Redesigning Redesigning Continuing Continuing Education for Education for the Health the Health ProfessionsProfessions

Institute of MedicineInstitute of Medicine

Established in 1970 by National

Academy of Sciences to exam policy

matters pertaining to the health of

the public National Academy of

Sciences is a private, nonprofit

society that was established by

congresssional charter to advise the

federal government

Historical Context for Historical Context for Continuing EducationContinuing Education

•Continuing Education not seen as

prestigious as undergraduate or graduate

education

•1960’s- most was provided by

pharmaceuticals

•Subject to criticism- Conflict of Interest

•CE industry has grown rapidly in last 10

years

•Increasing involvement of commercial

support and Medical Education and

Communications (MECC)

Concerns about Continuing Concerns about Continuing EducationEducation

•Flexner report in 1910- concerned about

UG medical education and lack of

standardization

•These mirror the concerns we have today

about CE

•CE largely driven by state requirements,

certification requirements and regulatory

bodies

RequirementsRequirements

•For MD’s- Michigan- 50 CME credits

per year

Alabama- 12 CME credits per

year Indiana- 0 CME credits per

year

•Nursing varies from 5-15 hours per

year

•Pharmacy varies from 10-60 hours per

year

•No evidence to support the number of

hours or the type of education

MedicineMedicine•ACCME- Accreditation Council for Continuing

Medical Education-accredits the providers

•Medical Schools, Professional Societies and MECC

(for profit)

•On average ACCME providers report profits of

23.5%

•58% of CME is industry funded

•1.5 billion of CME from commercial entities

•Some effort to develop safeguards but not enough

•Reports of planted members in audience to ask

about a drug

•What would happen if withdrew all commercial

funding- cost each MD on average $3,500 each

year

PharmacyPharmacy

•Pharmaceutical and medical device

companies have a leading role in CE for

Pharmacy and Medicine

•2006- 43% of CE programs for

pharmacists received commercial support

•Culture where pharmacists expect to

obtain CE at minimal cost and the CE

providers were dependent on industry to

cover their costs

Other ConcernsOther Concerns

•2.5 billion in income in 2007

•1.5 billion commercial funds

•Concerns about quality, inconsistency

in number and type of hours, conflict of

interest and funding lead to the

convening of a conference funded by

the Macy Foundation

Macy Foundation ReportMacy Foundation Report

•CE was more focused on number of

credits than on improvement in

performance or patient care

•Funded by organizations with conflicted

interests

•No incentives for Interprofessional Care

•They called for the appointment of an IOM

committee to consider the development of

a national Interprofessional Continuing

Education Institute

Committee on Planning for a Continuing Committee on Planning for a Continuing Health Care Professional Education InstituteHealth Care Professional Education Institute

Jako S. Burgers Senior Researcher, Scientific Institute for Quality of Healthcare

Linda Burnes BoltonVice President and Chief Nursing Officer, Cedars-Sinai Medical Center

Catherine DeAngelisEditor-in-Chief and Senior Vice President, Scientific Publications and Multimedia Applications, JAMA

Robert D. FoxProfessor Emeritus of Adult and Higher Education, University of Oklahoma

Sherry A. GliedProfessor and Chair, Department of Health Policy and Management, Columbia University, Mailman School of Public Health

Kendall HoDirector, eHealth Strategy Office, Associate Professor, Division of Emergency Medicine, University of British Columbia

Edward F. LawlorDean and William E. Gordon Distinguished Professor, George Warren Brown School of Social Work, Washington University

David LeachFormer Executive Director, Accreditation Council for Graduate Medical Education

Lucinda MaineExecutive Vice President and Chief Executive Officer, American Association of Colleges of Pharmacy

Paul E. MazmanianAssociate Dean for Continuing Professional Development and Evaluation Studies, Virginia Commonwealth University

Michael W. PainterSenior Program Officer, Robert Wood Johnson Foundation

Wendy RheaultVice President, Academic Affairs, and Dean, College of Health Professions, Rosalind Franklin University of Medicine and Science

