Lifelong learning is a concept that is being embraced by many industries, including healthcare, to emphasize ongoing personal and professional development that fosters knowledge growth and facilitates mastery in one’s field.
Known for decades as continuing medical education (CME), there is movement toward using the new term of continuing professional development (CPD) for physicians and surgeons. CPD is the structured vehicle by which professionals maintain, improve and broaden their knowledge, skill sets and core competencies, and develop the characteristics required by their profession. The Chartered Institute of Professional Development defines CPD as “the conscious updating of professional knowledge and the improvement of professional competence throughout a person's working life. It is a commitment to being professional, keeping up to date and continuously seeking to improve. It is the key to optimizing a person’s career opportunities, both today and for the future.”1
As medicine and healthcare undergo constant evolution and transformation, CME programs must keep pace with these changes to ensure that physicians have the best professional development resources available throughout their careers to translate new research into better patient care.
To that end, the Mayo Clinic convened a consensus conference in September that assembled more than 50 CME experts from the United States and Canada and also paved the way for a new CME enterprise. At the conference they established a blueprint for change designed to make CME a bridge to cost-effective, excellent healthcare and to ensure that CME serves as a lifelong centerpiece of physicians’ professional development.
A new CME enterprise will serve as a cohesive educational enterprise that links together the many disparate providers who now offer CME courses. Leaders say CME is currently too often an episodic, peripheral educational activity.
The conference was convened in response to a 2007 government report that concluded CME must become more rigorously scientific; more evidence-based and theory-driven; and more accountable to the public who entrust their health to physicians. Terrence Cascino, MD, executive dean of the College of Medicine at Mayo Clinic notes, “Our goal is to make CME focused and responsive to what is best for the patient.”
Over the next three years, conferees will collaborate to change CME using the following strategic imperatives to guide them. CME and its providers must:
- Function as a bridge to quality healthcare. CME’s mission is to help physicians and teams learn and improve, so the quality of healthcare services provided to patients also improves.
- Focus on collaborative best practices and patient-centered outcomes.
- Consider new instructional modes, such as issuing annual reviews of the best scientific literature in a field written both in a simplified style, as well as in the traditional scholarly scientific article format.
- Apply more widely and rigorously the science of quality improvement and its evidence to healthcare and physician practices.
- Ensure the highest ethics and integrity of healthcare information by eliminating conflicts of interest in CME offerings.
Richard Berger, MD, PhD, dean of the Mayo School of Continuing Medical Education and a professor of orthopedic surgery and anatomy, says the challenges to CME are urgent. “Doctors today must keep up with mountains of rapidly changing medical information needed to maintain a safe and up-to-date practice. Our task is to propose solutions based on sound learning theory, evidence and outcomes so we can integrate professional development through CME into physicians’ lifelong learning activities. With this conference the transformation of CME is underway.” The Mayo School of Continuing Education, formally organized in 1996, instructs more than 23,000 medical professionals annually through 200 courses.
Berger adds that transforming continuing professional development from episodic learning to more of a lifelong learning modality is a significant part of the purpose of the consensus conference. “We have established a mechanism for a coordinated national research agenda to formulate these strategies. What we do know is that several key elements must go into the lifelong learning process for healthcare workers to optimize their competence. This includes aligning the relevance of the education activity with scope of practice, transparent assessment of practice outcomes, and self assessment of knowledge and skills to detect gaps in competence, and then individualize learning processes to fill those gaps, strive toward point-of-care learning, recognize the effectiveness of team training, enhancing our awareness of and concurrence with validated practice guidelines founded upon evidence-based outcomes studies, with all of this embedded in a process of learning about quality and employing those lessons into everyday practice.”
Continuing medical educational leaders agreed to frame the CME improvement initiative as a “value proposition” that can motivate all stakeholders to seek it out and support it, from CME faculty members, to physician-students, to third-party payors, to hospital administrators, to members of the government. These leaders agreed that when CME is regarded as the first-line tool for improving healthcare and controlling medical costs through reduction of error and inefficiencies, everybody wins.
