University of Toronto Faculty of Medicine

Office of Continuing Education and Professional Development

From Knowledge to Action:

Bridging the Quality Gap

June 2006

Strategic Plan 2006 - 2011

Executive Summary.................................................................................................................................. 1 1 - Introduction........................................................................................................................................... 6 2 - Strategic Planning Process........................................................................................................... 6 3 - Key Factors in Strategic Planning Process .......................................................................... 7

3.1 Developments in The Office of Continuing Education 2000-2005............ 7 3.2 University of Toronto Faculty of Medicine Priorities ............................................ 9 3.3 Developments in Medical Education and the Health Care System....... 10 4 - Strategic Directions for Continuing Education and Professional Development 2006-2011 ......................................................................... 13

4.1 Vision, Mission, and Values .............................................................................................. 13 4.2 Continuing Education and Professional Development Strategic Directions.............................................................................. 14 4.3 Implementation of Strategic Directions................................................................... 21 5 - Conclusion ............................................................................................................................................ 22 Appendix I: .................................................................................................................................................... 23 Continuing Education and Professional Development Strategic Planning Committee Members Appendix II:................................................................................................................................................... 24 Continuing Education and Professional Development February 2, 2006 Strategic Planning Retreat Participants Appendix III: ................................................................................................................................................ 26 Glossary of Terms Figures, Boxes and Tables: Figure 1 .......... A Systems Approach to Continuing Education Figure 2 .......... Six Strategic Directions Box 1 ................ CEPD Vision, Mission, and Values Table 1............ Strategic Direction One Table 2............ Strategic Direction Two Table 3............ Strategic Direction Three Table 4............ Strategic Direction Four Table 5............ Strategic Direction Five Table 6............ Strategic Direction Six Table 7............ Strategic Direction Leaders and Year One Priorities

Table of Contents

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Introduction The Office of Continuing Education and Professional Development (CEPD)1, Faculty of Medicine, University of Toronto has continuously expanded in both the amount of educational programs provided as well as its scope of scholarship activity. The Office of CEPD is one of the largest academic health sciences continuing education program providers in the world, and the largest single provider of accredited courses and conferences among Canadian universities. Furthermore, faculty have become increasingly involved in research in continuing education, ranging from a commitment to incorporating evidence and educational theory into planning, implementation, and evaluation of education programs, to the procurement of grants to contribute to strengthening the evidence base of continuing education.

In September 2005, the newly appointed Vice Dean, Dr. Ivan Silver, launched a strategic planning process to establish the directions and goals for CEPD for the next five years. The Strategic Planning Committee (Appendix I) met bimonthly from September 2005 to June 2006. Throughout this time, they consulted with the Continuing Education (CE) Directors and Leaders Committee and CE Council. They also planned a full day retreat in February 2006 with approximately 60 educators, researchers, health professionals, consumers and representatives from colleges and licensing bodies (Appendix II) to gather their input regarding preliminary strategic directions and goals. The Strategic Planning Committee approved the final CEPD Strategic Plan in June 2006. Key Factors in Strategic Planning Process The strategic planning process involved extensive discussion and consultation about CE related activities and achievements to date, key opportunities related to University of Toronto priorities, and developments in medical education and the health care system, and their implications for the future of CEPD. These key issues include:

(1) Achievements in the four “pillars” outlined in the Office of CE 2000-2005 strategic plan: continuing health professional education, public education, knowledge translation, and faculty development.

(2) Faculty of Medicine Priorities to: advance the scientific and professional training

platform, enhance collaborations across the Toronto Academic Health Sciences Network, better integrate community-based teaching and practice sites into education and research enterprises, enhance information technology and communication capability, and develop benchmarking and performance measurement capabilities.

(3) Developments in theory and practice of health professional learning, changes in skills and

knowledge health professionals are expected to possess, the need for research and scholarship in CEPD, quality of care gaps, and consumerism and social accountability. Certain challenges identified included tensions between evidence based and best practice in CE, local vs. global focus, public education and outreach vs. health professional CE, and interprofessional, team based education vs. individual, discipline specific education.

1 The name of the Office was formally changed during this process from the Office of Continuing Education to the Office of Continuing Education and Professional Development.

Executive Summary

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Strategic Directions for Continuing Education and Professional Development: 2006-2011 The extensive consultation and discussion undertaken by the Strategic Planning Committee resulted in changes to the name, vision, mission, and values, to better reflect newly identified priorities and objectives. The name “Office of Continuing Education, Faculty of Medicine” was changed to “Office of Continuing Education and Professional Development”, and the vision, mission, and values are outlined below.

Vision Global leadership in continuing education and professional development. Mission Improving health through innovative continuing education and related research for health professionals and the public. Values As leaders who are committed to exceptional results, we embrace the following core values:

• Life long learning • Critical inquiry and scholarship • Inter-professionalism • Integrity, innovation and excellence • Accountability to our patients, learners and communities • Diversity in culture and perspectives • Social Accountability

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The strategic planning process resulted in the development of six strategic directions, and corresponding goals and initiatives, as outlined below. There is significant overlap, and thus there will be extensive collaborations and interactions both within and across strategic directions.

STRATEGIC DIRECTIONS GOALS 1 Promote best practices in continuing education and professional development

1.1 Promote best practices in continuing education and

professional development related to educational practice

1.2 Advance practice-based continuing education

1.3 Support and promote best educational practices in the use of technology in order to deliver the curriculum

1.4 Promote best practice for the use of quality assurance data and activities to guide continuing education initiatives

2 Foster scholarship and research in continuing education

2.1 Create a framework for scholarly activity in continuing

education

2.2 Establish a continuing education research infrastructure to pursue scholarship

2.3 Develop quality indicators or benchmarks for continuing education standards

3 Evolve the curriculum in continuing education

3.1 Broaden the learning objectives of continuing education

activities

3.2 Provide a repository of curriculum materials for continuing education providers

4 Broaden the scope and inclusiveness of continuing education

4.1 Identify and support collaborative relationships in continuing

education planning, delivery and scholarship

4.2 Enhance our capacity to develop, deliver and evaluate continuing education globally

5 Enhance faculty development in continuing education and professional development

5.1 Improve knowledge and skill level of continuing education

providers through faculty development

5.2 Increase educational opportunities for continuing education scholarship

6 Reinforce our infrastructure and funding base

6.1 Establish alternate streams of revenue

6.2 Enhance the profile and CEPD brand

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Implementation of Strategic Directions

Each of the six strategic directions has designated faculty leaders who are responsible for assessment, planning, implementation, and evaluation. The Academic Advisory Committee, consisting of the strategic direction leaders and members of the strategic planning committee, and chaired by the Vice Dean, Continuing Education, will guide the overall implementation of the CEPD strategic plan. The year one priority initiatives identified during the strategic planning process, will guide initial implementation efforts. STRATEGIC DIRECTIONS YEAR 1 PRIORITY INITIATIVES

1 Promote Best Practices in Continuing Education and Professional Development

Lead: Cathy Evans

• Advance e-learning CE opportunities and strategies,

targeting information retrieval skills.

