Old Dogs, New Tricks: Injecting Quality Improvement into CME

By Scott Harris

Quality improvement (QI) is a young concept. Its relative infancy means younger people (including medical students and residents) are more likely to be immersed — and to immerse themselves — in its tenets.

But what about established physicians? Many not only did not receive early exposure to the topic, but also are well accustomed to the kind of professional autonomy that can appear to work at odds with the more standardized and systemic thinking that QI efforts often entail.

Fortunately, professional development (or at least professional development opportunities) never stops in health care. And where physicians are concerned, continuing medical education (CME) remains the cornerstone of lifelong learning.

“CME can be a catalyst for quality improvement,” said R. Van Harrison, Ph.D., a CME expert and a professor in the department of education at the University of Michigan Medical School, which holds more than 200 CME series each year.

Of course, the average CME event already has a packed agenda. How do you inject QI into the conversation in a meaningful, accessible, and sustainable manner?

According to Harrison, CME is a natural entry point — or even selling point — for QI. CME activities can cover QI in a way that transcends the conceptual by imparting a specific objective that has been tailored to the QI-related trends or needs of an individual hospital or health system. That, in turn, provides physicians with tangible takeaways they can put into practice immediately. This arrangement can work particularly well for academic medical centers, where CME programming (and CME learners) can be directly informed by institutional data.

“As the QI folks identify problems, they can identify educational opportunities for new knowledge or system changes and share those with the education folks,”Harrison said.

On the other end of the loop, learners see how a certain practice plugs into their own clinical culture and ultimately affects care outcomes. In that way, CME makes a natural pitchman for QI. 

“It’s the success in seeing it that makes the difference,”Harrison said. “You can demonstrate a sequence of events that will help you improve immediately. Right after a discussion, people will have a new way to document or do something that helps them provide better care faster and more easily. That helps make the meeting more important.”

At Michigan Medical School, a suite of technologies guide physicians’ learning even as they go about their daily work. The cornerstones of the system are web-based resources and an electronic medical records system designed to root out gaps in care delivery and notify care teams.

Another approach is known as academic detailing, a process that brings experts directly into a physician’s practice to examine a specific area and make QI-related recommendations at the point of care. At Florida State University College of Medicine, health professionals work with faculty practice physicians to improve smoking cessation practices. At Dalhousie University Faculty of Medicine in Nova Scotia, Canada, health experts work one-on-one with care teams on subjects ranging from arthritis to hypertension. The practice is gaining enough traction that the federal Agency for Healthcare Research and Quality has created a National Resource Center for Academic Detailing, which provides relevant training and support to clinicians.

No one person, group, or program alone can improve quality; it takes a village. Harrison suggested institutions start by creating a pilot relationship between CME and QI officials within one department. Identify the key leaders overseeing each area and find interaction points. This will help ensure CME and QI benefit each other (not to mention physicians and patients) over the long term.

“Someone actually has to manage the throughput,”Harrison said. “Someone has to sit in the meetings and make sure quality issues or education issues are being considered. You have to customize this to your local department or group. Work with folks to implement a standard expectation. Is there an existing CME series that could take advantage of this? And make sure the follow-up happens.”

0 thoughts on “Old Dogs, New Tricks: Injecting Quality Improvement into CME

  1. Scott Harris’ commentary on the use of CME as a driver for change is a natural fit for the academic medical centers of this country. Here – at least ideally – adequate data sources exist to demonstrate clinical care gaps – the difference between what clinicians should do (exemplified by clinical guidelines, best evidence, best safety practices) and what they actually do. And, using grand rounds or other educational activities to describe the gap, engage clinicians, and demonstrate or describe better practices, just makes good sense. Certainly beats the model of the visitor-speaker-with-too-many-slides.

    This new, integrated, effective version of CME in the academic medical center is the heart of AAMC’s Aligning and Educating for Quality (ae4Q) project in which 11 members have participated. A year into the pilot project, many sites report process improvements (quality data used to plan and evaluate rounds; system-wide comprehensive education/quality programs; organizational changes) and one site has reported patient care outcome improvements – the real goal of this effort. For more information, visit http://www.aamc.org/initiatives/cme/ae4q.

  2. One of the “gaps” in the health care system in many sectors, especially in community-based practices is the lack of practice-based data that physicians can use to guide them to make changes in their practices. Physicians also need help in interpreting their practice data to make the necessary changes in their practice behaviors. In Ontario, we are initiating a pilot study with physician learning coaches to help physicians identify the practice data that is accessible to them, help them interpret it, link it to quality indicators where available and connect this to a CPD “prescription” to narrow their practice gaps.
    For other practical ideas about how to link quality improvement to CPD, physicians may be interested in reading this recent paper:
    Ann Intern Med. 2012 Feb 21;156(4):305-8.
    Continuing medical education and quality improvement: a match made in heaven?
    Shojania KG, Silver I, Levinson W.