In a recent article published by the American Association of Medical Colleges (AAMC), two authors challenged traditional continuing medical education (CME) notions in favor of a new program: Aligning and Educating for Quality (ae4Q), which recently entered its second phase after a successful pilot.
Launched in January 2011, ae4Q is designed to help medical schools and teaching hospitals align their clinical quality improvement with their CME programs and activities. The goal is to go beyond simply issuing certificates of attendance to physicians and instead move toward helping them demonstrably improve their performance. The programs assess clinical data to identify practice gaps and then develop a CME activity with that information. When the educational intervention is complete, physician performance is measured again to determine if it has improved.
In the past, physicians have experienced CME as “knowledge transfer,” and traditional CME has avoided an “integrative approach. “Most of today’s practicing physicians experience CME as knowledge transfer. “But by and large, CME remains rooted in an older tradition.” An instructor delivers a lecture and answers a few questions, ending with the assumption that he has transferred his knowledge, to the betterment of his colleagues.”
“If you’re just sitting in a room for an hour and listening to a lecture while you plan your dinner in your head, you haven’t been engaged,” said Dave Davis, M.D., senior director of continuing education and performance improvement at the AAMC. Davis and his colleague Nancy Davis, Ph.D., AAMC director of practice-based learning and improvement, are challenging traditional notions of CME through the ae4Q.
“I never thought it would be 2012, and we would still be delivering CME in the traditional lecture format,” said Chuck Kilo, M.D., chief medical officer at Oregon Health Sciences University. “There hasn’t been a whole lot of activity to move away from traditional lectures in which someone talks to you.”
Additionally, ae4Q goes beyond education by encouraging CME planners to collaborate with their quality improvement colleagues to tackle specific patient-centered quality goals. “This is a very big deal,” said Susan Pingelton, M.D., associate dean of CME at the University of Kansas Medical Center. “Institutions have their silos, and the continuing education silo is in one part of the medical center, while the quality improvement department is housed in its own silo in the hospital. In the past, these two entities never talked, never crossed.”
At the University of Kansas Hospital, an ae4Q pilot site, hospital leaders are breaking those silos and using ae4Q to improve care for patients by educating physicians and other providers on best practices for specific conditions. The incidence of venous thromboembolism (VTE) was unacceptably high. Pulmonary embolism, the chief complication of VTE, is the biggest cause of preventable death in today’s hospitals, and leaders at the institution knew they could do better. In an attempt to lower its rate of VTE, the University of Kansas School of Medicine’s CME department joined forces with the hospital’s quality improvement department to develop a multidisciplinary team of doctors, nurses, pharmacists, and educators to study the problem and determine why some patients were not getting necessary preventive care. The group examined 300 cases and identified the causes it believed led to the complication.
With that information in hand, the team developed an education plan centered on identifying risk factors for VTE and diagnosing and treating the condition. Small-group sessions complemented didactic learning, and physicians carried “badge buddies,” which listed the risk factors for VTE. Nurses were trained to work with physicians to prevent and detect VTE, and pharmacists assisted physicians by risk-assessing admitted patients. The hospital even posted an educational video on YouTube.
Did it work? “Between January 2011 and November 2011, our incidence of VTE fell by 35 percent,” Pingelton said.
Other medical schools and teaching hospitals also have experienced success with ae4Q. Physicians at the University of Iowa Hospitals and Clinics were ordering too much blood, setting up the potential for unnecessary or overtransfusions. The CME department at University of Iowa Carver College of Medicine began working with the chief quality officer at the University of Iowa Hospitals and Clinics to study blood utilization. A steering committee and four task forces studied the problem and developed the educational intervention. The chief quality officer subsequently presented relevant data to physicians at rounds and case presentations in the specialties that would most impact patients. The ensuing change was notable. Between October and December last year, utilization of red blood cells in the hospital decreased by 17 percent, and single-unit orders decreased from 63 percent to 13 percent.
“The real value of ae4Q goes way beyond an individual project,” said Susan Zollo, M.A., director of CME at Iowa’s medical school. “It has to do with an institutional mindset that acknowledges and continually reinforces the relationship between patient care, patient outcomes, and education—how we make sure that what is actually happening in the patient care setting is informing our educational process.”
Ae4Q’s ultimate aim of quality improvement is supported by a companion pilot program, Teaching for Quality (Te4Q), part of the AAMC’s Best Practices for Better Care initiative. Launched last January, Te4Q seeks to further integrate quality improvement and patient safety into medical education curricula by establishing interdisciplinary teaching resources and faculty development opportunities for teachers.
“Te4Q is a faculty development initiative to help cultivate teaching skills, specifically around quality and patient safety,” Nancy Davis explained. A steering committee drawn from medical schools and teaching hospitals around the country is developing teaching tools that ultimately will be available to the academic medicine community.