2 Foster Scholarship and Research in Continuing Education Lead: Mary Bell

• Create a framework for scholarly activity in CE • Compile an inventory of CE research at U of T • Develop capabilities in measurement and evaluation

of the impact of CE interventions • Hire a researcher in CE • Review criteria for Research and Development awards

3 Evolve the Curriculum in Continuing Education Lead: TBD Ivan Silver

• Establish a mechanism to develop a needs-based curriculum.

• Create a working document that defines approaches to Inter-professional Education and collaborative practice

4 Broaden scope and inclusiveness of Continuing Education Lead: Lee Manchul Linda Sugar

• Form a consortium of partners to address unmet needs in the community, tackling at least one urgent health care need through a collaborative CE intervention, including community affiliated hospitals.

5 Enhance Faculty Development in CEPD Lead: Suzan Schneeweiss Debbie Hebert

• Collaborate with the leads of the four CE Goals to provide customized faculty development that supports new initiatives

6 Reinforce our infrastructure and funding base Lead: Ivan Silver Susan Rock

• Explore and put in place alternative revenue generating programs to support CE strategic agenda

• Develop communications and marketing strategy

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Conclusion Given its role in health professional education, education research, and public education, CEPD is in a unique position to strengthen the interaction between health care practices, research, education, and policy through collaborations with a range of partners, including the continuum of medical education providers, health researchers, health professionals, technology experts, the public, government stakeholders, and college and licensing bodies. These partners are located in the University of Toronto and affiliated hospitals, community hospitals, the Greater Toronto Area, and also across the province of Ontario, Canada, and the world. The six strategic directions created through the strategic planning process and described in this report will provide a clear framework for the activities and priorities of CEPD for the next five years. As outlined in these strategic directions, CEPD is committed to the promotion of best practices in CEPD, fostering scholarship and research in continuing education, evolving the curriculum in continuing education, and broadening the scope and inclusiveness of continuing education. These four strategic directions will be fostered through the remaining two strategic directions, enhancing faculty development in CEPD and reinforcing our infrastructure and funding base. The strategic plan 2006-2011 will provide a framework for CEPD at the University of Toronto to achieve its mission of being a leader in improving health through innovative continuing education and related research for health professionals and the public.

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The University of Toronto, Faculty of Medicine, Continuing Education Office is a CE Office that should serve as a model for a “best practices” CE Unit. Its excellence in faculty leadership, education and research rival that of any other unit in North America. The Office has been able to blend high quality programming and research in a seamless way. It embraces both diversity in activity and disciplines.

Accreditation Report, 2002

The Office of Continuing Education and Professional Development (CEPD)2, Faculty of Medicine, University of Toronto has continuously expanded in both the amount of educational programs provided as well as its scope of scholarship activity. The Office of CEPD is one of the largest academic health sciences continuing education program providers in the world, and the largest single provider of accredited courses and conferences among Canadian universities. Furthermore, faculty have become increasingly involved in research in continuing education, ranging from a commitment to incorporating evidence and educational theory into planning, implementation, and evaluation of education programs, to the procurement of grants to contribute to strengthening the evidence base of continuing education. In September 2005, the newly appointed Vice Dean, Dr. Ivan Silver, launched a strategic planning process to establish the directions and goals for CEPD for the next five years. This document outlines the strategic planning process and participants, reviews the critical background and issues that shaped the plan, and then presents the resulting new vision and mission and the six key strategic directions.

The strategic planning process involved participation and input from a large number of continuing education (CE) leaders and stakeholders. In September 2005, a Strategic Planning Committee was established (Appendix I) whose mandate was to develop a strategic plan that would set out the directions, goals and actions for CEPD for the next five years. This Committee contained representatives from The CE Directors and Leaders Committee and the CE Council. The former committee consists of CE representatives from all departments in the Faculty of Medicine as well as other key CE leaders, and the CE Council consists of faculty, student, and community members representative of recent CE strategic initiatives. The Strategic Planning Committee met bimonthly from September 2005 to June 2006. Throughout this time, they consulted with the CE Directors and Leaders Committee and CE Council. They also planned a full day retreat in February 2006 with approximately 60 educators, researchers, health professionals, consumers and representatives from colleges and licensing bodies (Appendix II) to gather their input regarding preliminary strategic directions and goals. The feedback from the committees and retreat participants was used to develop and finalize the strategic plan. The Strategic Planning Committee approved the final CEPD Strategic Plan in June 2006. 2 The name of the Office was formally changed during this process from the Office of Continuing Education to the Office of Continuing Education and Professional Development.

1 Introduction

2 Strategic Planning Process

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The strategic planning process involved extensive discussion about developments in The Office of Continuing Education during the past five years, The University of Toronto Faculty of Medicine priorities, and the field of continuing education and the broader health care system, and their implications for the future of CEPD. The following section reports on these key factors that shaped the final strategic plan. 3.1 Developments in The Office of Continuing

Education 2000-2005 There have been tremendous developments in CEPD during the past five years, which reflect the following four “pillars” outlined in the 2000-2005 Strategic Plan:

• Continuing health professional education • Public education • Knowledge Translation • Faculty development

These pillars crossed the traditional boundaries of CE by broadening its target group to a wide range of health professionals, explicitly engaging with the public, creating an interdisciplinary health services research program, and focusing on the professional development of faculty. Each of these pillars has been successfully developed over the past five years, and an assessment of each illuminates existing resources, strengths and challenges, and how the new strategic plan could effectively build upon these efforts.

