Murray Kopelow: Thank you very much. It's an honor to be here.
I promise I'll finish on time; my wife says I'm like a gas, I can expand and contract
to fill any available space, and we'll try to do that. It's an honor to follow Dr. Nasca,
and I -- especially for him, I, too, have a renal model.
This is the countercurrent mechanism, that the important message from us in continuing
education is that practice informs the continuum of medical education. And as we progress along
the continuum of training and enter practice, then down the other way comes the information
about practice informing continuum. I think Eugene was right to have us here, the continuing
education here. We change -- we start the planning process for changing the medical
school curriculum; practice will change in 2025. If we change the residency, practice
will change in 2018. If you change what happens in continuing education, practice might change
next week, it might change next year.
So the people around this room, I try to bring you to the position of educators. Think of
yourselves as the continuing education enterprise in the United States. The model has changed.
An article by Danny Klass in academic medicine from June 2000, we used to train and practice
in this ballistic model, where we got launched into practice and sort of have this decay
curve which, hopefully, what we got to incompetence just after retirement.
[laughter]
That's really moved to this trajectory model that Tom drew the picture of. Not only did
we move from novice to master, but things change in our lives that -- in the period
that we are practicing, and this becomes the material that you become competitive with
that you need to think about that is going on in the life of the practitioners. We need
to acquire what we never knew when we entered practice. I don't know about you, but I didn't
know it all when I entered practice; I could only learn so much. I had to make that up
in practice. What was not known at the time, so that which you have invented and discovered
has added to the mix. And what should now be forgotten needs to be -- we need to spend
time -- The American Board of Internal Medicine Foundation has a project about choosing wisely,
but that which must be removed.
So our life as professionals, we do have a baseline, a minimally acceptable practice;
we have our own personal standard of what's acceptable. But there is a wide range in which
you can alter and impact what is it that people do, using the continuing professional education
systems that exist in the country.
Others have found this out. The other agencies of the federal government are using continuum
professional education to address public health imperatives. The Food and Drug Administration,
Office of National Drug Control Policy, National Institutes of Drug Addiction are all using
continuing professional education, much of it put on by organizations that are represented
in this room to address the opioid addition, and the overuse and misuse of opioids. Second
most common cause of accidental death in the United States today is due to prescription
drugs. One in 10 of us are abusing a prescription medication in some manner. Agency for Health
Research and Quality has used continuing education to deal with a comparative effectiveness research,
and get that word out.
So there's -- there is -- one of the only agencies -- Dr. Green, I draw this to your
attention -- the only federal agency to give up its ACCME accreditation in the last decade
is the NIH. So it's -- the others have come on board and started. So there is an opportunity
for this organization to deal with it. There are others in the private sector that are
also using continuing professional education. Some of them, you probably have something
to do with: the world of inter-professional collaborative practice, patient safety, the
opioid prescription. All of these people have started to use continuing professional education
as a strategic asset in the fulfillment of their mission.
And what we need to recognize, if we are, from the social science literature, if we're
actually going to change what people do, we need to make these behaviors, both their intention
and their habit, to do them. When people see people in practice it needs to be their intention
to address the issues of genetics, it needs to be their habit. And that comes about through
motivation; we talked about payment, and we talked about morbidity and mortality, but
we need to create the facilitating conditions for this to occur. And education and continued
professional education is one of those opportunities.
If you think of your touch points in your professional life, of organizations that do
accredited continuing medical education that you could impact, how many physicians in practice
could the American Medical Association, the University of Chicago, Baylor, Harvard, Hopkins,
how many places could you impact? Well, there are 20 million professional individuals who
participate in the Accredited Continued Medical Education Enterprise in a year. Those are
a lot of touch points. There are 130,000 activities that occur in the academic medical centers
but they occur in the community hospitals and in the clinics where people teach.
University of Chicago, they had an interesting program for their fellows and residents called
"Beyond the Walls," where the residents and fellows in critical care and anesthesia go
out of the university into the community to talk to organizations that impact their professional
life. Somebody mentioned about getting "Beyond the Walls," Eugene, of the centers. But 20
million participants. Two million people participate in the continuing education programs of the
people that are around the inside of this table. I didn't know about all of you being
here. That number probably goes up three or four times. So you, as individuals, can impact
the continuing professional education systems of the organizations that you operate in,
and you can change what your learners know and how they interact with people.
Accredited Continued Medical Education, the system that I am the CEO of, changed and created
the facilitating conditions in 2006 for you to do this. We focused our rules and regulations
on supporting change in knowledge, strategies, and performance-in-practice necessary to provide
optimal patient care. Accredited education doesn't need to be convinced of anything;
it is not the barrier to this. The barrier is getting the material into the point-of-care
education and then delivering. You have CME providers who are -- would be delighted for
you to phone.
One of the things that happened -- I spent six months as a special adviser to the Office
of National Drug Control Policy and the executive office of the president early in President
Obama's first term. And it was a real honor to have this opportunity to show to people
where the opportunities were for credited continuing education to be picked up and to
be used by others in the system. And one of the things that they said was, "When we come
to undergraduate and graduate education, we get told there's no room in the curriculum,
there's no time for it." But accredited continuing education, every year, almost wipes the slate
clean. The delivery system continues but the content gets renewed every year. So your opportunity
to participate to engage in change.
