Sketch of the CE-QI Bridge

The bridge between continuing education and quality improvement.

In September I attended a meeting in Baltimore, Maryland on the topic of quality improvement in continuing education in the health professions. A major topic of discussion in Baltimore was how best to facilitate communication between professionals working in the quality improvment (QI) field, and professionals working in the continuing education (CE) field. After the Baltimore meeting ended, the discussion continued in a forum on LinkedIn. One of the discussants -- Tiffany Harazinova of Indianapolis, Indiana -- wrote that we need to build a bridge between the worlds of CE and QI. Her comment captured my imagination, and I had recently set up a drawing board in my basement workshop, so I had some fun with Tiffany's suggestion. Here's what came out. (My friend Matt really likes the sharks.)

10 Steps to Forming a CCMEP Study Group

A study group in the dining hall at Harvard University's Currier House.

While it’s possible to purchase a course to prepare for the certified continuing medical education professional (CCMEP) exam, it can also be a lot of fun to form your own study group. As a bonus, you’ll have a chance to make friends while you practice adult learning principles.

Here’s an easy step-by-step guide to help you get started:

1)    Announce to your local colleagues that you are forming a study group for the CCMEP exam. Specify a start date, and begin recruiting members. Social media like Facebook, LinkedIn, or Twitter are ideal for this purpose.

2)    Set a deadline for people to contact you, and make sure they know space is limited. Stop recruiting when you have reached 6 or 8 members. Too many people will make your group hard to manage; too few and your group won’t be able to function without full attendance.

3)    Arrange the time and place for your first meeting. A casual restaurant that is centrally located would be ideal. Try to pick a night the restaurant isn’t too busy – your group might tie up a large table for several hours.

4)    Before the first meeting, read up on principles of adult learning from the content outline published by the National Commission for Certification of CME Professionals (NC-CME). Prepare a brief lesson to share what you’ve learned.

5)    Distribute copies of an agenda along with the content outline. Allow plenty of time at this first meeting for people to introduce themselves and explain why they want to take the exam. To set a light-hearted tone, include some ice breaker activities. One idea that works well is a brief “show and tell” session, where everyone brings an object related to an adult learning challenge they have successfully mastered. Allowing each person to boast a little will build self-confidence.

6)    Bring along a partially filled out sheet of paper titled “Our Learning Charter.” (Malcolm Knowles, an important adult learning theorist, would definitely have approved of this.) At your first meeting, write down the group’s answers to the following questions: a) what is our name? b) what is our chief learning goal? c) when do we hope to learn it? d) what resources will we use?  e) who will teach us? f) how will we know when we reach our goal?  g) how will we celebrate success? Invite everyone present to sign the charter, and remember to record the date.

7)    Sketch out a calendar for future monthly meetings. These can be in person, over the phone, or via webinar. Divide the content outline up into chunks, and assign one chunk per meeting.  Ask for volunteers to teach the various chunks to the rest of the group.

8)    Assign homework. For one person, the homework will be to prepare next month’s lesson. For everyone else, the homework will be to dream up 10 to 20 multiple choice questions that might appear on the exam.

9)    Ask for a volunteer to briefly review a helpful study resource at each meeting. This might be a book, journal, or Web site. The NC-CME has produced a peer-reviewed list of professional books and journals that can be downloaded for free – it’s a great place to start.

10) For your group’s last meeting, pool all of your imaginary test questions into a single, humongous list. Distribute the mock test to members for review before they take the exam. You may need a 3-ring binder for all the questions and other helpful review material you collect. When you take the real test, you’ll be pleasantly surprised how much you have learned. Champagne, hors d’oeuvres, and dinner at a nice restaurant can be a great way to celebrate when a member earns the CCMEP credential.

“A Curious Soul”

Philadelphia’s Derek Warnick Continually Reinvents His Role

A Profile for MAACME Members
Article copyright 2014 Harting Communications LLC, all rights reserved. 

Derek Warnick

Some colleagues who know him well describe Derek Warnick as a curious and witty introvert; others consider him a brave individual who embraces new ideas, his family, and good baseball. Now in his final week as grants manager for the continuing education office of Penn State College of Medicine in Hershey, Pennsylvania, Warnick coordinates the submission of proposals for commercial support across a broad range of therapeutic areas. Warnick has been working at Penn State more than two years, after being laid off from a medical education company in Exton. He starts a new job with a different employer on July 28.

“He is a curious soul,” says Brian McGowan, PhD, chief learning officer and co-founder at ArcheMedX Inc, an e-learning technology company based in Charlottesville, Virginia. “I love the man. I learn so much from him. I have an unbelievable amount of respect from afar, watching what he’s doing.”

Not for the Fainthearted

Graphic courtesy Intelligent Medical Decisions Inc., Media, PA

Performance improvement continuing medical education (PI-CME) is the newest, most complicated, and most expensive form of CME.  Here's a guide for medical writers who want to learn more, courtesy of the American Medical Writers Association.

More Clouds Than Sunshine in Harrisburg

If you follow @CME_Scout on Twitter, you know I like to report on the latest news and trends that affect how we do our jobs in the continuing medical education (CME) space.

So last week I chose to pay the $129 registration fee to attend the annual meeting of accredited CME providers hosted by the Pennsylvania Medical Society (PAMED) in Harrisburg. Here’s a quick recap, written for Linda, a CME colleague in Media who didn't have time to go.

