Facilitating a Culture of

Lifelong Learning and

Self-Improvement

A Focus on Learning and Change



Author: Dr. Craig Campbell
Date: May 3, 2012
I am a full-time Director with the Royal
College
I have no financial relationships with
members of pharmaceutical or medical
supply companies
I do not hold any research grants funded by
industry
I do not serve on any advisory board of any
for-profit industry
I have numerous biases about CPD and
Lifelong Learning
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Conflict of Interest Declaration
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Learning Objectives
At the end of this session you will be
able to:
1. Discuss the factors that influence or
enable culture change.
2. Explain some of the elements the Royal
College is pursuing to enable lifelong
learning and self-improvement among
specialists.


Cultural Shift in
the Continuing
Education of
Physicians
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Cultural Shifts are typically
characterized by
Change in Values
Change in Beliefs
Change in Behaviors
Cultural shift in CME is more
evolution than revolution!
An Anatomy of Cultural Shifts
Facilitating Cultural Shifts
Factor 1:
Cultural change requires an explicit
description of values & educational
principles.
Educational Values and Principles
Define the philosophy of CPD systems
Guide strategic decisions
Promote consistency and enable flexibility
Answers the Why Questions!!!

Continuing Professional Development
a focus on learning
1. Across each dimension of professional
practice and every CanMEDS Role.
2. Relevant to multiple practice contexts
3. Responsive to the practice needs of
the profession.
4. Focused on outcomes!


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A Description of Values
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A Description of Values
Individual
Physician
Practice
Context
Data with
Feedback
Education Support
Learning
Resources
Strategies & Tools
Role for Learners
1. Design and implement a personal
continuing professional development
plan.
2. Use learning activities to build
evidence-informed practices.
3. Identify and document the learning
activities and outcomes that enhanced
their practice.


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A Description of Values
Competencies Required for Practice
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Individual
Learning
Group/Team
Learning
New View of Life Long Learning
Guided By
Assessment
Informed By Data
Performance
Health Outcomes
Defining Educational Principles
Maintenance of Certification Program
1. Personal: learning must be relevant to ones
scope of practice.
2. Needs-based: learning addresses perceived and
unperceived needs.
3. Reflection: think critically about and learn from
practice experiences.
4. Continuous Improvement: learning that
demonstrates continuous improvement.


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Facilitating Cultural Shifts
Defining Educational Principles
5. Competency-based: learning that enhances the
competencies required for practice.
6. Choice: choose the activities to address
identified needs.
7. Inter-professional: learning within teams.
8. Evidence-informed: conclusions are based on
best evidence.
9. Systems-based: learning that enhances the
quality and safety of our health system.


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Facilitating Cultural Shifts
Facilitating Cultural Shifts
Factor 2:
Cultural shifts are facilitated by
establishing a clear set of goals or
outcomes.
Educational Goals or Outcomes
Defines what success looks like
How success will be measured?
Answers the What Questions!


Explicit Expression of Goals
MOC Program: A CPD System that
1. Enhances the learning (process and
skills) of the profession
2. Advances the care of the public
Our Tag Line
Enhancing Learning, Advancing Care
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Facilitating Cultural Shifts
Facilitating Cultural Shifts
Factor 3:
Cultural shifts must be founded on or
based on evidence.
Scientific evidence for the impact of
learning on
Behavior change,
Performance improvement
Health outcomes.
Evidence About What Works!
Importance of Evidence
Growing Expectations for
Engaging in Effective CME:
Medicine is a knowledge and technology
intensive profession
Scientific evidence that informs our
practices is doubling every 6-8 years!
Expectations practices reflect evidence-
informed care



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Persistent Gap in Performance
Consistent evidence of failure to
translate research findings into clinical
practice
30-40% patients do not get
treatments of proven effectiveness.

2025% patients get care that is not
needed or potentially harmful.

