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Learning in the Workplace: Role of CME/CPD
SACME Fall Meeting 2015Baltimore, November 13, 2015
What does - workplace learning - mean to you?
PanelModerator:Mila Kostic, CHCP, FACEHPDirector of CMEPerelman School of Medicine at the University of Pennsylvania
Suzanne Ziemnik, MEdVice President of Continuing Professional DevelopmentThe American Society for Clinical Pathology
Jack Dolcourt, MD, MEdAssociate Dean for CME, Medical Graphics and PhotographyProfessor of Pediatrics,University of Utah School of Medicine
Betsy White Williams, PhD, MPH Professional Renewal Center®Department of PsychiatrySchool of Medicine, University of Kansas
Mindi McKenna, PhD, MBACME Division Director for American Academy of Family Physicians
Julie White, MS, CHCPDirector, Continuing Medical EducationBoston University School of Medicine
Learning as a process, not an outcome
Learning is a process whereby knowledge is created through a transformation of experience. (D. Kolb’s Experiential Learning Model)
- Formal Learning – defined goals and outcomes, usually in canonical occupational knowledge
- Informal Learning – largely learning from experience, no set expectation or outcome
- Incidental Learning – unplanned by learner or instructor, mostly workplace learning - Just-in-time or at the point-of-care learning
Workplace Learning Is the way in which individuals or groups
acquire, interpret, reorganize, change, or assimilate a related cluster of information, skills and feelings. It is also primary to the way in which people construct meaning in their personal and shared organizational lives. (Marsick, 1987)
(Davis DA, 2010 Lifelong Learning in Medicine and Nursing Report) Learning and change in the health professions
– Vision and Recommendations CE Methods, IPE, Lifelong Learning, Workplace
Learning, Learning at the point of care
Workplace Learning- Increasingly Important “The greatest proportion – perhaps as much as
90 % of learning occurs incidentally … including exposure to the opinions and practices of others also working in the same context”
Workplace Learning link to Quality, Safety and Team Work “To raise quality, health care managers will
reposition CPD from a developmental tool for individuals to a strategic tool for the care delivery unit”.
(Cervero RM, 2000)
Stephen Billett, Readiness and learning in health care education, THE CLINICAL TEACHER 2015; 12: 1–6
Learning as an experience
Readiness refers to an individual’s ability to learn from what they know, can do and value (i.e. their conceptual, procedural and dispositional capacities).
Conceptual knowledge
(what individuals know)
Procedural knowledge Dispositional knowledge
(what individuals can do) (what individuals value)Interdependence amongst conceptual, procedural and dispositional
knowledge
Aligning experience is critical
We must pay attention to assessing readiness to learn at all 3 levels
Is there a role for us to play in the workplace learning?
What are we already doing?
Jack Dolcourt, MD, MEdAssociate Dean for CME, Medical Graphics and Photography
Professor of Pediatrics
University of Utah School of Medicine
The Huddle
Society for Academic CMEPanel: Role of CME/CPD in the Workplace Learning
November 13, 2015
Daily Huddle – Census Rounds
• 10+ years in 3 Newborn ICU (NICU) in SLC
• Predictable start time & location– Expectation: drop everything and show up
• Evolution– Nursing: bed availability for new admissions– Administration: anticipated discharges and
staffing– Rounding strategy
Evolution to include Safety
• Q1 2014 Zero Harm Initiative• Culture change
– All meetings begin querying safety issues– Empowering
• Identifying safety issues beginning of NICU census rounds– Interdisciplinary team (physician, APRN,
dietician, pharmacist, discharge planner, social work, head nurse, team leaders etc)
Examples of Types of Issues
Mostly no physical harm resulted• Communication• System structure• Medication or feeding errors• Laboratory errors and mistiming• Staff safety• Parents inconvenienced by outside
vendors
Opportunity for certified CIPE
• Formal instruction component– Dynamic & relevant to workplace– Relatively consistent group of participants– Interprofessional learners and teachers
» Team function» Interaction and opportunity for reflection
– Track changes – PDSA cycle
About Credit? Is it in the way? Does it help?
