CME in Professionalism building block or stumbling block

1
CME in Professionalism building block or
stumbling block?
Prof M de VilliersDeputy Dean Education, FHS,
Stellenbosch University Chairperson HPCSA CPD
Committee
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Overview

• Professionalism and CME
• CME as building block
• Stumbling blocks
• Maintenance of competence

8th International Conference on Medical
Regulation Cape Town, South Africa 6-9 October
2008
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There are numerous complaints of Dr LM arrogance
and rudeness to both patients and staff. We have
had personal experience of his bad attitude and
unprofessionalism.
There have been verbal complaints of Dr MJ
regarding her attitude, lack of respect for
patients rights and her poor dressing.
Dr TH is an intern. She has refused assistance
of senior doctors to the detriment of patients.
There have been complaints from the nursing staff
regarding her lack of respect and arrogant
behaviour.
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Can CME fix these attitudes and behaviours?
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CME and Professionalism

• - Commitment to professional competence
• - Commitment to improving quality of care
• - Commitment to scientific knowledge
• Medical Professionalism project. Medical
  professionalism in the new millenium a
  physicians charter. Lancet 2002359520-22

6
Professional competence

• lifelong learning
• maintaining knowledge and skills
• provide quality health care
• self-directed learning
• self regulation
• regulation of profession

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What do students think?
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Students view on professional competence
enthusiastically take part in activities,
discussions and projects
appropriate way of communicating
Inspires trust in patient and colleagues
Key attribute of professionalism (69)
well prepared for ward rounds and lectures

• time and effort put
• into maintaining,
• updating and improving
• medical knowledge

increase knowledge by reading extensively

• Van Rooyen M, Treadwell I. Pretoria medical
  students perspectives on the assessable
  attributes
• of professionalism. SA Fam Pract 200749(4)

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How professionalism occurs

• Acquiring professionalism
• Maintaining professionalism
• Attrition of professionalism
• Hilton SR, Slotnick HB. Proto-professionalism
  how professionalisation occurs across the
  continuum of medical education. Medical Education
  20053958-65

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Implications

• Professionalism arises from experience and
  reflection
• Provide stage-appropriate experiences
• Maximise opportunities for attainment
• Minimise inappropriate attrition

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• Good work is work undertaken with integrity as
  well as competence

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Stumbling blocks

• Needs assessment
• Educational methods
• Context
• System issues

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The need for needs assessment

• CME based on well conducted needs assessment are
  effective in changing doctors behaviours (Fox
  Bennet 1998)
• Without justification of CME content through
  needs assessment, CME programmes are unlikely to
  be effective (Norman et al 2004)
• Physicians have a limited ability to accurately
  self-assess learning needs (Davis et al 2006
• More focus on external needs assessment

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Most effective CME Linked to clinical
practice Interactive meetings Outreach
events Multiple interventions
Less effective CME Practice audit Feedback Consens
us processes Opinion leaders
Least effective CME Didactic Lectures Unsolicited
printing material Clinical guidelines
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Context place matters

• Moving from how people learn, to where people
  learn (Cervero 2003)
• Appropriate learning for rural doctors is located
  at or close to their practice (de Villiers et al
  2006)

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USEFULNESS OF UPDATING METHODS FOR PROCEDURAL
SKILLS AND KNOWLEDGE AREAS

• De Villiers MR, De Villiers PJT, Kent AP. The
  maintenance of competence of
• rural district hospital medical practitioners. SA
  Fam Pract 200648(3)18.

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System issues

• Successful CME strategies dependent on local
  environment (context), as well as clinical
  relevance (process)
• Key system issues include working conditions,
  heavy patient load, lack of learning culture, and
  passive learning
• Leadership in the service environment to create
  positive learning environment
• Provide protected time for learning in health
  services

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For CME to make a difference to professionalism
and quality of care, educational strategies need
to be supported and integrated into health
services
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Maintaining Professionalism
Situational analysis Training needs Broader
context
Context Organisation, society, training resources
Process Practical, feasible, adult learning
Content Relevant, local, applicable
Monitoring and evaluation Regular needs
assessment Performance assessment Constant
response to feedback
Improved knowledge, skills, competence
Professionalism Improved attitude,
job satisfaction
Improved quality of care
Marais BJ, De Villiers MR, Kruger J, Conradie H,
Jenkins L, Reuter H. The role of educational
strategies to reverse the inverse performance
spiral in academically isolated rural hospitals.
SA Fam Pract 200749(7)15.
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In conclusion

• Most behaviour changes due to a combination of
  factors
• Formal CME only responsible for behaviour change
  in 33
• Organisational factors, critical incidents and
  contact with other health professionals
  (Cantillon Jones 1999)

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Going forward

• Attaining and maintaining professionalism is
  about much more than attending conferences
• Great potential and innovation in providing
  effective CME
• Paradigm in CME is changing

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Prof Marietjie de Villiers mrdv_at_sun.ac.za Telepho
ne 27 21 9389035 Facsimile 27 21 9389558 P.O
Box 19063, Tygerberg, 7505 South
Africa www.sun.ac.za
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Reference list

• Cantillon P, Jones R. Does continuing education
  in general practice make a difference? BMJ
  19993181276-9.
• Cervero RM. Place matters in physician practice
  and learning. J Contin Educ Health prof
  200323(suppl)S10-S18.
• Davis DA et al. Accuracy of physician
  self-assessment compared with observed measures
  of competence. A systematic review. JAMA
  2006296(9)1094-1102.
• Davis D et al. Impact of formal continuing
  medical education. Do conferences, workshops,
  rounds and other traditional continuing education
  activities change physician behaviour or health
  outcomes? JAMA 1999282(9)867-74.
• De Villiers MR. The availability, utilisation and
  needs for continuing professional development of
  rural general practitioners in the Western and
  Northern Cape. SA Fam Pract 200022(2)11-16.
  Cantillon P, Jones R. Does continuing education
  in general practice make a difference? BMJ
  19993181276-9.
• De Villiers MR, De Villiers PJT, Kent AP. The
  maintenance of competence of rural district
  hospital medical practitioners. SA Fam Pract
  200648(3)18.
• Fox R, Bennet N. Learning and change
  implications for continuing medical education.
  BMJ 1998316466-9.
• Hilton SR, Slotnick HB. Proto-professionalism
  how professionalisation occurs across the
  continuum of medical education. Medical Education
  20053958-65
• Marais BJ, De Villiers MR, Kruger J, Conradie H,
  Jenkins L, Reuter H. The role of educational
  strategies to reverse the inverse performance
  spiral in academically isolated rural hospitals.
  SA Fam Pract 200749(7)15.
• Manning PR DeBakey L. Continuing medical
  education the paradigm is changing. J Contin
  Educ Health Prof 200121(1)46-54
• Medical Professionalism project. Medical
  professionalism in the new millenium a
  physicians charter. Lancet 2002359520-22
• Norman G, Shannon S, Marrin M. The need for needs
  assessment in continuing medical education. BMJ
  2004328999-1001.
• Shannon S. Practice-based CME. The LANCET
  2003361618.
• Van Rooyen M, Treadwell I. Pretoria medical
  students perspectives on the assessable
  attributes
• of professionalism. SA Fam Pract 200749(4)