Lesley Bainbridge, BSR (PT), Med, PhD, with the University of British Columbia, gave an interesting keynote on teaching interprofessional collaboration in healthcare, a hot topic for a few years now. She started out with a not-shocking-but-nonetheless-horrifying statistic: 70 percent to 80 percent of medical errors are caused by poor communication and collaboration among healthcare teams. That may be because HCPs learn by doing in the clinical setting, although, she pointed out, most know more about collaboration than we tend to give them credit for.

She talked a lot about various competency frameworks, and the similarities (many) and differences (few) between those developed by U.S. and Canadian organizations. She also provided a fairly daunting list of challenges for interprofessional education, from stereotyping to time, geography (we both have big countries), to resources, power/hierarchy issues, political will, unions, professional regulators, and policies that don’t support team-based approaches.

She says she wants to “put the ‘I’ back in teamwork,” meaning that people need to take personal responsibility for examining what stops us from collaborating effectively as practitioners. What barriers do you face? She gave us several areas to think about:

* Social capital: Basically, this is about trust and respect. How do you build these among colleagues and team members? How do you lose them? Are there “teachable moments” in everyday interactions you can take advantage of to build trust and respect?

* Rhetoric: The words we choose can make all the difference in an interaction. She suggested practicing word choice in e-mail, since it has a built-in time delay you don’t get in conversation. What words do you use? Does a disregard for grammar and spelling indicate a disregard for the recipient? Think about it.

* Perspective taking: Remember, her colleague told her, it’s not all about you (what??). How do you figure out where another person is coming from? How can you teach others to discover others’ perspectives? This one is particularly sticky, I think.

* Negotiate priorities: How do you work with others to determine what’s important and what isn’t?

* Resolving conflicts: How do you create a safe place to have conversations around areas of conflict?

* Building relationships: How do we build relationships, and how do we teach people to build constructive relationships with colleagues?

During this week’s #CMEchat on Twitter, I wondered if we could use some gamification elements to encourage healthcare professionals to engage in followup activities. I don’t know about you, but I find activities with gaming elements pretty addictive, and I bet most of your HCPs do, too.

So I was interested in reading this post by Alyce Kuklinski, MSN, ANP, on Pri-Med’s Off the Chart blog on “edutainment” and game-based educational formats. It sounds like Pri-Med is tip-toeing into using them, and why not? I remember going to an awesome session on just this topic at GAME a year or so ago, and wondering why more CME providers weren’t experimenting with the concept. Or maybe you are? If so, I’d love to learn what you’re doing and how.

Maybe the Alliance for CME will lead the charge and try some gamification on its own? Derek has some (pretty funny, I think) suggestions on how they can get started with an after-hours Outcomes Pecha Kucha game…

Update: I was just reminded by @CMEadvocate via Twitter than gamification elements can get corny quickly, and, as I noticed at the EventCamp Twin Cities hybrid conference this summer, they also can be pretty distracting.

If you’ve done it successfully, I’d love to know what worked (and what didn’t), and how you went about figuring out what your specific learners would find compelling. As always, I’d love to hear from you via a comment here, e-mail, or even (gasp!) by phone—978-448-0377.

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 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.

Derek makes some interesting points in this post, The Value (Or Lack Thereof) Of Self-Reported Outcomes In CME. I know he’s right about people just ripping through the checkoffs like (pick a metaphor) and not providing meaningful data other than a baseline from which you can find outliers, but I’m wondering if maybe he’s not asking the right question. He proposes three ways to get better data, including shortening up the form to asking just four questions. Which I’m sure would help, especially when two of them require write-in answers.

As he says, “My hope is, by simplifying and reducing the form to these four basic questions, more participants would be willing to take the time to give thoughtful, articulate answers that would provide meaningful insight into the achievement of the desired outcomes of the activity.”

The question I think we need to be asking is why learners aren’t motivated to give those thoughtful answers to begin with. As always, in my mind, anyway, it comes down to the old “what’s in it for me?” Obviously, they don’t see enough value in filling out the form to make it worth their while to do more than the bare minimum. Other than shortening the form, which just makes it less painful, not more valuable, what can you as a CME provider do to engage learners in the outcomes-gathering process so that they actually want to do a good job with those forms?

Update: I just did a quick archive search and found this article on outcomes from back in 2003 that touches on these issues. Some of the tips people gave me then were:

* Keep it short

* Use open-ended questions

* Ask about each objective (so much for keeping it short!), not just if objectives were met

* Offer incentives (free registration/hotel/airfare to participate in another activity)

• Tell attendees that you’ll be following up with a survey in three or six months (check the article for tips on how to get them to participate in follow-up surveys and questions to ask)

In re-reading this thing, it’s actually holding up pretty well for something written eight years ago. While that make me feel pretty good in one way, it’s kind of sad that we haven’t made much progress over that time in figuring this out.