How AAFP’s Credit SystemSupports Workplace
Learningpanel presentation at the Society for Academic CME (SACME) fall meeting
Baltimore November 13, 2015
Mindi McKenna, PhD, MBA
CME Division Director for AAFP
Mindi McKenna, PhD, MBAContext for My Comments (Disclosure)
Previous Affiliations / Responsibilities:• Executive Director, Healthcare Leadership Group• Faculty, Rockhurst University, Health Care Leadership MBA Program• VP of Business Development & Marketing, Cerner Corporation (medical software)• Director, Marion Laboratories / Marion Merrell Dow (pharmaceutical research and
manufacturing)
CME Division DirectorAmerican Academy of Family Physicians
Disclosure: AAFP manages one of the USA’s 3 CME credit systems,which reviews and approves thousands of learning activities each year for AAFP
credit.
Author of 2 books: “High Tech Medicine” and “Physicians as Leaders” with P. Pugno, MD
Myths and misconceptions about CME credit(health care is changing … is CME?)
• MYTH: “Certified / accredited" CME must be costly and complex.
• FACT: Small, basic, practice-relevant activities can qualify for CME credit.
• MYTH: CME must be “formal.” • FACT: Some informal learning activities qualify for CME.
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Misconceptions and myths about CME credit(health care is changing … is CME?)
• MYTH: CME doesn’t align with workplace learning.
• FACT: Point of Care (POC-CME) credits HCPs for learning and improving in practice.
• FACT: CME credits “learning-from-teaching / scholarship.”
• FACT: Simulation activities often qualify for CME credit.
19
Misconceptions and myths about CME credit(health care is changing … is CME?)
• MYTH: CME doesn’t align with QI or health system priorities.
• FACT: PI-CME credits HCPs for measuring patient care; for learning and changing; then re-measuring.
• FACT: PI-CME often meets MOC Part IV requirements.
20
Misconceptions and myths about CME credit(health care is changing … is CME?)
• MYTH: CME doesn’t align with HCP’s other requirements. • FACT: AAFP tracks which ACGME/ABMS core
competencies are addressed by the many thousands of CME activities we certify each year.
• MYTH: CME hasn’t changed in decades. • FACT: AAFP is launching “t2p” which credits HCPs for
“Translating To Practice” what they are learning through commitment to change, barrier mitigation, reminders and support.
21
What more could we be doing? Or differently?
A-B-C, Think – Pair - Share “A” How may that look like in academic CPD practice? “B” What skills, values and resources do we have that
can support us? “C” Is there anything we need from other CPD
stakeholders and how do we get it?
Silent Reflection (2 minutes)
Table Sharing (8 minutes)
Large Group Sharing (10 minutes)
Boston University School of Medicine | Continuing Medical Education
Julie White, MS, CHCPDirector, Continuing Medical EducationBoston University School of Medicine
Experience from 20 PI CME Programs
• Insert ourselves into the workflow
• Provide on-going project management
• Facilitate identification and implementation of interventions
• Assemble resources – clinicians from other departments, students, external services
• Offer CME/CNE credit and garner MOC IV approval
• Assistance with grant development and publications
• Making it meaningful to practice – encourage team participation
Experience from the Sim Lab and OSCEs
• Offer credit• Promote event• Educational design• Project management• Resource acquisition (space,
equipment, staffing, food)
Online Educational Resources
• Curriculum design• Application of adult education principles• Promotion/consumer behavior
consultation• Offer credit• LMS
Visionaries …
• Aligning MOC, OPPE, MOL, CLER, QI
• Bring in expertise from other fields – education, management, public health, …
• Overcome barriers, align resources, see beyond the silos
Workplace Learning (Virtually): Is there a role for CPD?
