The Path to Reinvigorating Lifelong Clinical Education

Contemporary forces, including resource constraints related to physician employment models, documentation and administrative tasks, limit participation in traditional live, in-person destination medical educational programs. Added to these challenges is the incredible rate at which the volume of medical knowledge is increasing. In 1950, it was estimated that medical knowledge doubled every 50 years; in 2020, the “doubling interval” is estimated to be down to a mere 73 days. To place this in another context, what a 2020 medical school graduate learned in her first 3 years of medical school will constitute only 6% of what is known at the end of the decade spanning 2010-2020!1

Simultaneously, the availability of high-quality, learner-directed, interactive virtual education (which goes beyond recorded and digitized teacher-centric live courses) and ubiquitous access via smartphones and tablets together have changed the landscape in the delivery and consumption of continuing education/lifelong learning for clinicians.

In recognition of this changing landscape, a team of faculty from the Mayo Clinic partnered with adult learning professionals at Knowledge to Practice (K2P) to collaborate on the evolution of their core cardiovascular curriculum to a contemporary approach incorporating live, online, and enduring materials. Recently, the team from Mayo and K2P reported on the results of the evolution from a traditional didactic face-to-face event to a hybrid model leveraging the K2P digital learning platform.2

In brief, the team found:

• A 3-fold increase in the overall reach of the curriculum, despite a stagnation in the growth of the traditional live course
• A greater “learning lift” with a smaller time investment with course material for those learners who interacted with the course’s digital content

There are important takeaways that we clinicians- as both consumers of knowledge, and as faculty engaged in delivering education-can learn from the Mayo/K2P experience. We can organize those takeaways in the context of three discussion questions:

1. What unique features about the faculty, platform, and actual curriculum design contributed to the outcomes?
   • Technology allowed pre-course self-engagement beginning with self-assessment, and importantly, ongoing engagement with course materials post-course. Additionally, the platform allows content and assessments to be perpetually refreshed based on learner feedback and performance
   • Content delivery is learner-centric, that is, based on what the individual learner needs. Learning methodology leverages adult learning theory to ensure streamlined, efficient assimilation, retention (currently tracking up to 6-months), and recall. Traditional CME programs, by contrast, have been pedagogical in design, led by faculty whose content is based on their respective areas of interest and expertise (thus, faculty-centric), not necessarily tied to learner needs, and often with redundancies as well as gaps in said content. The inclusion of objective self-assessments (well-known to be discordant with a learner’s perceived knowledge level) as a prelude to consuming materials allows the learner to approach the content with the goal of filling his individual knowledge and skill gaps.
   • Faculty was highly engaged and led by visionary, inspired course directors who champion the andragogical model.
2. How might these results apply to our evolving value-based care model?
   • The allocation of educational stipends for attendance at traditional didactic destination programs- which by design are not tailored to address individual learning gaps-seem incongruent in the context of our new models of care. The explosion of medical knowledge and the ubiquitous emphasis on metrics squarely places the emphasis on the “need-to-knows” over the “nice to knows” for each clinical team member.
   • Health systems accountable for safe, timely, effective, efficient, equitable patient-centered care will be incentivized to provide resources for each team member to fully experience learner-directed, interactive learning coupled with ongoing access to continually refreshed content informed by analytics.
3. Moving forward, how can we translate this “learning lift” associated with the contemporary educational model into real clinical outcomes?
   • The “bump” in clinician knowledge level pre- and post-course associated with this educational initiative is certainly not unique. What is encouraging is the demonstration of value associated with the investment of learner time in engagement with the course materials, showing the model to be time and resource-efficient. Learners who engaged in digital access to the course demonstrated a 3-fold knowledge increase with 50% less time dedicated.
   • Meaningful clinical outcomes associated with continuing medical education programs must go well beyond changes in pre and post-course knowledge assessment metrics. In our “show me the data” era, costly quality improvement (QI) efforts by health systems are requisite in the evolution of value-based care models. Shojania and colleagues3 break down healthcare QI strategies into broad areas including clinician education, audit and feedback (provider “report cards”), provider reminders at the point of care, patient education and self-management, and system-level process changes. Comprehensive QI initiatives are not typically based on a single approach; the successful ones use a multi-pronged approach incorporating a combination of these strategies. While efforts designed to improve clinician knowledge and skills alone are unlikely to change patient outcomes, clinician education-ideally built on an interdisciplinary curriculum- to address knowledge gaps are a requisite first step. If team-based, learner-centric education (with ongoing access to tools and content) can be provided as a component of a system-wide initiative, meaningful clinical outcomes may become a reality.

References

1. Densen P. Challenges and opportunities facing medical education. Trans Am Clin Climatol Assoc. 2011;122:48-58.

Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116346/

Accessed January 10, 2020.

1. Cullen et al Reinvigorating Continuing Medical Education: Meeting the Challenges of the Digital Age. Mayo Clinic Proc, 2019;94(12):2501-2509.

Available at: https://www.mayoclinicproceedings.org/article/S0025-6196(19)30579-8/pdf/

Accessed January 10, 2020.

1. Shojania KG, Grimshaw JM. Evidence-based quality improvement: the state of the science . Health Affairs. 24, no.1 (2005):138-150.

Available at: https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.24.1.138

Accessed January 10, 2020.