Immediate past president Jann Balmer was a champion throughout the meeting for the Alliance’s new strategic plan, and on Saturday morning she answered some of the questions people already have been asking, and encouraged all to keep the questions coming.

She also said a name change was definitely under consideration, and again encouraged members to chime in with their ideas (which a few on the Twitter backchannel already have been tweeting about). There were no guarantees on the ifs and whens, but she did say that members would get to vote on any new name that was proposed.

I have to applaud the Alliance for coming up with what I think is a really forward-thinking, comprehensive-yet-flexible plan to not just take the organization into the future, but to give it the will and ability to get in front of the changes we talked about all week that are transforming CME, from interdisciplinary/multidisciplinary learning, to new technologies, to an outcomes focus, to better use of adult learning strategies … you get the point. And they’re promoting it as well as it could possibly be promoted, from a prominent spot on the home page to the bingo card with the main eight points on it conferees got at registration, to the signs around the conference areas. If people aren’t getting the message, well, I don’t see what more could be done to get it across.

Bravo to all involved in drafting the new plan, and to those who will see it through implementation, and to the vocal members who are already helping to continue to shape it into a plan that will take this organization where it, and the enterprise, needs to go.

And I’d like to give another big shout-out to everyone involved in putting this year’s conference together. I haven’t felt such good energy, such a positive buzz, or heard so many good comments about the programming, as I did this year. I can’t wait to see what you come up with next!

Among the hot topics in CME today — from REMS to perceptions of bias to Maintenance of Certification Part IV — the one that left me feeling a bit queasy from the final Alliance for CME plenary session Saturday morning was a presentation on cognitive bias and errors in diagnosis, by Hilary Schmidt, PhD. She cited data about the scary high percentage of hospital admissions that involved missed diagnoses, patients with acute or chronic conditions who didn’t get the right care (it sounds like the AHRQ Web site has a lot of good info on this topic). When she asked us how many in the audience had a medical error affect our or a loved one’s life, I swear almost half of us raised our hands.

She then showed us just how cognitive bias can factor into missed or misdiagnoses by showing just how easy it is for humans to miss really obvious things, like an airplane engine and a moondancing bear, something called cognitive blindness. And how the power of suggestion can factor into perceptions of a situation.

The good news is that CME can help to reduce these types of errors. The more often we’re made aware of cognitive blindness and inattention, the less likely we are to get blindsided by it. Perfect concept for a performance-improvement CME program…if anyone’s doing it, I’d love to hear about it.

I know, it seems weird to get so excited about checklists, but I’m such a fan of Atul Gawande that I had to get a copy of his book The Checklist Manifesto as soon as it came out. So when I saw there was a session at the Alliance for CME conference on turning to-do lists into checklists, I had to check it out (so to speak)

It turned out to be actually a delightful experience (did I really just call it “delightful”? But it was). The presenters divided us into four sections, and tasked each section with writing a checklist for something fairly mundane (making a peanut-butter-and-jelly sandwich, catching a fish, knitting a sweater). Then someone from a different group was asked to go through the checklist and see if they could do the task by only following what was on the list. It was, not surprisingly for someone who’s read the book, harder than we thought we create a good checklist.

Some tips:

-Keep it between five and nine elements. If you need more, go to another checklist.

-each item should be something you read/confirm or do/confirm before you can move forward

-Be precise, not vague

-Make sure the most important aspects don’t get missed, but don’t make it a laundry list, either. Look at your processes to see what your team gets right 100 percent of the time and where things fall through the cracks. The latter, as long as they’re “mission critical,” need to be on the checklist.

-it should be more of a “done” list than a “to do” list.

As a hint on what you might want to include, check the ACCME’s data for which criteria providers are most found non-compliant in, which I believe were Criteria 7, 11, and 19 as of the most recent data.

They said there was a YouTube video of Stephen Colbert interviewing Gawande, which I can’t find on a quick search. I’m going to keep looking because I’m sure it’s both hilarious and informative. Update: Here it is — thanks, Jessica, for the link!

