Symposia

Life-long Learning That is Relevant and Sustainable

Moderator:
Catherine Crier, managing partner, Cajole Entertainment

Panelists:
Richard Baron, M.D., chair, American Board of Internal Medicine Board of Directors
Richard Berger, M.D., orthopedic surgeon, Mayo Clinic; vice chair, Accreditation Review Committee, Accreditation Council for Continuing Medical Education
Lucinda Maine, executive vice president, American Association of Colleges of Pharmacy
Bernadette Melnyck, R.N., Ph.D., dean and distinguished foundation professor of nursing, Arizona State University College of Medicine
Rick Nishimura, M.D., Judd and Mary Morris Leighton Professor of Cardiovascular Disease and professor of medicine, College of Medicine at Mayo Clinic

The importance of life-long learning for medical professionals seems like a no-brainer, said Catherine Crier, moderator for Tuesday's opening session on relevant and sustainable life-long learning.

But in fact, there are significant barriers, and effective post-professional learning is largely not happening, according to panelists representing practicing physicians, nursing education, professional associations and boards.

For this discussion, life-long learning for health care professionals was defined as a self- motivated, continuous journey embodying a desire to attain new knowledge, skills and other competencies that support high-quality, evidenced-based, patient-centered care.

Institutional cultural barriers to this continuous journey include lack of time, lack of practice data and lack of relevant training opportunities. Another barrier is lack of a "push" from patients, who believe that their doctors know everything they need to know.

Once doctors graduate, they are working 7a.m. to 7 p.m., doing the same thing day after day," says Rick Nishimura, M.D. "They don't feel the need the do anything further as they go on in years."

Research indicates that current learning opportunities — episodic, mostly passive lectures — don't improve practice. And learning strategies that are beneficial — self-directed approaches — have been difficult to implement and track.

Panelists agreed there's no easy way to learn what care providers really want to know — the 25 specific questions that come up in the course of a day treating patients. "There is no time to get the answers because there's no easy way to filter the information," says Dr. Nishimura.

Another approach to life-long learning is to determine what providers don't know and fill in the gaps. However, there are concerns that identifying anyone as "below average" would have ramifications.

Richard Baron, M.D., says this approach is ideal, but the data to identify practice differences is buried. As information technology becomes more sophisticated, physicians will be able to learn how well they compare to peers and practice standards.

Based on the discussions, participants developed more than 20 ideas to encourage providers to pursue learning throughout their careers.  Among the ideas most widely supported were:

• Require a change in payment policy that moves away from volume.
• Just-in-time learning — create a performance dashboard could help providers keep track of completion and performance on key indicators.
• CME or CPD should evolve to practice-based learning, focusing on the real patient care profiles and patterns of the provider's practice.
• Make continuous learning practical and fun, dependent on the certification board and integrated into the regular day (i.e. the "virtual" physician lounge.)