The following post is by one of our e-Council members, Robert R. Cooney MD, MSMedEd, RDMS, FAAEM, FACEP. Robert is the Associate Program Director for the Emergency Medicine Residency Program at Conemaugh Memorial Medical Center in Johnstown, PA. Thanks for tuning in and conversing with us. – TC.
“We got it wrong and sincerely apologize… We launched programs that weren’t ready and we didn’t deliver a MOC program that physicians found meaningful… We want to change that.” – ABIM President and CEO Richard Baron, MD in an open letter to diplomates
In this month’s upcoming issue of Medical Education, Wenghofer et al. provide us with some additional data about the effects of continuing professional development, specifically highlighting public complaints against physicians. This article is extremely timely given the recent developments in the United States. The American Board of Internal Medicine (ABIM) recently announced that it was going to institute a moratorium on its “Maintenance of Certification (MOC)” program for at least 2 years.
In this study, the researchers attempted to determine if a correlation existed between participation in different types of Continuing Professional Development (CPD) and complaints against physicians. Using the matched cohort analysis, they were able to demonstrate that physicians who participated in CPD were statistically less likely to receive complaints about quality of care in the year prior. There was no correlation regarding complaints overall, complaints related to attitude and communication, or complaints related to professionalism. They also found that physicians who participated in assessment-based CPD rate increased odds of receiving a complaint. The authors note that assessment based programs are often prompted by work-related events, which may explain why this particular type of CPD demonstrates this finding. They also note that older physicians and physicians seeing higher volumes of patients odds of receiving a complaint as well. This calls in the question the role of burnout amongst physicians who received complaints.
With the move to mandatory “lifelong learning” activities and regulatory oversight, there is a need for this type of research. All educators recognize the need for assessments to be both valid and reliable. Organizations that regulate these types of professional development must be held to the same standard, especially since a significant amount of money is at stake for the learners. Critics of the process point to its costliness, leg implementation, and they question its’ clinical relevance.
In the past year I have had the good fortune to study quality improvement from the experts at the Institute for Healthcare Improvement.
One of the key points that we learned is that there are three types of data:
1) data for improvement,
2) data for evaluation, and
Data that is collected for one purpose should not be used for another means (i.e. data collected for quality improvement should not be used for evaluation purposes). Unfortunately, we seem to mix purposes far too often. For example, evaluation of patient satisfaction is collected under the guise of quality improvement but is frequently utilized to evaluate physicians performance and even pay. I have similar concerns about regulated lifelong learning activities. The purpose of these activities should be to improve my practice, and ultimately improve my patient outcomes.
With these findings and concerns in mind, I’m hoping that the readership of Medical Education would be willing to discuss the following:
Q1: Does the current model of Continuing Professional Development ensure that physicians have the skills needed to manage patients in a 21st-century healthcare system?
Q2: How best should data from these programs be utilized?
Q3: How can we ensure public accountability for health outcomes when financial conflicts of interest exist within regulatory bodies that oversee these programs?
Please help start the conversation by replying below to these questions (and be sure to mark which question your answering by using Q1/cue twos/Q3). Feel free to share this via your preferred social network by using the #MedEdJ.