Improving Genetics Education Myths and Mistakes in Graduate and Continuing Education

Size: px

Start display at page:

Download "Improving Genetics Education Myths and Mistakes in Graduate and Continuing Education"

Sarah Farmer
5 years ago
Views:

1 Improving Genetics Education Myths and Mistakes in Graduate and Continuing Education Dave Davis, MD Senior Director, Continuing Education & Performance Improvement

2 Mistakes/myths about educating health professionals 1. More information is good 2. Education = lectures, conferences 3. Lectures = behavior change 4. CME and GME are only about doctors 5. CME is only about credit 6. CME (and GME to some extent) are isolated phenomena, unrelated to health systems, healthcare delivery or patient outcomes i.e., the clinical care gap

3 Framing questions 1. What s the clinical care gap? Why is it a special American problem? 2. What causes it? 3. What mistakes have we made in medical education that have contributed to the gap? 4. What can we learn from them? Can we apply them to genomics education?

4 Framing questions 1. What s the clinical care gap? Why is it a special American problem? 2. What causes it? 3. What mistakes have we made in medical education that have contributed to the gap? 4. What can we learn from them? Can we apply them to genomics education?

5 The clinical care gap. Ideal, evidence-based practice Current practice

6 The clinical care gap

7 Dartmouth Atlas quality of care indicators: HbA1c data 2010

8 Country-country comparisons

9 And for this expenditure, what do we get?

10 Framing questions 1. What s the clinical care gap? Why is it a special American problem? 2. What causes it? 3. What mistakes have we made in medical education that have contributed to the gap? 4. What can we learn from them? Can we apply them to genomics education?

11 What causes the gap? The evidence-to-practice puzzle

12 What causes the gap? The evidence-to-practice puzzle

13 The knowledge pyramid: Haynes, Straus et al Clinical practice guidelines CPGs Systematic reviews Studies Self/Patient experiences

NGC currently contains +/- 3000 individual guideline summaries Think about TACOS: Trial-ability

14 NGC currently contains +/ individual guideline summaries Think about TACOS: Trial-ability (Relative) advantage Compatibility, complexity Cost Observability Sustainability Courtesy, David Price, U Colorado

15 What causes the gap? The evidence-to-practice puzzle

the Continuum: what we know Traditional Student Premedical Medical School Residency and Fellowships Practice Life-Long Learning Non-Traditional Student Didactics lousy at Evidence-based

testable Student at admission can be role-modeled effective.

16 the Continuum: what we know Traditional Student Premedical Medical School Residency and Fellowships Practice Life-Long Learning Non-Traditional Student Didactics lousy at Evidence-based changing performance; Some traits may Medicine, be self directed experiential, Docs feedbackbased learning through more stages pass characterologic, learning, other topics Aspiring testable Student at admission can be role-modeled effective. of learning: and assessed Note: the flipped awareness, classroom agreement, Physicians and others not Note: predisposing, adoption to self-aware: objective needs Returning Student enabling, reinforcing adherence assessment, performance feedback important factors 2009 AAMC. May not be reproduced without permission.

17 What causes the gap? The evidence-to-practice puzzle

18 What causes the gap? The evidence-to-practice puzzle

19 Framing questions 1. What s the clinical care gap? Why is it an almost-unique American problem? 2. What causes it? 3. What mistakes have we made in medical education that have contributed to the gap? 4. What can we learn from them? Can we apply them to genomics education?

20 Mistake #1: The purpose of CPD reputation 1977: Does CME work? Referrals revenue registrations

21 Does CME change physician behavior? Healthcare outcomes?

22 And in fact, there are still some mis- (and some accurate) perceptions about CME*? *Continuing medical education, continuing education, lifelong learning, continuing professional development,

23 Size, scope of CME (US data, ACCME, 2011) 13,700,000 physician participations 9,500,000 aliied health participations 953,000 hours of instruction 133,000 activities

24 *The size, scope and effect of CME vs the clinical care gap 13,700,000 physician participants The clinical care gap 9,500,000 aliied health participants 953,000 hours of instruction 133,000 activities