Suzanne ZiemnikVice President of Continuing Professional Development
SACMENovember 13, 2015
Workplace Learning
• “The way in which individuals or groups acquire, interpret, reorganize, change or assimilate a related cluster of information, skills and feelings, and a means by which health professionals construct meaning in their personal and organizational lives” (Marsick, 1987)
• Contextual learning• Not necessarily designated for credit in traditional CE
frameworks
Opportunities in Pathology
• Pathology is becoming digital• Full Slide Scans -3gb an image• Crowdsourcing & sharing have become mainstream
• Virtual Training• Shared Viewing• Image Annotations
• Machine Learning• Image Comparison• Clinical Decision Support
PathInsights GI: Tools for Creation, Content for Consumption
PathInsights GI includes dynamic learning and collaboration resources:
• Comprehensive information set with personalized curation tools
• Peer collaboration tool• Master class online microscope • Expert teaching collections• Related study materials• GI specific CME • Case studies in presentation mode
Peer Collaboration Tool
• Pathologists virtually share their diagnostic problems directly with each other
• Peer dialogue on problematic details of the patient case• Tool allows for the permanent capture and subsequent reuse
of the teachable moment
Communities of Practice
Communities of Practice
Workplace Learning: What is the Role of
CME/CPD
Betsy White Williams, Ph.D., M.P.H.Professional Renewal Center®
Department of PsychiatrySchool of Medicine, University of Kansas
University of Kansas
Social Cognitive Theory• Learning occurs in a social context with a dynamic and
reciprocal interaction between the person, the environment and behavior.
• There is an emphasis on social influence and its influence on external and internal reinforcement.
• Considers how people acquire and maintain behavior while considering the social environment in which the individual behaves.
• Recognizes past experiences which play a role in whether behavior will occur.
Bandura, 1986
37
Workplace Learning
Workplace Learning
• In the research of each of the bases of performance:
• Cognitive• Behavioral, and• Environmental
• The whole cannot be fully understood without reference to the linkages among the three
CognitiveFactors
EnvironmentalFactors
Behavioral Factors
Organizational, Team, IndividualPerformance
Workplace Learning
• Basic dichotomy• Formal Learning
• Attendance at CPD event at workplace
• Completion of on-line training module
• Informal Learning• Happens through
experience and interactions
• Is indirectly judged as to outcome
FormalLearning
Informal Learning
Workplace Learning
• Learning organization (Sengue, 1990)…...”organizations where people continually expand their capacity to create the results they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspiration is set free, and where people are continually learning to see the whole together.”
…. “in situations of rapid change only those that are flexible, adaptive and productive will excel. For this to happen, it is argued, organizations need to ‘discover how to tap people’s commitment and capacity to learn at all levels’
40
Workplace Learning
Workplace Learning
System
Team
InterpersonalSkills
Knowledge/ Procedure
• Each area of the organization has a place for, indeed should be a focus of, CME/CPD
• To date we have focused on personal mastery
• There has been increased focused on interprofessional/team learning
• More opportunity for CME/CPD exists at higher levels of the organization
In SummaryWhat does - workplace learning - mean to you?Some ideas about what we are already doing
Case conferences and quality rounds, huddles QI work, faculty development Danger of hidden curriculum Contributing in non-credited practice improvement
What we have to pay attention to Context of the workplace – learning environment Assessing readiness to learn (change) in all 3 domains of
knowledge Dispositional readiness is central to the quality of engagement
and learning through clinical practice to secure appropriation of healthcare knowledge (beyond superficial engagement)
To learn more - Valsiner J, van der Veer R. The social mind: The construction of an idea. Cambridge, UK: Cambridge University Press; 2000.- Cole M. The zone of proximal development where culture and cognition
create each other. In: Wertsch JV (ed.) Culture, communication and cognition: Vygotskian perspectives. Cambridge, UK: Cambridge University Press; 1985: pp. 146–161.
- M. W. J. van de Wiel et al. Exploring deliberate practice in medicine: how do physicians learn in the workplace? Adv in Health Sci Educ (2011) 16:81–95 DOI 10.1007/s10459-010-9246-3
- Davis DA, 2010 Lifelong learning in Medicine and Nursing report- Stephen Billett, Readiness and learning in health care education, THE
CLINICAL TEACHER 2015; 12: 1–6- John Parboosingh FRCSC, FRCOGJ, Workplace Learning, First Regional
Conference and 9th National Workshop on Continuing Professional Development (CPD) of Physicians
- E. Wenger, 1999 Communities of Practice- Ericsson KA, Deliberate Practice, 2004, 2006- Wertsch JV. Mind as action. New York: Oxford University Press; 1998.