July 1997 Bulletin

Board focuses on learners' new needs

Workshop develops action plans for new CME curriculum

According to discussions at the March Board of Directors planning workshop, "CME" should stand for "Changing Medical Education."

In two days of discussion, the board and the Academy's education staff concluded that future education programs will not be like programs of the past, described by one Academy member as "sitting in a dark hotel room looking at slides in Maui." But what will the future bring and what does CME change mean for the "average fellow" of the Academy?

Hardly isolated from the winds of change that have gusted through the medical world, CME planners have been faced with obstacles:

Calling for a new look at Academy education programs, President Douglas W. Jackson, MD, focused the spring workshop on education. "The revolution in the delivery and financing of health care is being accompanied by a significant demand for change in both medical and continuing medical education," said Dr. Jackson. "At the same time, technological advances are impacting adult education."

Education of its members is the Academy's "core function," Dr. Jackson said, adding, "We all feel the challenge to be responsive to the changing needs of our members and to maintain the strong tradition of excellence in AAOS education."

Richard Gelberman, MD, chairman, Council on Education said, "Two concepts will form the foundation for the new model of the Academy program: a welding of CME to 'evidence-based medicine' and a linking of competence-based CME to practice performance."

The report of the workshop lists goals and strategies to achieve those goals, as well as action plans and directives to committees and councils. The integration of "new curriculum" topics such as evidence-based medicine, outcomes, guidelines and "value generation," will assist orthopaedic surgeons to increase their understanding of the new health care environment. The full report is available on the Academy's home page (www.aaos.org) under "Medical Education." Among its highlights:

In all activities, Academy councils and committees will explore new learning technologies and develop new learning activities.

James D. Heckman, MD, Academy First Vice President, said, "In today's rapidly changing health care environment, both our approach to continuing education and the content of our educational programs must change. The workshop enabled us to see the importance of developing appropriate, clinically relevant, outcomes-based and user-friendly forms of education that will be relevant to the contemporary practice of orthopaedics."

Three resource speakers from other organizations shared their views. Jeoffrey K. Stross, MD, an internist and member of the American College of Physicians, explored the changes in financing CME, new information technologies, and credentialing and risk management in a managed care environment. Gregory L. Skuta, MD, who has helped shape the education programs of the American Academy of Ophthalmology, described the organization's home study programs and work in preferred practice patterns, as well as funding of new initiatives. Robert J. Flaherty, MD, representing the American Academy of Family Physicians, compared traditional models of CME and the emerging "new models" of CME, including such concepts as "just in time education," often available on the Internet, and based on diverse styles in learning.

"If there was a recurring theme in the presentations," said Mark W. Wieting, the Academy's vice president for educational programs, "it was the focus on what the learner needs to know, as opposed to what the faculty wants to teach. Often these are the same, but the priority must be on meeting the learner's needsówhen the learner is available, using means that are readily accessible."

Much of the discussion at the workshop was based on several key resource documents, including the report of the Council on Education's "Task Force on CME in 2001," chaired by Robert W. Bucholz, MD, and Joseph D. Zuckerman, MD, who also are chairmen of the committees on Educational Programming and Surgical Skills Education, respectively.

"From my perspective, the recent board workshop served to reaffirm the Academy's commitment to its educational mission," said Dr. Zuckerman. The result, he said, will be that the board can "develop successful strategies that will allow the AAOS to remain the preeminent source of orthopaedic education in the 21st century."

Dr. Gelberman agreed. "We anticipate that there will be cumulative effects from the changing financial base for CME, the increased obligation to include outcomes and cost-of-care data in CME programs and the necessity to provide documentation on orthopaedists' updating their clinical and surgical skills," he said. "We considered innovative concepts in adult education that will enable us to respond effectively to these forces and concluded that a 'new curriculum' will evolve, one that is 'needs-based,' is interactive and participatory, one that is capable of assessing behavior change, and one that is shorter and has a more flexible structure."

Comparing the traditional model with the new model for CME discussed at the board's recent workshop.

Traditional CMENew CME
faculty-driven learner-driven/outcomes - needs-based
didactic - non participatory interactive - participatory
limited information sources available many information sources accessible through technology
success based on 'happiness index' success based on 'behavior change' - outcomes documented
funded by pharmaceuticals, device manufacturers and the individual funded by managed care organizations, individual and industry
long, structured development process shorter, more flexible development responding to needs
addresses wants addresses outcomes/practice assessment

Edward Toriello, MD, left, and Edward A. Rankin, MD discusses new trends in education

Douglas W. Jackson, MD, Academy president, left, and Alan H. Morris, MD, chairman of the Council on Health Policy and Practice, take part in workshop on Academy's continuing medical education

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