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 inthe ContinuingEducation 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

A Description of Values

IndividualPhysician

Practice

Context

Data with Feedback

Education Support

LearningResources

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

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

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 care 54.9%

Acute care 53.5%

Chronic care 56.1%

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.

Published 2007

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 2001221 references

Update 2009 + 81 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: 296:1094-1102.

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

ScanningActivities

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 ManagementStrategy 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

changeFosters 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