Continuing Health Professional Education The Office of CEPD is responsible for the accreditation and management of, and provides consultation services for, an extensive range of local, national, and international continuing health professional education programs. The number of courses and participants has continued to rise over the past ten years, and the audience has become increasingly multiprofessional. Among these offerings is the “Saturday at the University” program that is celebrating its 20th anniversary. A number of awards have been established to recognize faculty excellence in teaching and program development.

Public Education The Office of CEPD offered its first Mini-Med School in fall of 2002 prompted by requests for public education events and by the example of several American “mini med schools”. This program consists of a series of six lectures provided by University of Toronto faculty. The medical topics are geared to a public audience, and participants also benefit from exhibits and question and answer periods. Approximately one thousand people attended the mini-med school in the first year, and the program continues to be offered twice yearly and be well attended3. This movement towards public education is becoming more apparent in various Faculty of Medicine continuing education programs as the value of engaging the public in these ways is increasingly recognized.

3 Faculty of Medicine Academic Plan 2004-2010, June 2004, p. 78

3 Key Factors in Strategic Planning Process

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Knowledge Translation The Knowledge Translation Program (KTP) is a research initiative established in 2000 with funding from the Provost’s Academic Priority Fund. The goal of KTP is to systematically examine the processes through which knowledge is effectively translated into action in order to address the gaps between evidence and practice. KTP has recently become the “Centre for Knowledge Translation” within the University of Toronto, and has partnered and relocated to St. Michael’s Hospital, a fully affiliated teaching hospital of The University of Toronto; it will play a central role in the newly established St. Michael’s Hospital Li Ka Shing Knowledge Institute.

Faculty Development Faculty Development was a core responsibility of The Office of CEPD up until the year 2002, when St. Michael’s Hospital and The Faculty of Medicine partnered in a pioneering collaboration to create the Centre for Faculty Development, Faculty of Medicine, University of Toronto at St. Michael’s Hospital. Five key themes have guided the Centre’s programmatic efforts: instructional development, career development/ mentoring, interprofessionalism, professionalism and health professional education leadership. The Centre for Faculty Development provides workshops, rounds, speakers’ bureau, certificate courses, and the education scholars program, and promotes scholarship in faculty development.

Implications of “Four Pillars” for Strategic Planning Process Continuing health professional education and public education are clearly key and successful components of CEPD that should be further developed and enhanced in the 2006-2011 strategic plan. The success of both the Knowledge Translation and Faculty Development Programs, which have resulted in each program moving outside the domain of CEPD and being designated as independent centres within the Faculty of Medicine, have various implications for the current CEPD strategic plan. Faculty development and knowledge translation are closely connected with continuing education, and thus a strong link between CEPD and these two centres has been maintained; the strategic plan will have to identify strategies to further strengthen these vital relationships. In addition, CEPD needs to re-examine its scholarly role and research priorities, since to date they have been largely focused on knowledge translation. These internal changes, as well as a number of important external drivers which are discussed below, have challenged CEPD as it examines its priorities and strategic directions for the next five years.

“We are sitting in a knowledge factory at U of T. Our challenge is, in collaboration with others, to be able to distribute and translate this knowledge into clinical practice”.

Ivan Silver

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“We can no longer say that the University is only interested in education and research, how can we do that without fully considering the importance and relevance of our connection to the clinical world which we serve?”

Catharine Whiteside, Dean

Faculty of Medicine, CE Planning Retreat

3.2 University of Toronto Faculty of Medicine Priorities As an academic unit of the Faculty of Medicine, University of Toronto, the priorities of the Faculty, and its vision of “international leadership in health research and education” are critical influences on the future directions of CEPD. At the February 2006 Strategic Planning Retreat, Dean Catharine Whiteside discussed the following five objectives of the Faculty of Medicine and their relevance to continuing education:

1. Advance our scientific and professional training platform for the 21st century

2. Create collaborative platforms across the Toronto Academic Health Science Network (TAHSN)

3. Better integrate the community affiliated teaching hospitals and other community -based teaching and practice sites into the education and research enterprise

4. Enhance information technology and communications capability of the Faculty

5. Develop benchmarking and performance measurement capability across the Faculty

Within the framework of these objectives, Dean Whiteside identified the following particular strategies and networks, by which CEPD can work to enhance and progress education scholarship at local, national, and international levels:

• Curriculum innovation (e.g. molecular medicine, inter-professional education, simulation)

• Investment in leadership (e.g. career promotion, faculty development for community hospitals, bridging the quality care gap)

• Informatics- Health & Education (e.g. TAHSN, patient portals, graduate program in health informatics)

• Health education continuum (Council of Education Deans, IPE, national and international links)

• Affiliated hospital partnerships (e.g. knowledge translation, simulation)

• Leadership in international health (e.g. public health, health professions training in developing countries)

As noted by Dean Whiteside, CEPD is in a unique position to integrate research, education and clinical care, and to forge collaborative ventures within the University of Toronto medical education continuum and research networks, and with community hospitals, Toronto’s multicultural community, and health professionals in developing countries.

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3.3 Developments in Medical Education and the Health Care System CEPD is operating in a complex health care system, containing diverse stakeholders with multiple interests and priorities, as illustrated in Figure 1. Figure 1: A Systems Approach to Continuing Education

The goal of the strategic planning process (strategic planning committee meetings, consultation with CE committees, and strategic planning retreat) was to examine these multiple factors and to elicit input from the many stakeholders. The extensive consultation that occurred, in particular the retreat, resulted in the identification of key issues in continuing education and health care that were viewed as critical factors for CEPD to consider as it identifies its future directions. During these discussions, certain tensions and challenges related to defining priorities and allocation of resources also arose. The following section outlines these key issues and tensions. Key Issues in Continuing Education and Health Care

1. Health Professional Learning – There is a need to develop and implement education

programs that meet the varied needs and contexts of health professionals in order to optimize their learning opportunities and outcomes. This is a learner-centred approach that values practice-based, just-in-time learning. This approach draws upon evidence-based continuing education principles and also the many technological developments that have changed the ways that learning occurs and information is accessed.

