Creating Conditions for Adapting Skills to New Needs & Lifelong Learning

1. ‘If lifelong learning is to be effective, physicians should enter a practice environment that is constructed in a way that fosters, promotes, and facilitates lifelong learning’ Creating Conditions for Adapting Skills to New Needs & Lifelong Learning Presenter: Tanya Horsley, PhD Date: April 27, 2010

2. Recognition • European Observatory on Health Systems and Policies • Health Evidence Network of WHO/Europe • Dr. Jeremy Grimshaw Director, Canadian Cochrane Centre, Director Centre for Best Practices, Institute of Population Health, Canada Research Chair, in Health Knowledge Transfer and Uptake • Dr. Craig Campbell, Director, Office of Professional Affairs, Royal College of Physicians and Surgeons of Canada • Pace of presentation (!)

3. Overview • Issue • Overview (brief) • CME CPD • Lifelong Learning • What is an ‘effective’ lifelong learner (skills – competencies required) • European Context • Policy Options

4. Issue • Proliferation in volume and complexity of biomedical knowledge and technology • Challenge to healthcare professionals delivery of care • Through organized or individual learning strategies – physicians need to maintain currency

5. Issue • Underfunded • Inadequately staffed healthcare departments (less and less time for ‘learning’) • Limited access to performance data/ current health outcomes/literature resources, appropriate learning materials • Professional & public concerns related to variability in quality of care & the safety of the healthcare environment (e.g. medical errors)

6. Issue • No current standard approach to LLL in Europe • IS acceptance that LLL of physicians to maintain competence ++ for patients • Optimally, any strategy for LLL should be: • Highly self-directed • Content, learning methods, and learning resources specifically targeted at improving knowledge, skills, and attitudes • Linked to improving patients outcomes

7. CME to CPD • CME model (historically) perpetuated learning as a adjunct to daily practice • Educational strategies to keep physicians up-to-date of new diagnoses, management of clinical conditions, and new technologies… • These were wholly divorced from the clinical environment and health system. Frank, JR. (Ed). 2005. The CanMEDS 2005 physician competency framework. Better Standards. Better Physicians. Better Care. Ottawa, The Royal College of Physicians and Surgeons of Canada.

8. Background

9. Beyond the Medical Expert role Horsley, T. Unpublished work (2009)

10. Physician Learning and the CanMEDS roles

11. Lifelong Learning • Infrequently defined ‘a continually supportive process that stimulates and empowers individuals to acquire all the knowledge, values, skills, and understanding they will require throughout their lifetimes and to apply them with confidence, creativity, enjoyment in all roles, circumstances, and environments’

12. What does a ‘good’ Lifelong Learner do? Ability to create and use a practice profile describing the issues and problems within one’s practice Beyond the CanMEDS competencies - what are the ‘skills’ required to be an ‘effective’ lifelong learner? These could be translated into implementation strategies/actions at the 1. individual 2. organizational and 3. health systems level 1. Knowing practice 2. Scanning the environment 3. Managing knowledge in practice 4. Raising and answering questions 5. Practice assessment and enhancement Ability to systematically and effectively scan the environment for new and relevant ideas. E.g. identify new innovations Ability to formulate ‘good’ questions and the ability to translate these questions into learning opportunities Ability to establish a personal knowledge management system, foundational for information literacy Ability to use processes and tools to continuously assess and measure the impact of learning on enhancing knowledge, skills, and performance in practice

13. European Context • Patient and professional mobility is gaining increased attention • Mobility raises concerns related to ensuring competence of physicians licensed to practice in one state when they elect to practice in another • Additional challenges: • No legal framework to recognize the introduction of periodic validation and requirements to participate in CPD; thus revalidation is gaining increased attention

14. Question #1 What are the specific needs and issues that require reconsideration of lifelong learning concepts and processes in Europe?

