEEDS HI LO

14. Fox: learning needs Actual Need HI LO Perceived need High motivation
The CPD challenge:
low motivation
Mis-perceived need
No need for learning

15. We all know these guys don’t we. Some of them are here
We all know these guys don’t we? Some of them are here..many many of them!!
Probably the one thing that comes to mind when we think of the new generation of learner…the iPad-connected, facebook friendly, tweeting student or resident
My last lecture….
The iLearner

16. (inter)professional teams

17. New roles for clinician-faculty:
From Osler to Berwick and the work of the clinician
I have ben thinking a lot about this over the last year – partly because I live near Osler’s childhood home, partiyl because I’ve become a student of both Berwick and osler
Osler gave us a wonderful examples of the medical educator, clinician faculty
OLD: diagnosing illness, prescribing treatments, for patient with diseases –
the new – all of the above BUT a repsonsiblity fo rthe system in which the patient moves and its improvement.

18. New roles for leaders: breaking down the silos..
New roles for leaders: breaking down the silos..
Dave – two options for the silos – ignore links – they are for me

19. What will the future look like?
Cost
unbiased info
evidence, evidence, evidence
What will the future look like?
The clinician-learner
The
‘content’ of CPD
Health Care
System issues
Patient
Team members
These don’t quite fit..but this helps…
This is the third mind experiment – care gaps, causes and futures…
Here are some elements, all with the notion of the continuum behind them..let’s just touch on a few
The CPD system

20. The content/knowledge base of the new CPD: quality and evidence, clinical practice guidelines……..
There are several elements to the new content, all of which with significance for the new med ed, across the continuum
there’s so MUCH of it (CPGs, say): PBLI domain
There’ so much of it that’s bad: EBM, critical appraisal
And there’s the cost thing
Outcomes are important – eg CHF lectures

21. The Yerkes-Dodson Law: what we usually do
performance
information

22. The Yerkes-Dodson Law: what we could do
performance
information

23. Evidence synthesis and application, ala Haynes, Straus et al
Tools & Training
Systematic reviews/CPGs
Studies
Self/Patient experiences
Straus and others have portrayed evidence, information or knowledge as a multi-layered pyramid. At the base lie the countless patient experiences or encounters which the physician

24. What will the future look like?
The clinician-learner
The
‘content’ of CPD
effective CE methods
from lecture to learning
Health Care
System issues
Patient
Team members
These don’t quite fit..but this helps…
This is the third mind experiment – care gaps, causes and futures…
Here are some elements, all with the notion of the continuum behind them..let’s just touch on a few
The CPD system

25. Problem 1: choosing the wrong model (based on Nowlen’s Models of Continuing Education)
Update model
Competence model
Performance model

26. Educational Problem 2: confusing dissemination with implementation
Diffusion: distribution of information and the practitioners’ natural unaided adoption of policies and practices
Dissemination: communication of information to clinicians to improve their skills
Implementation: putting a guideline in place, involves effective communication, overcomes barriers by administrative and educational techniques
(after Lomas)...

27. Problem 3: not adopting the research
Physicians and others not self-aware: objective needs assessment, performance feedback important
Knowledge necessary but not sufficient for change; didactics lousy at changing performance
What works? Interactivity; sequencing; predisposing, enabling and reinforcing strategies
‘CPD’ > conferences; = practice-based tools (reminders, audit-feedback, protocols & training)
Docs pass through stages of learning: awareness, agreement, adoption to adherence
…………Cochrane reviews, AHRQ/EB reviews, others

28. Problem 4: formal CPD: JAMA 1999; 282:867-874

29. Changing the lecture/conference paradigm
“And, as you can see from my 78th slide….”
Golf game this aft…
My Charts are overdue
Teenage kids…arrgh
Surgery starts at noon…patients to see in hoostpial..
Pre-eclampsia patient in ER?

30. Reaching all learners…
FROM Formal CPD: lectures, courses, educational materials TO
Outreach visits
Small group learning
Opinion leaders
Academic detailing
Patient-mediated strategies
Audit/feedback
Reminders (computerized, etc)
Comprehensive, QI- or practice-based interventions
Other ICT-enabled tools (web-based, video-conferencing, PDAs, etc)
Reaching all learners…
Interactivity: Q&A, case discussion, reflection, MCQs, audience response systems, think-pair-share,

31. ‘Teaching’ the iLearner
My last lecture? It would be difficult to overestimate the effect that iLearning will have …..
But it’s most likely necessary but not sufficient…
© 2006 Association of American Medical Colleges. 31

32. What will the future look like?
alignment, silos, quality and safety
Phased interventions, the Pathman & Proceed Model
’It’s all about the outcomes, Stupid’
workplace learning
The clinician-learner
The
‘content’ of CPD
Health Care
System issues
Patient
Team members
These don’t quite fit..but this helps…
This is the third mind experiment – care gaps, causes and futures…
Here are some elements, all with the notion of the continuum behind them..let’s just touch on a few
The CPD system

33. the healthcare/education interface: a micro perspective

34. sing CPD/CPD as an intervention: Davis’ Pathman-PROCEED model: the macro/provincial perspective model
Methods/ Stages
Awareness
Agreement
Adoption
Adherence
Predisposing
Enabling
Reinforcing

35. Davis’ Pathman-PROCEED model: reducing pre-op XRays for low-risk procedures
Methods/ Stages
Awareness
Agreement
Adoption
Adherence
Predisposing
Newsletter
Standard CPD events
Enabling
Spec society buy-in
Small group sessions
Lab/XRay order forms
Reinforcing
(audit & feedback)

36. CPD at the end of the Universe
CPD & Improvement
CPD at the end of the Universe

37. Association of American Medical Colleges
Its roles….
Advocacy: GME, NIH funding, other issues
Articulation/Report generation
Convening
Support & Consultation:
Integrating Quality
‘Aligning and Educating for Quality’ – ae4Q
Teaching for Quality (Te4Q)
Resources: MedEdPORTAL, iCollaborative and other MedEd tools

38. The clinical /health care enterprise: focus on quality metrics, costs
addressing silos
The clinical /health care enterprise: focus on quality metrics, costs
A solution: ae4Q
The CPD enterprise: focused on courses and conferences, frequently related to commercial interests, self-assessed needs

39. Best Practices for Better Care
240 AAMC members on board
Five Commitments:
Teaching quality and patient safety to the next generation of doctors – Teaching for Quality (Te4Q)
Safer surgeries
Reducing Infection from Central Lines
Reducing hospital readmissions
Researching, evaluating and sharing new and improved practices

40. AAMC’s MedEdPORTAL

41. The research database www.rdrb.utoronto.ca
12 metropolitan areas, roughly 30 conditions studied, >6,000 patient records examined
Substandard care noted in 45% of clinical areas (of this, 46% underuse; 11% overuse)
Little variation by region or by type of condition (chronic, acute), socioeconomic status
Notable gaps in care in depression, alcohol abuse, diabetes care (about 45%), pneumonia (39%);
Better care (>50% compliance with recommendations) noted in hypertension, cardiac care, but just
NOTE: the inviible care gap (undiagnosed, undetected – e.g., smoking cessation, obesity counseling, care gap is HUGE)

42. More information: ddavis@aamc.org www.aamc.org/CPD www.mededportal.org
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