Big kudos to the presenters for putting on such a useful, fun, interactive, and interesting session: Mary Ales, Interstate Postgraduate Medical Association; Shelly Rodrigues, California Academy of Family Physicians; Carol Havens, MD, Permanente Medical Group; and Cheri Olson, MD, Franciscan-Skemp Healthcare.

My flight’s boarding, so I have to run.

I was a bad blogger yesterday–never did get around to posting anything. Since my flight has been delayed now and the San Francisco airport so nicely is giving me 45 minutes of free wifi (yay!), here’s some quick thoughts about yesterday’s sessions.

Plenary: Dr. Chaudhry, DO, FACP, with the Federation of State Medical Boards of the United States, took what could have been a fairly deadly topic (for me anyway) at 8:30 in the morning and made it really interesting. Anyway, he gave a great overview of the current state of maintenance of licensure, from the guiding principles to plans for implementing MOL in a phased approach because, as he said, “we don’t want to shock the system.”

And I learned some interesting historical facts, including that my home state of Massachusetts was the first colony to recognize physicians as a unique professional group way back in 1649.

I also went to a great session outlining some of the results of two studies that PACME conducted last year, one a benchmarking study, the other addressed outcomes. I hope they can make the results of these studies — and the ones PACME plans to conduct in 2011 — public. As we were talking about at the NAMEC SWOT meeting, it’d be nice to get some of the science of outcomes visibility in publications outside the usual CME literature.

The National Association of Medical Education Companies held a really interesting session after hours on Thursday on a SWOT (strengths, weaknesses, opportunities, and threats) analysis they had conducted via the CME LinkedIn group.

While many strengths were outlined, I thought they all boiled down to this at the core: CME itself is becoming more effective by being designed based on knowledge/care gaps in mind, including multiple touch points, using multimedia formats to engage physicians, using social media to disseminate information, and measuring outcomes to determine what’s working, what isn’t, and what further education is needed.

An interesting strength someone in the audience chimed in with was that CME providers also are a strong economic force, “we provide employment,” he pointed out. In terms of MEC-specific strengths, people pointed out that they’re innovative and nimble in responding to changes, and “we’re held to a higher standard already.” As another person pointed out, “We’re the only group that actually chooses to do this,” which I thought was an interesting thing to say!

While there were a few weaknesses as well, again they boiled down to the fact that the CMI enterprise isn’t telling its own story very well, from the bias safeguards around commercial support, to why and how it’s different from promotion, to articulating a universal definition of what the different outcome levels mean.

Key quote: “We continue to let others define who we are as an industry. We should not be apologists for the good work we do.”

The opportunities are, as the presenter said, “hiding in plain sight,” including some that may spring from healthcare reform, the growing role of social media in healthcare, and the wealth of data the CME enterprise is generating (if providers can stop protecting data from “competitors” and share the wealth with each other, that is.)

Similar to weaknesses, most of the threats people talked about stem from a lack of communication: confusion in the media, and among healthcare providers, on the difference between certified CME and promotion, for example.

There was a lot of great discussion, and the energy in the room was high. But, as session leader Jan Perez said, it’s easy to just let the idea of advocating for CME drop once everyone gets back to their daily grind. We talked about contacting our local congressmen/women, writing letters to the paper when articles are published that bash CME, submitting papers outlining good CME cases to non-CME association and disease-state publications.

What else can CME stakeholders do to set the record straight?

I can’t begin to say how much I loved this session on experiential learning! Maybe it’s because I still had the message about connecting emotions with learning to make the message stick from the morning plenary, but the examples of the different experiential learning methods presenters Debra Bryan, MEd, and Carl Patow, MD, both with HealthPartners Institute for Medical Education, were amazing. They really showed us how you can facilitate emotional engagement that ultimately translates to changes in behavior.