2. Expanding the Professional Development Curriculum – The knowledge and skills health

professionals are expected to possess have significantly moved beyond the traditional core

Scientific Discoveries

Social Resources

Industry

Health Care System

Education System

Health professional licensing and certification Implementation

put into practice in local context (practice-based CE, quality assurance)

Education Experts present new information (formal CE)

Information Knowledge resources (eg. journals, internet)

Health Care Accreditation Bodies

CE Provider Accreditation Bodies

Information Provider Accreditation Bodies

Health

Professionals • Awareness of

new knowledge • Learning new

knowledge skills and attitudes

• Actual clinical

performance

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of clinical content. For example, CanMEDs outlines a series of competencies (communicator, collaborator, health advocate, manager, scholar and professionalism) that physicians must possess; furthermore, there is increasing emphasis on the need for health professionals to have the skills needed to practice in interprofessional collaborative models of care. Thus, CEPD is uniquely situated to provide education opportunities that will enable health professionals to develop and/or strengthen these skills and competencies, through, for example, interprofessional and team education.

3. Revalidation and Maintenance of Practice Standards – The regulatory colleges are raising

their standards for maintaining practice eligibility, which has contributed to an increasing demand for continuing education to meet these enhanced standards. There are opportunities to link continuing education programs with professional competency requirements; this might involve the development of tools to assist health professionals identify their learning gaps and access relevant and effective learning resources.

4. Research and Scholarship – Education research findings should be integrated into all

levels of education planning, implementation, and evaluation, and, in turn, it is necessary for CEPD to contribute to the ongoing development of this evidence base in education research. This requires education planners and leaders to be knowledgeable about the existing evidence, and to have the skills, resources, and opportunities to participate in the development of best practices in continuing education. Examples of areas of research requiring further investigation include practice based CE, continuous quality improvement, and methods of effective health professional and health team learning.

5. Quality of Care and Knowledge Management – We know that significant gaps in care

exist, and “CEPD can play a major role in using continuing education to bridge the gap in quality of care”4. The University of Toronto is a knowledge incubator/centre. In collaboration with others, there is the opportunity for CEPD to play a meaningful role in the cycle of knowledge creation, distribution, and translation. Given the extensive education programs that are managed or accredited through CEPD, there are tremendous opportunities to evaluate the impact of these programs and to integrate them into broader quality improvement initiatives, for example, in conjunction with audit and feedback activities.

6. Consumerism – Patients and the public want credible health information, reflecting a

growth in personal accountability and responsibility for one’s health, and technological advancements that have enabled the availability of extensive amounts of information. As health professionals and continuing education providers, CEPD has a responsibility to incorporate a consumer perspective into its activities and to find effective strategies to enable consumer-provider dialogue.

7. Social Accountability - An important global trend is the incorporation of social

accountability into medical schools’ agendas. The World Health Organization defines this as the “obligation (of medical schools) to direct their education, research and service activities towards addressing the priority health concerns of the community, region, and or nation they have a mandate to serve. The priority health concerns are to be identified jointly by governments, health care organizations, health professionals and the public." CEPD needs to ensure that education programs and related research activities are addressing the needs of the populations they are serving.

4 Dr. Wendy Levinson, Stakeholder Panel, CEPD Strategic Planning Retreat, February 2, 2006

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Tensions and Challenges in Setting Priorities and Principles:

1. Evidence based vs. best practice in CE Some participants felt that adherence to an evidence-based model is too restrictive and there is a need to recognize the value of expertise and the realities of the context in which education is being provided.

2. Local vs. global focus

Some participants noted that it is necessary to prioritize existing resources, and questioned to what degree does CEPD focus on continuing education in the Greater Toronto Area multicultural communities, and teaching and community affiliated hospitals vs. underserved communities in Canada and internationally.

3. Public education and outreach vs. health professional continuing education

The question arose regarding the objective of public education, and to what degree is CEPD responsible for this education, given the existence of finite resources, and the original target audience of health professionals.

4. Interprofessional, team based education vs. individual, discipline-specific

education Some participants raised the question of how to balance the movement towards interprofessional team based education with the continued need for traditional discipline-specific education.

The challenge for CEPD is to address local, national, and international developments in medical education and the broader health care and delivery context, to explicitly address the existing tensions and challenges, and to thus play a leadership role in moving the field of CEPD forward in this environment.

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The extensive consultation and discussion undertaken by the Strategic Planning Committee resulted in the development of a new name, vision, mission, and values, as well as the creation of six strategic directions with corresponding goals and initiatives.

4.1 Vision, Mission and Values During the strategic planning process, the need to change the name, vision, and mission to better reflect newly identified priorities and objectives became quickly apparent5; these changes are reported in Box 1. The name “Office of Continuing Education, Faculty of Medicine” was changed to “Office of Continuing Education and Professional Development”, and the new vision represents CEPD’s expanding leadership role and global reach. The new mission reinforces a commitment to innovation, clarifies the broader target audience of health professionals and the public, and confirms the core business of continuing education programs and related research. The set of core values are closely aligned with the values of the Faculty of Medicine, and represent the guiding principles for CEPD. Box 1: CEPD Vision, Mission, and Values

5 The former name was the Office of Continuing Education, Faculty of Medicine, University of Toronto

4 Strategic Directions for Continuing Education and Professional Development: 2006-2011

Vision Global leadership in continuing education and professional development. Mission Improving health through innovative continuing education and related research for health professionals and the public. Values As leaders who are committed to exceptional results, we embrace the following core values:

• Life long learning • Critical inquiry and scholarship • Inter-professionalism • Integrity, innovation and excellence • Accountability to our patients, learners and communities • Diversity in culture and perspectives • Social Accountability

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4.2 Continuing Education and Professional Development Strategic Directions

The strategic planning process resulted in the development of six strategic directions, as outlined in Figure 2. Each of these strategic directions, and the corresponding goals and initiatives, are outlined in the following pages. There is clearly considerable overlap among these directions, and thus there will be extensive collaborations and interactions both within and across strategic directions. Figure 2: Six Strategic Directions

Office of Continuing Education & Professional Development

Mission, Vision and Values

Strategic Directions

1

Promote best practices in continuing education and professional development

2

Foster scholarship and research in continuing education

3

Evolve the curriculum in continuing education

4

Broaden the scope and inclusiveness of continuing education

5

Enhance faculty development in continuing education and professional development 6

Reinforce our infrastrcture and funding base

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Strategic Direction 1: Promote Best Practices in Continuing Education and Professional Development A core, broad goal of CEPD is to promote best practices6 in continuing education and professional development (Table 1). As outlined in the table, core elements of this strategy are to promote the application of educational principles, theory, and research into the planning, implementation, and evaluation of education programs. A particular emphasis will be on advancing practice-based continuing education, and developing technological capacities to address learning needs of health professionals and the public situated in various geographical locations. This strategic goal also includes linking CE programs with quality assurance initiatives in order to demonstrate effectiveness, and potential areas for improvement. Table 1: Strategic Direction One

GOALS INITIATIVES 1 Promote best practices in Continuing Education and Professional Development related to educational practice

• Promote needs-assessment and rigorous program evaluation • Apply practice- based outcomes in CE delivery • Promote the application of educational theory and research to CE practice where applicable • Ensure educational activities are appropriate to learning needs and objectives.