Marie E. SiniorisPresident and CEO, National Center for Healthcare Leadership

Gail L. Warden (chair)President Emeritus, Henry Ford Health System

Charge to CommitteeCharge to Committee

Review issues in continuing

education (CE) of health care

professionals to consider the

establishment of a national

interprofessional CE institute to

advance the science of CE

Committee ProcessCommittee Process

12 month study

3 face-to-face meetings

2 public workshops with 17 speakers

Extensive literature review

16 external reviewers

Conclusions about CEConclusions about CE

•Purpose of CE is to enable health professionals

to keep their knowledge and skills up to date,

with the ultimate goal of improving

performance and patient outcomes

•CE should be interprofessional and include a

broad variety of professionals (e.g., dentists,

dieticians, nurses, physical and occupational

therapists (etc)

Key messagesKey messages

There are major flaws in the way CE is conducted, financed, regulated, and evaluated

-Focus on meeting regulatory requirements rather than identifying personal knowledge gaps -Concerns about conflicts of interest in CE activities-Regulations that vary widely by profession, specialty, and state, leading to inconsistent learning

Key messages (continued)Key messages (continued)

•The science underpinning CE is fragmented

and underdeveloped

-Often characterized by didactic learning methods (e.g.,

lectures) in traditional settings (e.g., auditoriums)

-Little specific information about how to best support

learning

-Health professionals lack a dependable basis for

choosing among CE programs

-Leaves the larger value of continuing education for

health professionals uncertain

Key messages (continued)Key messages (continued)

• CE should be interprofessional in

nature

• A new, comprehensive vision for CE

is needed that prepares all health

professionals to perform to their

highest potential

Toward a system of continuing Toward a system of continuing professional developmentprofessional development

•In CPD, learning opportunities:

-Stretch from the classroom to the

point of care

-Shift control of learning to

individual practitioners

-Adapt to individuals’ learning needs

Toward a system of continuing Toward a system of continuing professional developmentprofessional development

•CPD system offers promise to:

-Advance evidence-based, interprofessional, team-based

learning

-Strengthen the research workforce, particularly

through academic institutions

-Engender coordination and collaboration among the

professions

-Provide higher quality for a given amount of resources

-Lead to improvements in patient health and safety

Alternatives consideredAlternatives considered

•Status quo

•Program within a federal agency

(AHRQ or HRSA)

•Purely private structure consisting of

professional societies

•Coalition that includes the quality

improvement community

•Public-private structure

Recommendation 1 Recommendation 1 Commission planning of an Commission planning of an instituteinstitute

The Secretary of the Department of

Health and Human Services should

commission a planning committee to

develop a public-private institute for

continuing health professional

development

Recommendation 2Recommendation 2Envisioning a CPD systemEnvisioning a CPD system

Recommendation 3Recommendation 3Improve quality and safetyImprove quality and safety

Recommendation 4Recommendation 4Improve scientific foundation of Improve scientific foundation of CPDCPD

Recommendation 5Recommendation 5Enhance data collectionEnhance data collection

Recommendation 6 Recommendation 6 Develop national regulatory Develop national regulatory standards standards

Recommendation 7Recommendation 7Strengthen financial supportStrengthen financial support

Recommendation 8Recommendation 8Foster development of Foster development of interprofessional modelsinterprofessional models

Recommendation 9Recommendation 9Support research Support research

Recommendation 10Recommendation 10Evaluate progressEvaluate progress

Planning committee for the Planning committee for the CPDICPDI

Structure of CPDIStructure of CPDI

Structure of CPDI (continued)Structure of CPDI (continued)

Managed by competency-based board

Initial oversight and coordination by

federal government as a central

convener

Board should determine whether the

government’s responsibilities should be

transferred back to CPD stakeholders.

Unless the board determines otherwise,

the Secretary will eventually have no

formal role in the institute

For more information about the report and to

download the summary:

www.iom.edu/continuinged

Thank YouThank You