I won’t even try to explain them — you have to experience experiential techniques to really understand why they’re so effective — but suffice to say they showed us everything from poetry, narrative storytelling (first-person stories from patients and others, to films, to short “micro-scenarios” to live “black box” theater), to what they called “third things,” which ranged from game shows to iconic object exercises and art observation. OK, I’ll explain the latter two just because I’d never heard of them before, at least not by name.

As one of the first people to show up, I was asked to take part in the iconic object exercise, which just meant I should check out some items they had spread out on a table, and pick one that resonated with me in some way. Two other early birds were asked to do the same, and later on we were asked to share with the rest of the room why we picked what we picked (a matchbox, a cork, and a seashell — mine was the matchbox, which reminded me of my grandmother’s matchbook collection).

Art observation involved bringing healthcare providers to an art museum and showing them a piece of art that evokes emotion. Then they are to talk about what it says to them, and why, which can help sharpen visual thinking. You can then have a docent tell them what the piece is supposed to be about, but it really doesn’t matter, since there are no “right” answers. It’s all about learning to really look at something and think about what you’re seeing.

You know how you usually feel by 3:45 pm after a day of lectures and PowerPoints? I left the room feeling energized, enlightened, and ready to learn more. What I’d love to see next year would be some sessions that use more experiential formats to teach other types of content. I can’t be the only one who would love that, and learn from it. I can’t help thinking about the format experimenting that meeting planners did at a meeting I went to a week or so ago, and wishing the adult educators here could try being a little more experimental — and experiential — as well.

I wanted to go to the “4×6″ session as much to see what the format was all about — which was four eight-minute (I think they were supposed to be six from the name) presentations, followed by discussion and Q&A — as for the topic. Though the topic was interdisciplinary education, one of the dominant themes of the day and one I’m really interested in. Anyway, I loved the concept, and it came off really well (it helps that all of the presenters were really good, even if some struggled a bit to make it under that eight-minute wire). But in the end, it really wasn’t much different from most panel discussions — why they’re called discussions, I don’t know, since most end up being discrete mini presentations just like at this session. I’m not complaining, though. Lots of good information came out of it.

First up was Bob Meinzer, New Jersey Academy of Family Physicians, who quickly went over two case studies that included patients in the interdisciplinary mix. It’s important to address their gaps, he said, because the communication between healthcare providers and patients is central to being able to provide a patient-centered medical home.

Next was Karen Thomas, CCMEP, and Scott Kober, CCMEP, both with the Institute for Continuing Healthcare Education. One of their main messages was that interdisciplinary education must truly address the daily challenges in each learner type’s job.

Sandra Pinkerton, PhD, with Texas Health Research & Education Institute, outlined a case where nurses played a key role in helping to improve physicians’ venous thromboembolism-related performance through a non-educational strategy. Very cool.

Last but not least was Brian Tyburski, Center of Excellence Media, who provided a interdisciplinary case that ended up with the vast majority (high 90 percent) saying that they afterward felt more confident interacting with other team members, and were more aware of the roles of other healthcare providers on their teams.

The Q&A was really lively, and the panelists were swarmed afterward with people wanting to learn more about the cases presented. It wasn’t exactly Pechakucha, but it was a good break from the usual lecture/PowerPoint. And the content was excellent.

The opening plenary session of the Alliance for CME conference today was a really comprehensive discussion of what’s needed to move from individually focused continuing professional development to education that will help an entire organization become better able to provide improved care and enable better outcomes for patients. At its heart was a presentation by Marijke Thamm Kehrhahn, PhD, University of Connecticut School Neag School of Education, who introduced the TRIO model of adult learning. This model is based on the idea that there are individual learner attributes, environmental factors, and key experiences that all feed into optimal adult learning.

I loved this quote: “Learning for information is not the same as learning for performance.” Ain’t that the truth? And she went on to outline for us how she took an issue in her work (feeling grumpy after schlepping tons of stuff up five floors in the morning) and very scientifically went about finding a way to make it better (aka, take the elevator for her first trip up to the office).