2 Advance Practice-Based Continuing Education7

• Provide tools for learners to self evaluate, self direct and to translate knowledge into practice • Enhance opportunities and capabilities for learning-in-practice and just-in-time learning • Enhance the information retrieval skills of practitioners • Promote practice-based small group self-directed learning • Promote communities of practice

3 Support and promote best educational practices in the use of technology in order to deliver the curriculum

• Enhance and raise awareness of opportunities for live/face to face interactions, while promoting e-learning strategies. • Integrate live and e-learning modalities contingent on teaching strategies to improve access and enhance learning. • Engage in distributed learning with geographically inaccessible learners (rely on technology for inaccessible learners, e.g. CD ROMs, videoconferencing) • Create repositories of information on- line • Engage in patient-mediated education through the public media and interactive websites • Engage the community through public education as a connection between the University and the community and as a means of needs assessment and accountability.

4 Promote best practice for the use of Quality Assurance Data and activities to guide Continuing Education initiatives

• Initiate discussions and partnerships with appropriate stakeholders. • Plan the use of more practice-focused programs linking data to education

being offered. • Identify need for Quality Assurance through CE programs

6 A program or project has been defined as “best practice” when it has been a success based on evidence,

has a positive impact on patient outcomes and can be successfully replicated in other locations and situations. Source: University of Saskatchewan, Health Sciences Deans’ Committee - http://www.usask.ca/healthsci/Glossary%20of%20Terms.pdf

7 Practice-based learning and improvement (PBLI) encourages clinicians to measure and upgrade performance while accessing the best evidence available for medical decision-making. Practice Based Learning and Improvement. Mazmanian P. S3

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“There is a tremendous opportunity at University of Toronto to become the leader in evaluative CE with a focus on rigorous evaluation”.

Dr. Sharon Straus, CE Planning Retreat

Strategic Direction 2: Foster Scholarship and Research in Continuing Education The second strategic direction addresses the role of scholarship and research in continuing education, which involves the creation of a research infrastructure, expanding the definition of scholarship to recognize and nurture a range of scholarly activities, and ultimately improving the rigor of CE planning, implementation, and evaluation. These goals and initiatives, as outlined in Table 2, address the need to develop and strengthen research partnerships within the University as well as the broader academic community, to address quality of care issues and be accountable for CE activities, and to be leaders in evaluative CE. Table 2: Strategic Direction Two

GOALS INITIATIVES 1 Create a framework for scholarly activity in Continuing Education.

• Use contemporary definition of scholarship to inform a new framework

• Expand definition of scholarship to be more inclusive and integrative, differentiating between discovery, innovative work, research and scholarship, defining each and finding mechanisms to nurture.8

• Compile inventory of CE research at U of T; identify strengths and gaps, determine who is doing what in CE, linking The Wilson Centre, The Centre for Knowledge Translation, and The Office of IPE.

• Review for Research and Development awards

2 Establish a Continuing Education research infrastructure to pursue scholarship

• Link infrastructure to existing research activities in the University, not with a view to creating a new structure or a new Institute, but rather, linking and leveraging.

• Hire a CE Researcher

3 Develop quality indicators or benchmarks for continuing education standards.

• Ensure rigor is applied to the organization, delivery of CE and evaluation of its outcomes

• Direct resources in ramping up evaluation of educational activities within the CE Office (Evaluating impact should include several dimensions, e.g. patient’s health care, patient satisfaction, whether better health care is applied)

8 The scholarship of discovery refers to the pursuit of inquiry and investigation in search of new knowledge. The scholarship of integration consists of making connections across disciplines and advancing knowledge through synthesis. The scholarship of application asks how knowledge can be applied to the social issues of the times in a dynamic process that generates and tests new theory and knowledge. The scholarship of teaching includes not only transmitting knowledge, but also transforming and extending it. The scholarship of engagement connects any of the above dimensions of scholarship to the understanding and solving of pressing social, civic, and ethical problem. Source: Boyer, Ernest. (1990). Scholarship Reconsidered: Priorities of the Professoriate. Menlo Park, CA, The Carnegie Foundation for the Advancement of Teaching: 147. University of Washington – Community Campus Partnerships for Health http://depts.washington.edu/ccph/scholarship.html

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Strategic Direction 3: Evolve the Curriculum in Continuing Education The third strategic direction, evolve the curriculum in continuing education, addresses the need for education to address the expanding roles of health professionals (e.g. CanMeds competency requirements) and changes in workplace structures and environments. This framework, the details of which are noted in Table 3, refers to the enhancement, and not the replacement, of existing curriculum. The development and evaluation of interprofessional team-based curricula and programs for the new academic Family Health Teams will be a major focus of this strategic initiative. As noted below, materials for continuing education providers will be developed to provide them with the knowledge and tools needed to effectively evolve the CE curriculum. Table 3: Strategic Direction Three

GOALS INITIATIVES 1 Broaden the learning objectives of Continuing Education Activities

• Establish a mechanism to develop a needs based curriculum • Facilitate the incorporation of health professional competencies,

including team-based learning • Support the professional development of health teams • Encourage the incorporation of systems thinking into all

educational offerings • Incorporate the principles of population health and the

determinants of health

2 Provide a repository of curriculum materials for Continuing Education providers

• Create an online repository site for curriculum development • Provide linkages to other resources • Incorporate the CanMeds competencies in the Continuing