You need to know some of the lingo. If you'd go to the accredited education systems with
additional practice gap, and not much of that has been clearly articulate yet here, but
if you can address what it is that the practitioners are not doing, and if you can articulate what
it is that you want to change in the people of there, you're going to have a very welcome
audience. You're going to be very well-received and embraced. An example, a concrete example
about what you can do is if you go to someone and say, "The professional practice gap is
that the family docs, the pediatrician, someone is failing to check the genetic history."
Or, failing to explain properly why genetic testing is -- that's the professional practice
gap. They need to know, "Well, why is that?" Well, because they do not know what is known
about genetics or genetic screening. That's what we want to effect their knowledge; the
competency to effect medical knowledge or communication perhaps.
The educational format that you want to use, Mira talked about point-of-care learning.
But there's other formats. You might want to use something didactic followed by the
use of standardized patients. And measurement of their success in the context of standardized
patients or practice profile. You can change the facilitating condition, change how they
practice. There is unequivocal educational literature evidence for the impact of using
this process to change what it is that you want to change which may be what people do,
may be what their strategies are, or may be simply what they know. Thank you.
Marc Williams: Thank you very much.
Murray Kopelow: Was that on time?
Marc Williams: Yeah. Absolutely. Great. And a couple comments and one question, and
then we'll open it up. I'm assuming, at least taking leads from Dr. Nasca, that you must
be a pulmonologist since we heard a bit about Boyle's Law right at the beginning there,
so --
Murray Kopelow: No, I'm --
Marc Williams: -- that's great.
Murray Kopelow: -- married to an anesthesiologist, a pediatrician.
Marc Williams: Even better, all right. So this -- I also
heard a takeaway there which is I think we need to go back to NIH related to the accreditation
and CME issue. I noticed Teri furiously typing on that one already, so --
[laughter]
-- I think that may have been a bit of a game changer. I'm -- was curious in the sense,
I really hadn't appreciated the impact of having information flow back, the bidirectionality
of the information. And I guess I'd like you to expand, if you would, just a bit about,
given our content area, how you think we who have generally not been embedded within practice
could more effectively communicate a practice level need back to our CME. Any suggestions
that you might have for that.
Murray Kopelow: Well, when I asked that question I was given
Bloomberg article from September 2006. The, you know, the business about the misdiagnosis.
I was also given your article from the last year or two years ago about what we could
do about impacting and changing practice. Embedded in the Bloomberg article is the failure
to have proper management systems or to know how to interpret results; that was the professional
practice guide. Those are concretes. And I think it would be immensely valuable if you
spent some time pulling out of your literature or out of -- from what you already know, the
clear articulation of that so that you can go to the accredited provider. Because in
each of your shops, there is an accredited provider, and if you can put on the table,
this is a professional practice guide that we want to change, they will be the strategic
asset of how to do it, what educational format and et cetera.
Marc Williams: Great, thank you. I'll, again, just to highlight
something that I took away from that is that that's a potential role in terms of synthesizing
all of the gaps that we know exist in literature, that type of literature review, and putting
it in one place could be a potential utility. There was a question up front.
Katherine Johansen-Taber: Hi, so -- hi, Katie Johansen-Taber from American
Medical Association. Since you brought up the example of the tying the -- being able
to prescribe opioids to some sort of a educational certification, I wondered if there was a lesson
that we can learn from that because there was a bit of backlash, and the AMA was one
of the groups that opposed making education mandatory in order to have a DEA license or
to be able to prescribe certain types of medication. And the reason for that position was a bit
of a worry that it would -- it would create access problems for patients who did legitimately
need this type of medication. And, you know, for some reason their physician had decided
not to undergo the education, just didn't want to deal with it, didn't want to have
to jump through all of the hoops.
So is there some sort of lesson that we can learn from that type of situation, where if
there was a way to tie education to the ability to order a genetic test or some other way
to participate in practicing genetic services, is there a way to keep it from seeming like
we're being exclusionary or possibly --
Murray Kopelow: It is --
Katherine Johansen Taber: -- creating an access problem?
Murray Kopelow: It's important to learn a lesson. And in my
perception, the lesson with respect to the opioids is, why didn't we listen a decade
ago? This conversation is occurring about something which is 10 years away from the
Food and Drug Administration or someone saying, here is how genetic testing must be used because
the patient's the public health is being jeopardized by the way we are practicing. So here we are,
10 years away from that, and we have the opportunity to say yes. We have -- we have the -- I, as
the CEO of the accrediting body for continuing education, separate from any advocacy positions
of any of your organizations, is saying, we're living in -- let's learn from the past and
from the experience of something where the profession didn't respond to this rising number
of deaths, or the -- and do something. And that's the opportunity, so we're way early
from anything else.
Marc Williams: So, Bruce, while you're moving up to the podium,
one quick question.
Donna Arnett: Thank you, Marc. I really appreciate the organizers
putting both the graduate medical education and the CME both front and center at the beginning
of the meeting. From the American Heart Association's perspective, we deal with both these rare
conditions that would require very specialized care, as well as common diseases that affects
large segments of our population. And so when you think about how we're going to actually
care for these common diseases where, you know, 70 million Americans have hypertension,
or two-thirds of our population is obese, we're really going to have to expand through
CME the educational level of multiple levels of practitioners from physicians to nurses
to be able to deal with these common conditions.
Marc Williams: Thank you.