Here’s another kind of handy sidebar from the article that I think still holds up:

Measurement Tools

Here’s a look at just a few of the many ways to measure CME outcomes:

SELF-REPORT THROUGH EVALUATIONS: Asking attendees what they learned and how they planned to (or how they did) use what they learned through immediate, post-meeting evaluation forms and follow-up mailings, e-mailings, faxes, and telephone interviews

Pros: Easy to implement, relatively inexpensive

Cons: Not very reliable, can be difficult to get a significant number of responses

CASE STUDIES: Presenting attendees with a case study related to a specific practice area, both as a pre-test and as a post-meeting evaluation. Can be done via telephone, fax, e-mail, or mail

Pros: While still a form of self-report, studies have found it to be reliable in terms of predicting physician behavior; can be as cost-effective as evaluations

Cons: Need to have expertise to design an effective case study; can be difficult to get responses

CHARTS/PATIENT CARE RECORDS: Measuring baseline performance and post-meeting behavioral improvement by looking at attendees’ patient care records

Pros: Highly effective form of evaluation, especially when the records are available in database form

Cons: Privacy issues can be an impediment; can be difficult to obtain outside of hospitals and large healthcare systems

STANDARDIZED PATIENTS: Objective, structured clinical exams where physicians visit stations and examine patients presenting a particular disease. Docs have to come up with the right answer before they can move on to the next station.

Pros: Highly effective form of evaluation; allows CME provider to observe physician interacting with actors posing as patients

Cons: Requires a lot of time and resources to develop and implement

As I may have mentioned before, there’s a group of CME professionals that e-gather every Wednesday at 11 am ET on Twitter to talk about the art and science of CME. The moderator of the 7/12/11 session, Brian S. McGowan, PhD (aka CMEAdvocate on Twitter), posed several questions, which the group then dug into in bites of 140 characters or less. The full archive of the chat is available, but I thought I’d make it easier to wade through by providing a summary of some of what we talked about (and fellow #CMEChatters, if I misinterpreted anything, please let me know in the comments!).

Brian began by pointing out that the CME community was told back in 2006 that online education was effective. What has changed with online CME since then?

While the CME tweeters said that while more and better interactive formats are available now, too much of online CME is an endurance test, with overly long activities that consist of talking headshots and PowerPoint slides, they said. Too often CME providers spend a lot of time and energy trying to reproduce the live experience online; “Is that really the goal?” asked one person. And while there has been progress with Web 2.0 tools that include the interactivity and peer feedback that is vital to learning, CME providers have been slow to embrace the power of these platforms.

Is the lack of Web 2.0 adoption related to the science of learning (and e-learning), or is it just a matter of wanting to stick with the status quo? Exacerbating the issues, said one tweeter, was a disconnect between IT, Web, and education departments that often may not be on the same page. And, while the technology is there for the taking, not everyone wants to commit the time and costs of implementing it (more on this later).

Covering Daily and Archived Coverage

Daily conference coverage is a staple at many live CME conferences. Reporting what happens is necessary if you want to move the content and knowledge outside of the room, but does anyone really learn using this method?

One problem, one person tweeted, is that the learner is at the mercy of what the writer deemed to be important—this can be the biggest pitfall, another noted, since it limits the spectrum of coverage to the writer’s preferences (note from Sue: Hmm, consider the source when reading this writeup!). And does the writer’s status in that field affect the credibility of their coverage choices? The question is how to balance the simple reporting of the CME and the need for engaged learning and being able to put that learning into the context of a healthcare professional’s practice, something that will likely depend on the education needs of individual learners. One suggestion that was greeted with Twittery enthusiasm (several retweets) was that organizations could set up reporting plans that matched their abstract review and approval plans. This might be more efficient, but would it be more effective, questioned another tweeter.

However, aside from providing credit, how is this daily coverage any better than what gets reported in the evening news, queried a #CMEChatter. Actually, said another, the evening news may be more effective in reaching docs—think about the “physician as consumer,” and patients, who may benefit as soon as their next appointment. Another noted that the evening news and the daily coverage often are coming from the same sources set up by the medical societies.

Whatever the shortcomings of daily reporting, whether by news media or the conference organizers, another said, “some coverage is better than no coverage for those who can’t attend.”

Which brought the group to tweeting about the pros and cons of archiving and repurposing live lectures. If it’s archived in a timely and media-appropriate fashion, it can be a great way to reach more learners, said one #CMEChat participant. It’s also cost effective, extending your reach and giving you more bang for your buck, said another. Repurposed archived activities also can ensure the entire body of knowledge gets disseminated, not just what one writer deemed to be important.

A weakness, of course, is that you end up with the long, talking-head online lecture that the chatters said is a disadvantage of online CME. So you basically can’t win, said one tweeter: “Online coverage gets skewed by buzz and what is reported, repurposed video tells a broader story, but is indigestible?”

But what if Web 2.0 features were enabled for all repurposed content and faculty were encouraged to re-engage? “Nirvana” and “Valhalla” were mentioned in response. “If faculty could re-engage asynchronously using Web 2.0 tools, then all learners could reap the benefits of ‘live’ Q&A” for real interactivity,” said one. That would be the model of medical education in the near future, another tweeted. But they were quickly brought back to earth when another person pointed out that there remains the problem of getting the audience to engage. And then there’s the faculty: “Just one more thing for them to do. ‘I’m going to need a higher honorarium for that,” snarked a tweeter.