Education that is done by the University of Toronto

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Strategic Direction 4: Broaden the Scope and Inclusiveness of Continuing Education CEPD already maintains many productive relationships with multiple players in health professional continuing education, education research, specialty societies, professional colleges, and government institutions, as well as with the public, and the goal of the fourth strategic direction, as outlined in Table 4, is to enhance and expand these collaborations. Particular efforts will be expended in the development of new relationships and collaborations with community hospitals, underserved local communities, and at-risk communities in Canada and internationally. An initial strategy will be the establishment of an advisory board with stakeholders from the health practitioner community, other professional/academic bodies, government, and business and consumer interest groups. Table 4: Strategic Direction Four

GOALS INITIATIVES 1 Identify and support collaborative relationships in Continuing Education planning, delivery and scholarship

• Collaborate with other faculties at the University of Toronto, teaching hospitals and community affiliated hospitals

• Collaborate with other university Continuing Education offices, specialty societies, professional colleges, and government institutions nationally and internationally

• Collaborate with the Ontario Guidelines Advisory committee • Explore collaboration with industry e.g. for Information Technology

projects and practice-based Continuing Education • Create an advisory board with stakeholders from the health

practitioner community, other professional/academic bodies, government, business and consumer interest groups

• Expand our array of public education activities to a broader array of topics, formats, and audiences

2 Enhance our capacity to develop, deliver, and evaluate Continuing Education globally

• Access and respond to, needs in at-risk communities, including those in Canada and globally through effective collaborative partnerships.

• Develop capacity to reflect on, integrate, and disseminate knowledge acquired from global CE activities.

• Form a consortium of partners to address unmet health needs in the community.

• Identify collaborative CE interventions.

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Strategic Direction 5: Enhance Faculty Development in Continuing Education and Professional Development The fifth strategic direction, enhance faculty development, is conceptualized as an ‘enabling strategy’ for the first four strategic directions as it will play an essential role in fostering faculty who have the necessary skills and expertise to successfully achieve identified goals. CEPD will continue to foster a strong working relationship with the Centre for Faculty Development, Wilson Centre for Research in Education, and The Centre for Knowledge Translation to achieve the goals and initiatives. The leaders and teams of the first four strategic directions will participate in identifying priority topic areas, yet a number of topics have emerged through this planning process, such as:

• Use of new technology and information retrieval • Research methodology for rigorous evaluation • CanMeds competencies • Practice based CE • Integration of health professional competencies • Quality improvement

This strategic direction will build capacity of current faculty CE leaders already committed to best practices in education, and will also focus on recruiting new faculty to the field of CE. Table 5: Strategic Direction Five

GOALS INITIATIVES 1 Improve knowledge and skill level of Continuing Education providers through Faculty Development

• Target and provide learning opportunities for CE providers in needs assessment, education methodologies, evaluation, and knowledge translation

• Provide learning opportunities for CE providers on how to incorporate health professional competencies, and population health principles into CE activities

• Enhance current course offerings to support CE providers • Prioritize faculty development requirements to achieve 4 CE goals

outlined above

2 Increase educational opportunities for CE scholarship

• Establish effective working relationships with the Wilson Centre for Research in Education and the Knowledge Translation Program

• Realign CE awards to recognize and reward scholarship • Create CE Fellowship

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Strategic Direction 6: Reinforce our Infrastructure and Funding Base In response to changes in the funding model of The University of Toronto, CEPD must seek and secure new and alternate sources of sustainable revenue over the next five years, as described in strategic direction six (Table 6). As part of this objective, CEPD will strengthen its profile and identity through a comprehensive communications and marketing strategy (e.g. website enhancements) targeted to its diverse stakeholders and audiences. Through these communication efforts, CEPD will enhance University, public, and government awareness of its role within the University, the community, and internationally, and explore funding opportunities that will support CEPD’s efforts to address gaps in health care delivery, systems, and outcomes. Table 6: Strategic Direction Six

GOALS INITIATIVES 1 Establish alternative streams of revenue

• Explore public education models as a source of revenue generation • Pursue partnerships with other Faculties across the University • Explore and pursue government funding and agency grants to

support targeted CE initiatives

2 Enhance the profile and CEPD brand

• Develop a marketing and communications strategy for CEPD • Improve the CEPD website to enhance its effectiveness as a

communications tool

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4.3 Implementation of Strategic Directions

Each of the six strategic directions has designated faculty leaders (Table 7) who are responsible for assessment, planning, implementation, and evaluation. The Academic Advisory Committee, consisting of the strategic direction leaders and members of the strategic planning committee, and chaired by the Vice Dean, Continuing Education, will guide the overall implementation of the CEPD strategic plan. The year one priority initiatives (Table 7) identified during the strategic planning process, will guide initial implementation efforts. Table 7: Strategic Direction Leaders and Year One Priorities

STRATEGIC DIRECTIONS YEAR 1 PRIORITY INITIATIVES 1 Promote Best Practices in Continuing Education and Professional Development

Lead: Cathy Evans

• Advance e-learning CE opportunities and strategies, targeting information retrieval skills.

2 Foster Scholarship and Research in Continuing Education

Lead: Mary Bell

• Create a framework for scholarly activity in CE • Compile an inventory of CE research at U of T • Develop capabilities in measurement and evaluation

of the impact of CE interventions • Hire a researcher in CE • Review criteria for Research and Development awards

3 Evolve the Curriculum in Continuing Education

Lead: TBD Ivan Silver

• Establish a mechanism to develop a needs-based curriculum.

• Create a working document that defines approaches to Inter-professional Education and collaborative practice

4 Broaden scope and inclusiveness of Continuing Education

Lead: Lee Manchul Linda Sugar

• Form a consortium of partners to address unmet needs in the community, tackling at least one urgent health care need through a collaborative CE intervention, including community affiliated hospitals.