25 Mistake # 2: not paying attention to the research in CME and GME Physicians and others not self-aware: objective needs assessment, performance feedback important Knowledge necessary but not sufficient for change; didactics lousy at changing performance by themselves CME and GME > conferences; = practice-based tools (reminders, audit-feedback, protocols & training) Effective education possesses three characteristics: predisposing, enabling and reinforcing strategies What works in standard continuing education (and probably GME)? interactivity; sequencing Cochrane reviews, AHRQ/EB reviews, others

26 Mistake #3: thinking of CME only as the event

group learning Opinion leaders Academic detailing Interactivity: Q&A,

Reminders (computerized, etc) audience response systems, think-pairshare

27 The formats (and effect) of CPD? Formal CPD: lectures, courses, educational materials PLUS Outreach visits Small group learning Opinion leaders Academic detailing Interactivity: Q&A, Patient-mediated strategies case discussion, Audit/feedback reflection, MCQs, Reminders (computerized, etc) audience response systems, think-pairshare Comprehensive, QI- or practice- Simulations based interventions Other ICT-enabled tools (webbased, video-conferencing, PDAs, social networking, etc)

28 Mistake #4: thinking of CME & GME in isolation Forces affecting medical education

29 The Reports

30 National initiatives: ABMS MOC framework I: status and standing II: self assessment MOC III: CME/CPD IV: practice based learning

31 Other national initiatives Maintenance of licensure ACGME NAS, CLER Government Others

32 Framing questions 1. What s the clinical care gap? Why is it an almost-unique American problem? 2. What causes it? 3. What mistakes have we made in medical education that have contributed to the gap? 4. What can we learn from them? Can we apply them to genomics education?

33 Lessons learned 1. Think about the message; remember TACOS 2. Leverage the change, aligned with others 3. Apply more effective means of education: Use all kinds of GME/CME methods, including Just in Time; increase relevance, interactivity 4. Consider all health professionals 5. Think about the pipeline 6. Stage the educational innovation or intervention 7. Use already-present resources; imbed (ae4q) and spread (Te4Q) the message

34 Think about the pipeline Traditional Student Premedical Medical School Residency and Fellowships Practice Life-Long Learning Non-Traditional Student EBM, self directed learning can be taught, modeled and assessed so can thinking Aspiring about Student genomics Note: the flipped classroom, other educational methods Returning Student A question: where will we get the faculty? 2009 AAMC. May not be reproduced without permission.

35 Stage genomics education: Pathman, PROCEED and a CME-based implementation planning guide Davis et al, BMJ, 2003 Methods/ Stages Awareness Agreement Adoption Adherence Predisposing Enabling Reinforcing

36 Use already-developed resources AAMC s mededportal Local initiatives

37 Imbed the message ae4q aligning and educating for quality

38 SPREAD THE MESSAGE A train-the-trainer model QI/PS trained faculty/staff Continuing Education & Improvement Unit

39 T Current picture Possible Future More effective Less Effective Traditional, Didactic education Little attention to Genomics Little attention to system-linked, effective educational systems

40 More information:

41 This morning.. Perry Pugno, VP Education, American Academy of Family Physicians Benjamin Raby, Director, Brigham and Women s Hospital Pulmonary Genetics Center; Editor, Genetics Section, UpToDate Alex Djuricich, Assoc Dean, CME; Director, Med-Peds Residency program, Indiana U School of Medicine Diane Selbert, Director & Chair, Family Nurse Practitioner Program, Unified Services University Jean Silver-Isenstadt, Exec Director, National Physicians Alliance Maren Scheuner, Chief, Medical Genetics, VA Greater Los Angeles Healthcare system

CNMC Rounds: Can CME save lives? Dave Davis, MD Senior Director, Continuing Education & Performance Improvement (with Nancy Davis, PhD)

CNMC Rounds: Can CME save lives? Dave Davis, MD Senior Director, Continuing Education & Performance Improvement (with Nancy Davis, PhD) CNMC Runds: Can CME save lives? Dave Davis, MD Senir Directr, Cntinuing Educatin & Perfrmance Imprvement (with Nancy Davis, PhD) 1 Dave Davis, MD Nthing t disclse (srt f sad, huh?) What d yu think f when