15. Policy Option #1 Compulsory engagement in continuing medical education/continuing professional development/lifelong learning systems or programs

16. Policy option #1 “A self-regulating profession must hold its members accountable to the public it serves for the competencies they profess to hold”

17. Policy option #1 • Advocating for a compulsory system is based on public expectation, a professional obligation and a regulatory requirement • Ideally systems should: • Support the development of physician lifelong learning skills and competencies (CanMEDS – beyond the medical expert role) • Be relevant to the practice profiles of each learner (relevant to one’s practice context) • Address perceived and unperceived needs (learners practice) • Include continuous assessments (learner and health team) • However, policy option does NOT recommend a ‘one size fits all’ model

18. Policy Option #1 • Important to recognize • Although mandatory systems ensure licensed physicians engage in CME/CPD and achieves minimal expectations, there remains a lack of evidence that engaging in particular types of CME/CPD improves professional practice/patient outcomes • Not established to prove or disprove competence or fitness to practice • Cultural shift required to see true improved outcomes • Lifelong learning is a foundational concept to achieve the expectations of the profession, public, and health system

19. Implementation considerations • Who will fund CME/CPD activities? • Employers? Medical Societies? Physicians themselves? Industry? What is the financial model each country will adopt? • Access issues? • How do you connect ‘rural’ physicians to opportunities for lifelong learning? • Who will manage the ‘recording’ and documentation of learning? • Example: Royal College Membership/Fellows • How to deal with non-compliers?

20. Policy option #2 Development of a common CPD accreditation system for providers and/or programs

21. Policy option #2 • Undergraduate and postgraduate education accreditation systems have been established • What models could be considered? • Providers-focused model • Individual program or activity-focused or • A combination of both

22. Policy option #2 • Foundational components that should be considered for any accreditation model • Typically based on a set of standards (educational and ethical requirements for an activity or qualify for credits) • Opportunity for mutual recognition of a National CPD accreditation system • Accreditation systems could be the same or substantively equivalent • Based on a set agreed upon minimum standards of principles, values and metrics • Important to determine HOW these are expressed within each country / across the EU

23. Policy option #3 Defining the role and expectations of the healthcare system in supporting continuous quality improvement in lifelong learning

24. Policy option #3 • Barriers to optimal care • Structural (financial disincentives) • Organizational (lack of appropriate equipment) • Peer group (local standards of care not in line with desired practice) • Individual (knowledge, attitudes, skill deficits) • Information overload leading to acts of omission • Patient expectations (direct to consumer marketing)

25. Policy option #3 • Alignment and synergies must occur between physicians, CPD providers, and the healthcare system (shared responsibility) • An initial and important policy option is to ensure the creation of knowledge infrastructures and targeted knowledge translation activities

26. Policy option #3 • Access to information is not the only issue • Physicians lack skills required for ‘lifelong learning’…thus, facilitators are required: (CPD provider level) • CPD providers, CME departments within Universities, etc. must develop educational tools, courses, and materials targeted at the broad spectrum of ‘skills’ as outlined by the CanMEDS framework • E.g. Manager (how to develop a practice profile), scholar (how to develop a ‘good’ question), communicator (e.g. how to develop rapport, trust, and ethical therapeutic relationships with patients, and professional roles (what are the concepts of ‘ethical practice’?)

27. Policy option #3 (system level) Examples individual countries or collective partnerships could consider: • Knowledge portals designed to organize, appraise, and summarize knowledge resources (identify relevant high quality sources) • Knowledge services that screen and appraise research knowledge (ACP Journal Club) • Just-in-time knowledge services that provide real time (synchronous) knowledge support (for practice based questions) • Rapid response services (asynchronous) providing a scoping review (rapid, 1-2 weeks)

28. Policy option #3 • Practical steps for implementation are poorly identified within the literature • Some interventions could be delivered via CPD mechanisms (e.g. audit and feedback, reminder systems) • There is an important and highly synergistic relationship that needs to be leveraged between CPD and lifelong learning activities such as knowledge translation

29. Questions to prompt discussion / reflection? • Are these policy options important to /relevant for/feasible within your country? • Can you provide examples of lifelong learning models/strategies that could inform the policy options/implementation issues? • How is CME/CPD currently funded within your jurisdiction? Is this sustainable? What have been the major barriers? • What do you see as being the biggest challenge to implementing these policy options? Are there solutions?