Clearing New Channels

Brian finished up by asking what the #CMEChatters would build if they could build their own channel for sharing new medical data.

It would reinforce learning by including e-mail and text notification options to alert learners to new comments, and include ratings, voting, and sharing as well as comments, they said. “I would love to see Web 2.0 be part of every online CME activity and I want Wi-Fi in every live session (plus powerstrips),” said one person. While that sounds great, another person questioned how much time participants would be willing to spend on the Web 2.0 piece, since he can barely get them to complete a short evaluation. The best way to get them involved is to have a colleague show how they’re successfully using social media, someone tweeted. Another said it was up to providers to show learners the benefits and create the top-of-mind desire to engage. Then there’s the stick approach: It also can be a required as a prerequisite to the learning, suggested another.

And, voicing the frustrations of the already overloaded, another person said, “Does the world need a new channel? Isn’t our attention scattered enough already?” While a few agreed with that sentiment, most seemed to want to find ways to overcome the barriers to making their vision become reality. While the costs of re-engineering a Web site might seem prohibitive to a small provider, the costs will go down if you “cut out 40 percent to 50 percent of the fluff” and concentrate efforts on just the things that will enhance learning. “The idea that this all costs more is untenable,” he added. “We are adding in efficiency and stripping away proprietary shiny silver objects.” Another person noted that the new learning management system platforms have Web 2.0 built in already.

Stay tuned for the next #CMEChat on Wednesday at 11 am ET. It really is all that and a piece of pie!

I spent way too much time over the weekend devouring this article: 47 Mind-Blowing Psychology-Proven Facts You Should Know About Yourself. Some—like the fact that we’re actually pretty lousy at multitasking—I knew. Then there’s things like the relationship between dopamine and Twitter that I had no idea about. It’s all fascinating, and it’s all germane to how people learn.

This article on how Internet use has affected our ability to remember things is pretty interesting, if not exactly surprising. Researchers have found that we tend to remember things we can’t look up on the Internet, and forget things we know we’ll be able to retrieve electronically. We’re also better at remembering where we store information—in this case, which folder we stashed a bit of info in on a hard drive—than we are the bit of info itself.

While it’s not a new idea, it does confirm what CME providers have been saying for a long time, that since healthcare providers can’t possibly remember everything they need to know, what they need to learn is where and how to find what they need to know when they need to know it. The biggest revelation seems to be that we’re using the Internet as “our primary external storage system,” but we all knew that already, didn’t we?

Blogs, Twitter, LinkedIn, Facebook, YouTube—it’s all too much to deal with on a personal level, much less try to figure out how to use all of today’s social media tools to enhance your CME program. You may even be wondering if you should be using them for CME at all. I’m kind of wondering too.

That’s why we tapped two of the CME community’s top experts in social media and CME, Dr. Joseph Kim and our own social media columnist, Brian McGowan, PhD, to clue us in on how docs are using all this social networking technology, and how and when you can use it to improve your activities. Register now for this free webinar on July 21 at 2 pm ET. Here are a few more details:

What Social Media Can Do for CME

How CME providers are using social media to expand and extend the learning experience for healthcare professionals—and for themselves.

Date: Thursday, July 21, 2: PM ET

You’ll learn to:

• Match various adult-learning formats with the appropriate social media technology

• Use social media to improve learning and measure educational outcomes

• Mitigate the potential risks and reap the rewards of using social media to communicate with and educate HCPs

• Find social media resources geared to CME providers, and use them to deepen your own educational experiences

Panelists

Brian S. McGowan, PhD, CCMEP, is an adult education specialist who focuses on medical education and evidence-based educational design. He has dedicated the past 12 years to medical education as a faculty member, mentor, accredited provider, and commercial supporter. In addition to being the social media columnist for Medical Meetings, McGowan is the chairman of the Emerging Technologies Committee for the Alliance for CME. He currently serves as director, Medical Education Group, Oncology, with Pfizer, Inc.

Joseph Kim, MD, MPH, is CEO of education company and publisher Medical Communications Media. Kim currently serves on the board of directors for the National Association of Medical Education Companies. In 2011, he received the Alliance for CME President’s Award because of his participation in the Alliance for CME Social Media Work Group. He has also served on the Alliance for CME Emerging Technologies Committee. Kim is also an active member of the mobile health (mHealth) and social media community and often speaks at national conferences.

We know that humans learn through stories, and that things learned through stories tend to stick. And when you can relate those stories to your everyday experiences, well, you can count on the knowledge to become part of your everyday repertoire.

Which is why I found this editorial on the practice of medicine and Grimm’s fairy tales to be such interesting reading. The archetypes he wrote about are still being played out in the corridors of our hospitals today, as the author points out. If they help healthcare professionals better understand their patients, why not include some classic stories in the way medicine is taught? Just a thought.