Murray Kopelow, MD, chief executive officer of the Accreditation Council for Continuing Medical Education (ACCME), comments, “We need CME that matters to patients and makes a direct, positive impact on patients by functioning as a reliable bridge to quality health care. We need this to be true everywhere CME is offered. And we need physicians to internalize lifelong learning as part of their professional identities. When this happens, patients can all be confident that his or her physician has the resources needed to keep up with evolving medical knowledge.”
As an increasing number of physicians explore new opportunities in health management organizations, integrated health systems, urgent care centers, physician group practices, ambulatory surgery centers and other healthcare facilities, they must possess the abilities that are critical in executive roles.2 Lois Lister, senior vice president and managing principal of the executive search division of Cejka Search, describes the aptitudes common among physicians: critical thinking skills, thoroughness, the ability to solve complex problems, strong motivation to be successful, and in many cases, the ability to work well with other physicians. Lister notes, however, “Medical training and clinical practice do not encourage development of all characteristics and habits that executives must have to succeed and advance into top-level positions.”3
Berger says that it is imperative to define how CPD can support today’s physician’s practice skill sets. “We will be striving to learn more about how physicians and associated healthcare workers learn most effectively through a nationally coordinated research effort,” Berger explains. “Today’s physician has less time than ever to learn about more things than ever. The learning process needs to be as efficient and relevant as possible. We need to incorporate the core competencies, including communication and professionalism into as many learning opportunities as possible to strive toward the highest degree of integrity in practice as possible. There will need to be nimbleness to educational activities to keep them up to date, but at the same time recognizing the need for validation and evidence-based data.”
The challenge is that the vast majority of the more than 650,000 practicing physicians in the United States today have received little or no formal training in business administration. They have practiced medicine in a fee-for-service environment that has not required them to be aware of how the marketplace works and how a healthcare institution or practice must be run from a financial perspective. While they are clinical veterans, they are business novices in dire need of a new skill set that will help them navigate the choppy waters of post-managed care healthcare. Enter the physician MBA program. Although some physicians may have earned their master’s of business administration (MBA) degree through a traditional program, there are now MBA programs tailored specifically for physicians to prepare them for increasingly complex processes, systems and trends in the healthcare industry, including new reimbursement structures, increased public reporting, advanced quality improvement initiatives, and the nuts and bolts of day-to-day operations where clinical and business imperatives intersect in a healthcare facility. It’s a strategic mindset that isn’t part of the medical indoctrination but is essential to success in the fast-paced business world.
Francine R. Gaillour, MD, a business, career and executive coach for physicians and clinical leaders, and director of Creative Strategies in Physician Leadership, says that physicians should pursue an MBA in order to obtain a solid education in business, to learn the business world lingo, and to interact with other physicians who can help them broaden business knowledge, perspective and opportunities.4 There are dozens of established, accredited physician MBA programs around the country, according to the Association of American Medical Colleges, including offerings from the University of Tennessee, the University of California, Irvine has a Healthcare Executive MBA, and the University of Massachusetts, which offers an MBA through the American College of Physician Executives.5
The focus of physician MBA programs should be on developing leadership skills and business acumen, according to Michael Stahl and Peter Dean, authors of The Physician’s Essential MBA, and members of the faculty of the University of Tennessee’s Physician Executive MBA program. Important subject matter that should be addressed in these kinds of programs, according to Stahl and Dean, include: strategic leadership principles, health policy and economics, skills for embracing change in a rapidly changing healthcare landscape, and more.
2. Pyrek KM. Making the Grade: Physician MBA Program Creates Medical Entrepreneurs and Physician Executives. Immediate Care Business. September 2007. Accessed at: http://www.immediatecarebusiness.com/articles/0791feat3.html
3. Lister L. 21st century physician executive: An in-depth look at healthcare recruitment in the 21st century. www.cejkasearch.com
4. Gaillour FR. Do You Need an MBA? What do you learn in business school anyway? PhysicianLeadership.com. Accessed at: http://www.physicianleadership.com/articles/physician_MBA.htm
5. Association of American Medical Colleges. Group on Faculty Practice (GFP) MBA Programs for Executives and Physicians. Accessed at: http://www.aamc.org/members/gfp/mba.htm