The 8:15 a.m. overview was short on specifics of areas of non-compliance and areas for improvement, as promised on the original agenda. Instead, Barbara Dugan, associate director for CME at the Pennsylvania Medical Society (PAMED), followed a revised agenda and spent a great deal of time on a participatory exercise aimed at familiarizing attendees with ACCME's simplification initiative. (See photo 1 below.) We received a good, color-coded handout in our packets related to this topic. To me, ACCME simplification is long overdue. As a board-certified editor, I've often found the wording of ACCME criteria to be obscure and redundant.

 

Photo 1: Participatory exercise related to simplified ACCME criteria

Photo 2: Example of a simplified ACCME criterion

Photo 3: A key terminology change

The 9:45 a.m. presentation on the Sunshine Act was given by Sterling North, director of continuing professional development at Geisinger Health System, and Justine Rubino, certification supervisor at University of Pittsburgh Medical Center (UPMC). They used slides developed by Barbara Barnes, MD, MS, associate vice chancellor at UPMC and vice president for sponsored programs, research support, and CME at UPMC.

North's presentation raised more questions than it answered. North, by his own admission, is not an expert on this topic and could not answer many questions from the floor, at least not in a convincing manner. "I don't want to be an expert on the Sunshine Act, quite frankly," North told us. "Here's another thing that we're being faced with . . . I'm not an expert, I'm dealing with this just like you guys are."

For example, Barnes' slide deck did not emphasize the fact that honoraria paid to faculty of ACCME-accredited educational activities are exempt from reporting under the act. This seems like it would have been important information to include, given the fact that the audience for the day-long meeting consisted of accredited CME providers from around the state. This point did come up during Q&A however, because I asked about it. Leslie Howell, director of CME, training, and physician leadership programs for PAMED, confirmed that faculty honoraria for ACCME-accredited programs are exempt from reporting, but added there is a complicating wrinkle: what about programs accredited indirectly, through state medical societies? According to Howell, the majority of accredited CME providers in the United States fall into this category. Howell recommended taking a hard line on this issue, insisting that providers accredited directly by the ACCME and those accredited indirectly through their state medical societies all report data annually through the same PARS portal and are therefore all a part of the same system, so the exemption holds.

Barnes' slide deck was moderately helpful in other areas. Here are 4 highlights of what she considers the implications for CME:

1. Payments to teaching hospitals for commercial support and exhibits will be reportable.

2. It is likely some companies will also report for non-teaching hospitals (there is nothing to prevent them from doing this).

3. Although it is not required, companies may try to report "directed" payments to physicians in accredited CME activities for honoraria and meals.

4. Payments to hospitals and directed payments to physicians for meals and speaking will be reportable for non-CME activities.

Questions from the floor reflected physicians' concern regarding what conclusions may be drawn from these data once released to the public. Another person wondered how the ACCME's definition of "commercial interest" aligns with the federal government's definition under the new open payments system. There was also considerable discussion of whether medical trainees (residents) are covered, and whether physicians who are no longer seeing patients are covered.

Ms. Rubino offered her perspective that drug companies do not seem to understand the law. There is a common theme of wanting to overreport, and they seem to collect a great deal of information they don't need. There is also a great deal of variation among companies with respect to the information they are gathering. Her job within a centralized office at UPMC allows her to survey a wide range of agreements with many commercial supporters and she sees "no consistency" on key points such as meals and types of participants required to report. "It's not standard by any means," Rubino said.

One of the most helpful parts of the presentation was provided by Ms. Rubino, who distributed a handout containing examples of language taken from actual letters of agreement (LOAs) that UPMC has executed with various commercial supporters and exhibitors.  She gave us 6 examples from LOAs and 2 examples from exhibits. The most egregious example of overreporting given was example 6, in which the commercial interest informed UPMC that the following data would be collected for each "transfer of any value" to a U.S. physician:

1 address

2 professional type

3 specialty

4 NPI#

5 state license number

6 state of license

7 non-US license

8 date of payment

9 total amount of payment

10 currency of payment

11 form of payment

12 nature of payment

13 expense type

14 product

15 therapeutic area

16 city, state, and country of travel

Pretty amazing, eh? Seems like Big Pharma may be trying to make a virtue out of necessity here, gathering as much physician data as possible since this is required by the Sunshine Act anyway, with the hopes of being able to use the data for other purposes, perhaps sales and marketing and direct mail, at a later date. The vibe in the room full of many hospital-based physicians was one of disbelief, mistrust, anger, and frustration.

Which reminds me: the meeting was aimed at directors, coordinators, and chairs of CME from both accredited and non-accredited community hospitals and medical specialty societies in Pennsylvania. There appeared to be roughly 60 people in attendance, including faculty and presenters. (See photo 5)

Photo 5: Meeting room setup. Leslie Howell sits at far left.

The "Leading from the Middle" presentation by Donald Hess, MD, MPH, was interesting, engaging, offbeat, and a little too long. Linda didn't ask about it so I won't elaborate. Same for the fish bowl exercise in problem-based learning.

The final panel discussion consisted mostly of elderly physicians quizzing a bright, young, and obviously competent hospital CME director on how she produces short e-learning modules on a variety of topics using Adobe Captivate software and how she then attempts to measure changes in physician competence and patient outcomes afterwards.

The wrap-up and final Q&A got bogged down in the nitty-gritty details of CME committee work and, in my view, missed any mention of the elephant in the room: What is being done to save vibrant and effective CME at local community hospitals in Pennsylvania, which are so obviously on the brink of extinction?

Helping the Poor in Coatesville

I heard back from the Brandywine Health Foundation yesterday. Now it's time to schedule a meeting in Coatesville. If you can read this, please contact me via email at donharting at verizon.net.