5 Enhance Faculty Development in CEPD

Lead: Suzan Schneeweiss Debbie Hebert

• Collaborate with the leads of the four CE Goals to provide customized faculty development that supports new initiatives

6 Reinforce our infrastructure and funding base

Lead: Ivan Silver Susan Rock

• Explore and put in place alternative revenue generating programs to support CE strategic agenda

• Develop communications and marketing strategy

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The strategic planning process provided a valuable opportunity for leaders and stakeholders in the CEPD community to comprehensively examine CE related activities and achievements to date and identify key opportunities related to University of Toronto priorities and developments in medical education and the health care system. Given its role in health professional education, education research, and public education, CEPD is in a unique position to strengthen the interaction between health care practices, research, education, and policy through collaborations with a range of partners, including the continuum of medical education providers, health researchers, health professionals, technology experts, the public, government stakeholders, and college and licensing bodies. These partners are located in the University of Toronto and affiliated hospitals, community hospitals, the Greater Toronto Area, and also across the province of Ontario, Canada, and the world. The six strategic directions created through the strategic planning process and described in this report will provide a clear framework for the activities and priorities of CEPD for the next five years. As outlined in these strategic directions, CEPD is committed to the promotion of best practices in CEPD, fostering scholarship and research in continuing education, evolving the curriculum in continuing education, and broadening the scope and inclusiveness of continuing education. These four strategic directions will be fostered through the remaining two strategic directions, enhancing faculty development in CEPD and reinforcing our infrastructure and funding base. The strategic plan 2006-2011 will provide a framework for CEPD at the University of Toronto to achieve its mission of being a leader in improving health through innovative continuing education and related research for health professionals and the public.

5 Conclusion

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Appendix I: Continuing Education and Professional Development Strategic Planning Committee Members Dr. Ivan Silver, Chair............................ Associate Dean, Continuing Education and Professional Development, Faculty

of Medicine, University of Toronto Bell, Dr. Mary....................................... Departmental CE Representative (Medicine), Department of Medicine, Faculty

of Medicine Evans, Ms. Catherine ............................ Departmental CE Representative (Physical Therapy), Assistant Professor,

Department of Physical Therapy, Faculty of Medicine Evans, Dr. Michael ............................... Assistant Professor, Department of Family & Community Medicine, Faculty of

Medicine Hawkins, Ms. Vashty............................ Recorder, Office of Continuing Education and Professional Development,

Faculty of Medicine Hebert, Ms. Debbie............................... Departmental CE Representative (Occupational Therapy), Tutor, Department

of Occupational Science and Occupational Therapy, Faculty of Medicine Leith, Ms. Sandra (retired).................... Director of CE, Office of Continuing Education and Professional Development,

Faculty of Medicine Manchul, Dr. Lee .................................. Departmental CE Representative (Radiation Oncology), Assistant Professor,

Department of Radiation Oncology, Princess Margaret Hospital Meuser, Dr. James ................................ Departmental CE Representative (Family and Community Medicine),

Associate Professor, DFCM, Faculty of Medicine, University of Toronto Perrier, Ms. Laure ................................. Information Specialist, Office of Continuing Education and Professional

Development, Faculty of Medicine Rock, Ms. Susan ................................... New Director of CE, Office of Continuing Education and Professional

Development, Faculty of Medicine Schneeweiss, Dr. Suzan ........................ Departmental CE Representative (Paediatrics), Assistant Professor, Department

of Paediatric Emergency Medicine, Hospital for Sick Children Sugar, Dr. Linda.................................... Departmental CE Representative (Laboratory Medicine and Pathobiology),

Associate Professor, Sunnybrook Health Sciences Centre Axler, Helena........................................ Facilitator, Helena Axler & Associates Inc.

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Appendix II: Continuing Education and Professional Development February 2, 2006 Strategic Planning Retreat Participants

Barankin, Dr. Tatyana........................... Assistant Professor, Department of Psychiatry, Faculty of Medicine Bell, Mary, Dr....................................... Associate Professor, Department of Medicine, Faculty of Medicine Chalin, Dr. Catherine ............................ Professor, Department of Public Health Sciences, Faculty of Medicine Drazin, Mr. Yale ................................... Executive Director, Guidelines Advisory Committee Evans, Ms. Catherine ............................ Assistant Professor, Department of Physical Therapy, Faculty of Medicine Evans, Dr. Michael ............................... Assistant Professor, Department of Family & Community Medicine, Faculty of

Medicine Feld, Dr. Ronald.................................... Professor, Department of Medicine, Faculty of Medicine Fishbein, Ms. Barbara ........................... Director of Professional Practice, College of Audiologists and Speech-

Language Pathologists of Ontario (CASLPO) Giblon, Dr. Barnett ............................... CE Representative, Medical Alumni, Faculty of Medicine Goldman, Ms. Joanne ........................... Researcher, Office of Continuing Education and Professional Development,

Faculty of Medicine Halsband, Ms. Natalie........................... Course Administrator, Office of Continuing Education and Professional

Development, Faculty of Medicine Hawkins, Ms. Vashty............................ Recorder, Office of Continuing Education and Professional Development,

Faculty of Medicine Hawryluck, Dr. Laura ........................... Associate Professor, Department of Medicine, Faculty of Medicine Hebert, Ms. Debbie............................... Tutor, Department of Occupational Science and Occupational Therapy, Faculty

of Medicine Hodges, Dr. Brian ................................. Associate Professor, Department of Psychiatry, Faculty of Medicine Hyman, Mr. Avi.................................... Director, Academic Computing, Faculty of Medicine James, Ms. Susan .................................. Deputy Registrar, College of Occupational Therapists of Ontario Kalu, Mr. Kalu...................................... Mini-Med participant Kane, Dr. Gabrielle ............................... Assistant Professor, Department of Radiation Oncology, Faculty of Medicine Klass, Dr. Daniel................................... Director, Associate Registrar, Quality Management, College of Physicians and

Surgeons of Ontario Kopelow, Ms. Judy ............................... Centre for International Health Krauss, Mr. Ferdinand .......................... Academic Computing, Faculty of Medicine Leith, Ms. Sandra.................................. Outgoing Director of CE, Office of Continuing Education and Professional

Development, Faculty of Medicine Lemieux-Charles, Dr. Louise................ Chair, Department of Health Policy, Management and Evaluation, Faculty of

Medicine Leslie, Dr. Karen................................... Associate Professor, Department of Paediatrics, Faculty of Medicine Levinson, Dr. Wendy............................ Chair, Department of Medicine, Faculty of Medicine Lind, Ms. Alison ................................... Marketing and Development Coordinator, Office of Continuing Education and

