Medical Education: Community of Change

Clinical "communities of practice" can be a key CME tool in changing healthcare quality
Apr 30, 2007



I love chicago deep-dish pizza. My cholesterol is high. I rarely exercise. Heart disease runs in my family. My primary care doc hasn't told me anything I don't already know. I want to change my behavior. Really.

As a CME professional—a continuing medical education expert—I know better. I can quote AHRQ studies and IOM reports about health, risk, and disease as one would quote Shakespeare. I trained as a molecular pharmacologist. Nobody understands clinical medicine better than me. I really know better, but change is hard.


Steve Singer
Our daily practice—what we do each day—is a complicated thing. Education and habit form a gestalt over time, distilling experiences into the knowledge, skills, and attitudes that define who we are and how we think and act. Similarly, the daily lives of physicians are imbued with the same complicated, idiosyncratic struggle between a confident status quo and something else.

The Big Question

This past fall, the Accreditation Council for Continuing Medical Education (ACCME) released Updated Accreditation Criteria for Accredited Providers. In one sense, the document is a step-by-step how-to guide for medical education best practice. However, the broader impact of the Updated Criteria document is as a vision statement addressing a rhetorical question: Are we (the CME community) really contributing to the improvement of healthcare in the United States?

The impetus for releasing the new criteria at this time is fairly clear: A growing chorus of national healthcare stakeholders has reached a critical mass in sharing concern for the state of healthcare quality in the United States, reports the Rand Corporation's The First National Report Card on Healthcare Quality [2006]. These stakeholders have suggested that CME can help to provide a solution to improve health-professional performance and, thereby, healthcare quality, according to the Institute of Medicine's Health Professions Education: A Bridge to Quality [2003].

So, are we getting the job done? Med ed grant proposals are filled with discussions of adult-education methodologies and CME-participant feedback on approaches that increase retention and translation of knowledge into practice. Savvy providers do their homework, knowing that participant responses vary by clinical discipline and healthcare setting. They measure and re-measure their audiences and do their best to address real problems in healthcare delivery. However, in spite of this well-intentioned analysis and planning, most CME is miles away from answering "yes" to the ACCME's question.The reason for this may be that as we've tried to dissect and manipulate clinical practice through medical education, we've lost sight of whom we're dealing with: people like us—smart, aware, and thoughtful. Aware of the need to learn, adapt, and improve but mindful that wanting to change is quite a distance from adopting change.

Refocus CME

CME professionals need not reinvent the wheel to accomplish more. But we do have to better align our approaches to the way in which healthcare is actually delivered. The 2003 Institute of Medicine report outlined five competency areas for better preparing healthcare providers to deliver the best care possible to their patients. These competency areas included patient-centered care, interdisciplinary teams, evidence-based medicine, quality improvement, and informatics. Each of these components of care revolves around health professionals and their capacity for change. CME interventions should address at least four out of five of these competency areas if changes in healthcare delivery are to occur.