I just finished “Personal Best,” Atul Gawande’s latest New Yorker article, in which he explores the idea of improving performance in the operating room (and throughout the healthcare system) not by holding more traditional continuing medical education activities, but by providing personal coaching. The coach would observe the healthcare practitioner in practice, and suggest ways to improve outcomes for the patients, along with efficiencies for the team, and reduce errors and costs.

This is such a great idea, even better than academic detailing, which is pretty great in itself. Gawande called on a retired general surgeon he knew from his resident days to act as his personal coach. The doc sat in the corner of the OR and observed, then gave Gawande his observations. He’s been working on implementing his suggestions, and it appears to be working: His complication rate is heading downward after a long period of stagnation.

The idea isn’t without its challenges, he admits. You have to trust that the coach’s advice will be good, and you have to be able to find people who are willing and qualified to do it. But the biggest sticking point may be this: “The greatest difficulty, though, may simply be a profession’s willingness to accept the idea…it will never be easy to submit to coaching, especially for those who are well along in their career. I’m ostensibly an expert. I’d finished long ago with the days of being tested and observed. I am supposed to be past needing such things. Why should I expose myself to scrutiny and fault-finding?”

And this part made me smile, in a sad way: “I have spoken to other surgeons about the idea. ‘Oh, I can think of a few people who could use some coaching’ has been a common reaction. Not many say, ‘Man, could I use a coach!’”

I’m lucky that I had the huge good fortune to have a fantastic coach in my early years with Medical Meetings, my former editor Tamar Hosansky. I wish everyone could have that level of personal, supportive backup throughout their careers. We would all be doing a better job, whatever our jobs may be.

I loved the interactive case studies (just like I love Medical Meetings’ Ethical Hypothetical case studies). My only complaint is that it took such a long time to get through all the introductory stuff that we ran out of time to do even five cases.

The session on excellence in education—I still have whiplash! Dr. James Holly raced through the Southeast Texas Medical Associates model, which I think I’ll fall in love with once I have a chance to actually look through all his slides and the Setma.com Web site, where he says they post pretty much everything. Basically, its model of care is all about performance-improvement CME, where they continually measure performance over a set of metrics. He urged other providers to just take those first baby steps toward PI CME, whatever the right toddles might be for your specific organization.

I went to the specialty society community of practice breakout session, and it was interesting to see what their hot topics were: quality (in terms of both value proposition and PI CME); innovations in collaborating with all sorts of other organizations; Risk Evaluation and Mitigation Strategy and CME; and strategic planning/visioning. I promised not to write about the specifics of what we talked about, but it was one of the better sessions of the day, I thought.

Speaking of REMS, I got a little lost during the hot topics session on just that subject later in the afternoon. I don’t know if it was due to the post-lunch slump or what, but I’m still not entirely sure I have a good grip on all the issues related to it. I have a feeling REMS will feel a bit nebulous until the FDA publishes its blueprint (or maybe it’s just me). Kudos to the panel for agreeing to come back for a half-hour of informal Q&A between the next session and the reception—I wasn’t the only one who still had lots of questions when we ran out of time during the session.

Thanks to the AAFP’s Mindi McKenna, PhD, MBA, for bringing the discussion back to earth with a great session on the implications of Maintenance of Certification and Maintenance of Licensure for CME collaboration. She also included some audience participation in the form of asking us to respond to questions using an audience response system (did you know that 62 of the 69 licensing jurisdictions require docs to earn CME, or that 15 states currently mandate topic-specific CME? I do now.).

The reception afterward was really nice, too. It seemed to be pretty well-attended, and the crab cakes and conversations both were delicious!

Next up after the keynote was the AMA’s Bette-Jane Crigger, PhD, who walked us through 10 myths about the recently passed CEJA Report 1-A-11.

Call me crazy, but a lot of it seemed to be that famous word-parsing thing that CME professionals tend to do, where meaning gets read into something that perhaps doesn’t deserve it, and where it gets glossed over in areas where perhaps it deserves more attention. Or is just too vague to really draw meaningful conclusions, a not uncommon thing in this field, it seems.

Example: Myth 1 was that the CEJA report prohibits industry support of CME. No, she explained, it doesn’t prohibit it; “The goal is to gain independence from industry support.” Not prohibited, but try to avoid it if at all possible.

Or take Myth 6, that it just duplicates the ACCME’s Standards for Commercial Support. Yes, there are some similarities, she said, but it also offers complementary guidance, since it’s aimed toward physicians, where ACCME’s SCS are for CME providers.

It was interesting, but she really didn’t do any myth-busting. Instead it was more of a comparison of complaints received against the goals the report tried to achieve.

One of the most interesting questions went unanswered: How will this new report affect the criteria for PRA Category 1 credit? That’s still to be determined, she said. Likewise, while it only addresses accredited CME, “the principles should be thought to be equally germane” to other activities (such as those for maintenance of licensure and maintenance of certification) as well.

The National Task Force on CME Provider/Industry Collaboration conference got under way today. My brain is uncomfortably stuffed; if it had a belt, it would have to let it out so all that gray matter could expand to accommodate all the info crammed into it today.

One of my big takeaways was similar to that of the thoughtful CME educator blogger: That perception still trumps reality. He says it better than I could, so I’ll let that one lie.

This morning’s keynoter, Dr. William Carey from the Cleveland Clinic, centered his talk around the thesis that a well-regulated industry/CME relationship benefits patients, healthcare professionals, and the public good. And yet, because so much of the discussion around CME and industry occurs under the circus tent of a media and political theater that doesn’t (and for the most part doesn’t care to) understand all the nuances and firewalls, CME providers still have to deal with misperceptions about what it is they do, and why.

It’s not all black and white, he pointed out. Docs are painted to be so good and pure and patient-centric, and yet who was it who carried out the infamous Tuskegee syphilis experiment? And Big Pharma is thought to be so nasty and self-serving that everything it does is suspect, and yet somehow it manages to produce live-saving drugs, make contributions to charities, and support education that has nothing to do with its product categories.

All this misperception can make moving forward feel like this (my new favorite video!):

Then he went into the latest AMA Council of Ethical and Judicial Affairs 1-A-11 report, which in its fifth iteration the House of Delegates finally passed this summer.

Dr. Carey wound up by polling the audience about the possible impact the CEJA report could have on CME, the results of which Dr. Joseph Kim kindly compiled here.

Other than the video, my favorite part of this session actually came afterward, when we were directed to write down (on a form provided) our key takeaways, and what we planned to do with them, then discuss them with others at our table. There was only one other person at my table (that’s what I get for sitting up front), but we had a great discussion, and who knows, I may actually do some of what I said.

Check out this terrific article by Jennifer Young, a former intern with the American Society for Nephrology, on how this society entered into the world of social media and transformed itself in the process. As she says, as ASN began looking to expand its audience and its mission, it realized “a shift in focus really required a shift in media.”

She outlines step-by-step how ASN worked its way into social media, and some interesting lessons learned along they way. One thing that struck me is how the communications team was intent on collecting data, both on what other groups were doing and in collecting statistics on ASN’s own efforts.

Thanks to SocialFish for the pointer!

I was just looking again at the chart of MM’s Social Media columnist Brian McGowan put together to showcase the results of research he and some colleagues did about how docs use social media to share medical knowledge with other physicians and something struck me.

Is it even possible that only 70 percent of the docs surveyed said they use e-mail? That means 30 percent don’t even do that? How can any professional in this day and age get by without ever e-mailing anyone? And we’re looking at ways to get them to use social media in some way to share learning? This is going to be a tough hill to climb, folks.