CE IN NURSING AND MEDICINE: WHAT DOES THE FUTURE LOOK LIKE? RECOMMENDATIONS FROM A MACY CONFERENCE ON LIFELONG LEARNING SPONSORED BY THE AACN & AAMC January 13, 2010 2:00 3:00 PM ET Presenters Dave Davis, M.D., FCFP Joan Stanley, Ph.D., RN, CRNP, FAAN Melinda Steele, M.Ed., CCMEP, FACME Madeline (Mattie) H. Schmitt, Ph.D., R.N., F.A.A.N., F.N.A.P. Don Moore, Ph.D.
The Lifelong Learning Initiative AAMC/AACN Overview Background; forces for change in continuing education Goal, themes and timelines of the Lifelong Learning Initiative Recommendations general the competency of lifelong learning interprofessional/team-based education the methods of continuing education workplace and point-of-care learning What s next? Discussion + Forces for change Research about effective CNE, CME, QI The 2007 Macy Report; others Accreditation req ts Accountability; performance measurement Competency assessment, recertification Content issues: new diseases, prevention, screening CME The LLLi Governmental cost containment issues QI initiatives Knowledge explosion Regulatory focus on outcomes Bias, COI and Commercial support issues
The LLLi: timeline Phase 1 Phase 2 Phase 3 Literature review, preliminary synthesis (note limitations) The AAMC/AACN LLLi planners Consensus Conference Participants Follow up, recommendation writing, further lit review, consensus LLLi planners, conference participants and others Nov 08 Feb 09 Feb 09 Feb Fall 09 A Vision for Continuing Education & Lifelong Learning We envision a continuum of health professional education from admission into a health professional program to retirement that values, exemplifies, and assesses lifelong learning skills; emphasizes interprofessional and team-based education and practice; employs tested, outcomes-based continuing education methods; and links health professional education and delivery of care within the workplace. To achieve this vision, we encourage an understanding of and support for the need for change, and collaboration among stakeholders responsible for the interdependent elements of this vision academic institutions, healthcare systems, continuing education providers, accrediting bodies, licensing and credentialing boards, funders, and others. Statement endorsed by the American Association of Colleges of Nursing Board of Directors and the American Association of Medical Colleges Council of Deans, 2009
Interprofessional Education Lifelong Learning Skills Patient Workplace Learning Continuing Education Methods Point of Care Jointly sponsored by the Association of American Medical Colleges and the American Association of Colleges of Nursing 7 Themes, target audiences Boards, specialty societies, accreditation bodies (education and healthcare) Medical, nursing schools CE methods Workplace, Point of Care Learning GOALS GOALS Interprofessional team-based care Lifelong learning Recommendations
GENERAL RECOMMENDATIONS 2.1 Health professional organizations, CE providers, faculty and others must assimilate and disseminate evidence to the public, p0licy makers, and regulatory agencies that CE and lifelong learning contribute to improved health care quality and safety, cost-effectiveness of care and improved access. 2.2 Health professions, including the academic institutions preparing new clinicians and the regulatory bodies that credential clinicians the academic and care facilities, must embrace a new construct of lifelong learning which includes the development, fostering and testing of knowledge management and related skills. Such skills are necessary from admission to health professional education through one s practice career. 9 2.3 Health professions organizations, academic institutions, policy makers, insurers, CE providers, and regulatory bodies need to embrace an inter-professional education (IPE) framework. The framework must be patient-centered and flexible and encompass a significant and measurable component across the entire educational continuum from entry into health professional education throughout one s career. Achievement of this recommendation also would require the development of a national vehicle for fostering IPE. 2.4 Health professions organizations, policy makers, the public, regulatory bodies, higher education institutions, and CE providers must continue to investigate the most effective CE methods to support healthcare providers, practices and health systems to improve healthcare quality and safety. 10
SECTION II GENERAL SECTION 2.5 Health professions organizations, healthcare delivery systems and regulatory bodies should embrace Point of Care learning strategies. This includes the simplification and streamlining of credit systems for POC activities; facilitation of research on POC learning including self-assessment mechanisms and the use of technological approaches to improve practice. 2.6 Higher education and healthcare institutions, professional organizations and others should support the development and re-education of continuing education providers to achieve the goals of a newly envisioned CE system and to support effective lifelong learning across the health professions. 2.7 Health system leaders, payers, regulatory agencies, and CE providers, recognizing the potential contribution to quality, costeffective care, should support the increased development and use of work-place learning strategies, including point-ofcare learning. 11 LIFELONG LEARNING 3.1 Academic institutions, curriculum designers and planners, faculty members and others must develop, test and refine curricula to incorporate lifelong learning skills. Their accrediting bodies must incorporate measurable LLL outcomes into standards and program expectations. 3.2 Continuing education planners, faculty teachers, and regulatory bodies, including accrediting, certifying and licensing bodies, must understand and support the principles of lifelong learning in education activities and their regulatory processes, including credit systems, standards and assessment processes. 3.3 Health care settings and systems, employers and their accreditation systems must understand and foster lifelong learning. 12
INTERPROFESSIONAL & TEAM-BASED CONTINUING EDUCATION 4.1 Faculty, curriculum planners and others must consider and incorporate meaningful, formal and experiential, interprofessional education in entry-level and advanced training for all health professionals. This should include curricular re-design, creation of experiential learning opportunities, evaluation of IPE activities, and the design/implementation of IPE continuing education programs specific to work settings. 4.2 Organizations concerned with the assessment of competence, including licensing and certifying bodies, should develop and test inter-professional team competencies in conjunction with health professional organizations. 13 4.3 Continuing education providers, faculty members, certification and CE accreditation bodies should support and create strategies for meaningful, outcomes-oriented IPE. These strategies should include streamlined curricula and program design and development of certification processes that encourage IPE, superseding the individual professional accreditation components and systems. In addition, standardized CE accreditation processes should address both intra and inter-professional educational and performance criteria that are not solely profession specific. 4.4 Healthcare institutions must create multiple opportunities for meaningful, interactive health professional learning experiences that provide feedback on the health professional s performance. In addition, the healthcare institutions accrediting and regulatory bodies should incorporate requirements for IPE experiences into standards and policies. 14