Grol R (2001). Med Care
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Persistent Gaps
in Quality of Care
Adherence to recommended health care
indicators provided to adults (in the
USA)
Content Areas
Preventative care 54.9%
Acute care 53.5%
Chronic care 56.1%
McGlynn A (2003). NEJM
Persistent Gaps
in Patient Safety
Quality of care concerns in hospitals
Adverse events occur in 2.5 16.6%
of all hospital admissions
At the Ottawa Hospital adverse event
rate was 12.7% with 38% deemed
preventable*
o 61% of the events occurred prior to
hospital
Forster et al CMAJ April 13, 2004
Traditional View of CME
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less about learning
from patients in clinics
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or in acute care contexts
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or during team interactions
or from assessing
team performance here
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Impact of Group Learning on
Performance / Health Outcomes
Continuing Medical
Education
Marinopoulos, Dorman T, Ratanawongsa N
Effectiveness of Continuing
Medical Education
Agency for Healthcare Research & Quality
Evidence Report / Technology Assessment.
Published 2007
Funding: American College of Chest
Physicians
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Continuing Medical Education
Forsetlund, Bjorndal, Rashidian
Continuing Education Meetings and
Workshops: Effects on Professional Practice
and Health Care Outcomes.
Cochrane Systematic Review
First published 2001 221 references
Update 2009 + 81 trials
More than 11,000 health professionals

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Accuracy of Self-Assessment
Davis DA, Mazmanian PE, Fordis M, Van
HR, Thorpe KE, Perrier L.
Accuracy of physician self-assessment
compared with observed measures of
competence: a systematic review.
JAMA 2006: 296:1094-1102.
Research Question. To determine how
accurately physicians self-assess compared
with external observations of their
competence.
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Audit and Feedback
Jamtvedt G, Young JM, Kristoffersen
DT, O'Brien MA, Oxman AD.
Audit and feedback: effects on
professional practice and health care
outcomes.
Cochrane Database of Systematic Reviews
First publication 2003: 88 trials
Update in 2006: 118 trials (30 new trials)
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Some Conclusions
CPD Research Literature on
Performance
Mean impact of most interventions is
typically between 5-10%
Several important lessons and findings
1. Importance of measuring baseline
performance (needs assessment)
2. Need to identify measureable outcomes

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Some Conclusions
CPD Research Literature
on Performance
Effectiveness of educational interventions
1. Multiple more than single
2. Sequenced
3. Repetitive
4. Frequent measurements over time.

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New MOC Framework
Section 1
Group Learning
Section 2
Self-Learning
Section 3
Assessment
Accredited
Group
Learning
Planned
Learning
Knowledge
Assessment
Unaccredited
Group
Learning
Scanning
Activities
Performance
Assessment
Systems
Learning
CPD Strategies within
the MOC Program
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Group
Learning
Self-Learning
Assessment
Intentional Integration of.
Facilitating Cultural Shifts
Factor 4:
Cultural shifts are enabled by technology
that informs and supports:
System development and innovations
Learning and documentation strategies
Data integration and management

Learning Management
Strategy before System
Facilitating Cultural Shifts
Role of Technology
Transformational in enabling us to .
1. Create a learning management system,
2. Link CPD resources to practice needs
3. Support the development of communities
of practice
4. Integrate and leverage practice data
Facilitating Cultural Shifts
Role of Technology
1. From e-Learning to m-learning
2. Inform learning by data on.
Performance of individuals or teams
Health outcomes of patients
Health status of communities
3. Virtual simulation
4. Communities or Networks of Practice
Facilitating Cultural Shifts
Factor 5
Cultural shifts are enabled by effective
strategic partnerships.
Change is a process that requires time
and multiple levels of support
Continuous involvement of
stakeholders!

Must have organizational
commitment and support!
Facilitating Cultural Shifts
Factor 6:
Cultural shifts are enabled by effective
educational support strategies.
For the Royal College this meant
Creating a regional educational support
program
Recruiting and enabling a cohort of CPD
educators who practice in each province!

Education about CPD, the MOC system,
and the competencies of learning
Facilitating Cultural Shifts
Factor 7:
Cultural shifts are enabled by the
development and implementation of
rigorous program evaluation
Provides evidence against the goals
Ensures regular feedback
Promotes organizational commitment
to change
Fosters a Culture of
Continuous Improvement
My Reflections
Factor 8:
Cultural shifts require a leadership team
that is credible, committed, consistent,
and consultative.
Change will be resisted and challenged
Not every decision will be right
Expect unintended consequences!
Transformations take time
One cant get discouraged!!
Our Collective Imperative.
Cultural Shift in the Continuing
Education of Physicians
Remains incomplete due to:
1. Limited strategies and tools to facilitate
the planning and documentation of
learning activities and outcomes.
2. Accessibility of formative assessment
options to identify gaps in knowledge,
competence and performance.
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Looking Forward to Your
Comments and Questions