Professional Development, Faculty of Medicine Lyddiatt, Ms. Anne ............................... Patient Partners in Arthritis MacDonald, Dr. Geraldine.................... Faculty of Nursing, University of Toronto Manchul, Dr. Lee .................................. Assistant Professor, Department of Radiation Oncology, Faculty of Medicine Marlow, Dr. Bernard............................. Director of Continuing Education and Professional Development, The College

of Family Physicians of Canada Masi, Dr. Ralph..................................... Assistant Professor, Department of Public Health Sciences, Faculty of

Medicine Meuser, Dr. Jamie................................. Assistant Professor, Department of Family and Community Medicine, Faculty

of Medicine Naccarato, Ms. Anna ............................ Manager of Operations, Office of Continuing Education and Professional

Development, Faculty of Medicine

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Parikh, Dr. Sagar................................... Associate Professor, Department of Psychiatry, Faculty of Medicine Patcai, Dr. John..................................... Lecturer, Department of Medicine, Faculty of Medicine Perrier, Ms. Laure ................................. Information Specialist, Office of Continuing Education and Professional

Development, Faculty of Medicine Polatajko, Dr. Helene............................ Chair, Department of Occupational Therapy, Faculty of Medicine Regehr, Dr. Glenn................................. Professor, Department of Theory and Policy Studies in Education, University

of Toronto Richardson, Dr. Denyse ........................ Chair, Department of Medicine, Faculty of Medicine Robinson, Ms. Jan................................. Registrar, College of Physiotherapists of Ontario Rogers, Ms. Jessica............................... Program Manager, Guidelines Advisory Committee Ryan, Dr. Heather ................................. Consumer representative Schneeweiss, Dr. Suzan ........................ Assistant Professor, Department of Paediatrics, Faculty of Medicine Shupak, Dr. Rachel ............................... Associate Professor, Department of Medicine, Faculty of Medicine Sibbald, Dr. Gary .................................. Professor, Department of Medicine, Faculty of Medicine Silver. Dr. Ivan ..................................... Associate Dean, Office of Continuing Education and Professional

Development, Faculty of Medicine Slinger, Dr. Peter .................................. Professor, Department of Anaesthesia, Faculty of Medicine Smith, Mr. Randy.................................. Technician, Vertically Sound Spencer, Ms. Jan ................................... Marketing and Development Coordinator, Office of Continuing Education and

Professional Development, Faculty of Medicine Sriharan, Ms. Abi.................................. Scholar in Residence, Peter A. Silverman Centre for International Health,

Mount Sinai Hospital Straus, Dr. Sharon................................. Principal Investigator, Knowledge Translation Program, Faculty of Medicine Stubbs, Barbara Dr................................ Assistant Professor, Department of Family and Community Medicine, Faculty

of Medicine Sugar, Dr. Linda.................................... Associate Professor, Department of Laboratory Medicine and Pathobiology,

Faculty of Medicine Way, Dr. Daniel .................................... Medical Officer, Quality Management, The College of Physicians and

Surgeons of Ontario Wilson, Dr. Lynn .................................. Associate Professor, Department of Family and Community Medicine, Faculty

of Medicine Zwarenstein, Dr. Merrick...................... Principal Investigator, Knowledge Translation Program, Faculty of Medicine Axler, Ms. Helena................................. Facilitator, Helena Axler & Associates Inc. Rackow, Ms. Valerie............................. Reporter, Helena Axler & Associates Inc.

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Appendix III: Glossary of Terms Best Practice A program or project becomes “best practice” when it has been a success based on evidence, has a positive impact on patient outcomes and can be successfully replicated in other locations and situations. Source: University of Saskatchewan, Health Sciences Deans' Committee CanMeds (Canadian Medical Education Directives for Specialists) A framework of core competencies for medical specialists. Distributed Learning A system and process that uses a variety of technologies, learning methodologies, on-line collaboration, and instructor facilitation to achieve applied learning results not possible from traditional education in a truly flexible, anytime/anywhere fashion. Source: College of Education at The University of Texas at Austin Knowledge Translation The process whereby information is transferred to clinicians and applied in practice, a process that requires understanding of organizations, individual and team education and health services research, among others. Source: Knowledge Translation Program, University of Toronto Interdisciplinary A partnership where members from different domains work collaboratively towards a common purpose. Source: MacIntosh & McCormack, 2001 bib.htm#b58 Interprofessional In the health professions, one may have multiple disciplines within one profession. For example, a Faculty of Medicine may mount an interdisciplinary initiative inviting only physicians from different fields such as Internal Medicine, Psychiatry and Family Medicine. By using the suffix of “professional” in an interprofessional initiative, it makes it clear that individuals from different health professions are included. Source: Oandasan I, Reeves S. Journal of Interprofessional Care 2005 (Suppl) 21-38./ Practice Based Learning Practice-based learning and improvement (PBLI) encourages clinicians to measure and upgrade performance while accessing the best evidence available for medical decision-making. Mazmanian P. Practice Based Learning and Improvement. JCEHP 2003;23(Suppl 1): S3. Quality Assurance: Formal process of implementing quality assessment and quality improvement in programmes to assure people that professional activities have been performed adequately. Source: New Zealand Ministry of Health Scholarship (Boyer's Definition)

• The scholarship of discovery refers to the pursuit of inquiry and investigation in search of new knowledge. The scholarship of integration consists of making connections across disciplines and advancing knowledge through synthesis.

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• The scholarship of application asks how knowledge can be applied to the social issues of the times in a dynamic process that generates and tests new theory and knowledge.

• The scholarship of teaching includes not only transmitting knowledge, but also transforming and extending it.

• The scholarship of engagement connects any of the above dimensions of scholarship to the understanding and solving of pressing social, civic, and ethical problem.

Source: Boyer, Ernest. (1990). Scholarship Reconsidered: Priorities of the Professoriate. Menlo Park, CA, The Carnegie Foundation for the Advancement of Teaching: 147. University of Washington – Community Campus Partnerships for Health Self Directed Learning Individual learner's initiative and responsibility to (with or without assistance) identify, assess, and set priorities for learning needs; define goals; select and organize learning activities; and evaluate outcomes in terms of performance. Source: Knox, AB. Life-long self directed education. Syracuse, NY: ERIC Clearinghouse, 1973.