She also outlined a model for levels of change that was right on: we start off not even thinking about making a change. Then we may begin thinking about it. Then we may actual try it out–which starts off feeling mechanical and weird, which can make you abandon the change at this point. If you stick with it, though, the new way of doing things begins to feel comfortable and routine, and gets integrated into practice. The last stage is where you own the change by refining it to make it fit your situation better, and getting others to buy into the change as well.

Have you ever made a change that didn’t go through those stages? The thing that really got me thinking, though, was when she asked the audience to reflect on something we learned that we put into practice. For all the talking we do about this, I haven’t spent a lot of time thinking about what has prodded me into making changes. It’s really worth taking the time to work through what made you go from not thinking about it to considering making a change, and from thinking about it to trying it, sticking with it, and finally making it your own.

Another big moment for me was when she said that, for real learning to occur, there needs to be an emotional connection that leads to a change in your actual physical state. I think we all kind of hesitate to go there, because no one enjoys getting pushed out of their comfort zone, but when I think about when I’ve learned something I then put into practice, that’s been the case every time.

But the tricky part is taking that from an individual level to an organizational one: Building a learning culture in the organization that enables individual learning to trickle up, and organizational learning to trickle down.

Another great quote, this time from response panelist David Price, MD, Colorado Permanente Med Group/The Permanente Foundation: “Co-located learning is not interdisciplinary learning.” It’s not enough just to have different disciplines in the room — it has to be designed to meet each discipline’s educational needs.

While there still aren’t a ton of tweeters so far at the Alliance for CME conference, there are a lot more than last year. Here’s what they’re talking about:

I have been grumbling in my mind about having to get up at 4:30 Eastern to catch a flight to San Francisco for the opening bell of the Alliance for CME’s annual conference, but after attending this afternoon’s Medical Education and Communication Company Alliance member section meeting (and yes, there was some talk about dropping the “communication” part of the group’s title, a la NAMEC), I can say that it was worth the trek.

It may help that I’m a bit of a believer in social media as something that can, as one presenter said, help individual CME providers, support the development of the CME community, and help providers and others advocate for the profession, but I already got a bunch of takeaways. Section leader Alicia Sutton, CCMEP, put together a terrific lineup, including a panel of CME providers who, in five minutes each, gave us a glimpse into how they’re using different social media to augment their CME programs. One person talked about using Facebook to reach out to patients through chapters of a society for sufferers of a particular disease state and using the responses to inform their needs assessment. Another told a tale of using Twitter to reinforce key educational messages from activities. Another talked about how her organization used social media to market a CME activity. And yet another discussed how his organization set up a learning blog, and what they learned along the way in terms of challenges and best practices. I’m not a big fan of panels in general, but this one was just terrific, and left me wanting more. The Q&A also rocked the house.

Then Jeremy Lundberg, who is on the Alliance for CME’s social media working group, took to the mic to share how the ACME came up with its social media strategy, which it just recently began to roll out. A key takeaway from his session was how the Alliance used a POST methodology, which he explained meant:

People: assess where your audience currently is at when it comes to social media

Objectives: winnow it down to 3-5 things you reasonably want to accomplish, and determine what metrics you’ll use to measure how well you’re accomplishing them

Strategy: Plan how you want your relationship with the audience to evolve

and only then

Technology: figure out which technology will help you do what you want to do with your audience.

He also went over the latest social media survey conducted with the MECCA group, including the fact that the biggest challenge for most (66%) was a lack of personnel and financial resources to support a social media initiative.

Note: While he didn’t say it, I think it’s vital that, when developing your objectives, you don’t just think about what objectives will be good for your organization. It’s tempting to focus on things like recruiting new members and getting more people to sign up for your activities, but if your objectives don’t start with “what’s in it for me” — with “me” meaning your audience or your learners — you’re missing the boat. The quickest way to turn people off in the world of social networks is to be all about what’s in it for you, not what you can give to those who choose to be in your network.