CONTINUING EDUCATION METHODS AND ACTIVITIES 5.1 Health care systems, insurers, state and federal government agencies must recognize the potential of a more effective CE system, supporting both the implementation of a broad range of more effective methods, activities and interventions within the current system of CE and beyond it. 5.2 CE providers, planners, faculty members in academic and other institutions, and health professions organizations should increase their engagement in professional development processes to re-shape the delivery of CE, incorporating the evidence about formal classroom teaching and alternative methods. 15 5.3 CE accrediting bodies should re-assess current processes and support a re-alignment of CE methods to match: a) health system and health professional needs, and b) the evidence about effective CE methods, further accreditation should embrace and support more evidence-based approaches to formal CE by altering accreditation standards and collaborating with other bodies as appropriate. 5.4 Certifying boards, licensing boards and other credentialing or regulatory agencies and the public should work in collaboration to adopt requirements regarding CE that incorporate the changes outlined above. This endeavor could result in a more credible and universal vehicle to assure the public of continued professional development and the pursuit of excellence. 16
CE METHODS: What would they look like? Increased integration of evidence and exposure of effective/alternative teaching methods into faculty development offerings Development of a uniform/consistent learning portfolio format Rewards/incentives from accrediting, licensure, and credentialing bodies for participation in effective/alternative teaching methods But how can I use more interactive learning methods without high cost? 17 Use of ARS systems to guide and inform discussions in didactic sessions Case based discussions (M&M formats) Large group cases followed by small group discussions Patient testimonials and interaction Simulations, standardized patients, role play Commitment to change contracts POC reminders: email, chart flags, flow sheets, checklists Additional follow-up resources and support materials: AHRQ Clinical Effectiveness Guides, patient education materials 18
WORKPLACE AND POINT OF CARE RECOMMENDATIONS 6.1 Health care systems, leaders, health system accreditation systems, insurers and others invested in the quality of care must embrace and support the construct of workplace learning within current health care systems. 6.2 Credit-granting, licensing and certifying bodies must recognize the importance of - and permit the simplified granting of credit for - demonstrable participation in workplace learning. 6.3 Continuing education planners, academic health centers, hospitals, health systems and other health care organizations should assist in the design, implementation and testing of a fully integrated educational and workplace learning system. 6.4 Health system and related research foundations should support pilot and more thorough studies of workplace learning in order to develop a fully integrated educational and workplace learning system. 19 7.1 Health care systems, hospital and health system, accreditation bodies and others should weigh the advantages of supporting Point of Care learning technology, resources and education. 7.2 Academic institutions and curricula, CE providers, health professional associations and others should incorporate POC learning as an integral component of lifelong learning across the educational continuum. 7.3 Health professions, academic institutions and others should undertake efforts in faculty development, in order to better train tutors, role models and teachers in this area. 20
7.4 Credited granting bodies, recertification boards, licensing bodies, IT developers and others, should recognize the importance of POC learning by creating smart, easy credit for users of POC learning, enabled by IT resources. 7.5 Designers and developers of POC learning resources must continue to develop tools and methodologies for delivering POC information; and facilitate and combine learner self-assessment and practice performance. 7.6 Funders and granting agencies, payers, CE providers, and health care systems should support the need for more innovative, coordinated research in POC learning, with an emphasis on outcome & measurements, theory (conceptual models) and innovations. 21 What s next? Disseminate and Implement the recommendations Encourage discussion, debate Create pilot projects Enable changes (websites, webinars, discussion groups, MedEdPORTAL, other means) 22
A Vision for Continuing Education & Lifelong Learning We envision a continuum of health professional education from admission into a health professional program to retirement that values, exemplifies, and assesses lifelong learning skills; emphasizes interprofessional and team-based education and practice; employs tested, outcomes-based continuing education methods; and links health professional education and delivery of care within the workplace. To achieve this vision, we encourage an understanding of and support for the need for change, and collaboration among stakeholders responsible for the interdependent elements of this vision academic institutions, healthcare systems, continuing education providers, accrediting bodies, licensing and credentialing boards, funders, and others. Statement endorsed by the American Association of Colleges of Nursing Board of Directors, July 2009 and the Association of American Medical Colleges, Dec 2009 (decision pending) The Lifelong Learning Initiative http://www.aamc.org/meded/cme/lifelong
Q&A Please submit your questions and comments via the chat box on the left side of your screen. Polling Question Based on your understanding of the content presented today in this webinar, how likely are you to make changes in your approach to continuing education in the health professions? * I am very likely to make change(s) * I am somewhat likely to make change(s) * I don't know if I will make change(s) * I probably will not make change(s) * I definitely will not make change(s)