A wealth of approaches for producing individual and system-wide change exists in adult-education and "human performance training"
literature. Anthropologist Jean Lave and learning theorist Etienne Wenger first coined the term communities of practice in 1991 to describe apprenticeship. Lave and Wenger's model proposed that this kind of expertise arises from "situated learning,"
a product of the social and physical environment in which the apprentice works and lives. This "living curriculum for the
apprentice" that Wenger describes may hold import for CME. Lave and Wenger's communities of practice have rules for membership:
- Members of the community share a commitment to a specific domain of interest
- It is a community in the active sense; members seek to build relationships with other members to help, share, and learn from
- Members are practitioners; in Wenger's words, "they develop a shared repertoire of resources: experiences, stories, tools,
ways of addressing recurrent problems"
In light of these criteria, a clinical department can become a community of practice, but the fact that an interdisciplinary
group of health professionals works in the same place providing medical care together does not make it one. There are no structural,
logistical, or geographical limits to a community of practice. Its members may or may not interact face-to-face or under any
formal structure of governance. However, communities of practice are collaborative learning networks that progressively and
continuously seek solutions to shared problems. They may be hierarchical, but their orientation is always focused on effective
problem-solving by empowering each member to exert their expertise and their perspective on the issue at hand. And, most importantly,
communities of practice often include members outside of the organization in which many members may reside.
CME can play a pivotal role in identifying, developing, and nurturing clinical communities of practice and, by doing so, greatly
impact the quality of care delivered to patients. By relating the aspects of a community of practice to clinical medicine,
we can envision tactics that a CME provider can take.
Define "educational need" as the distance between current practice and best practice in the delivery of care to a specific
patient in a specific setting. This approach is generally understood; however, the emphasis on "patient" and "setting" (read:
What happens at the point of care?) is often overlooked. Here, CME professionals can provide a unique perspective and single-minded
focus that is often difficult for clinicians to see and describe.
Integrate CME into existing "learning networks" and mimic the nature of those interactions. CME professionals cannot afford for their activities
to be stand-alone events with no connection to the daily practice of their audiences. Whether it is functional or not, all
health professionals work within a complex, multidisciplinary system that greatly affects their clinical decision-making.
Ask learners about what they do each day, and identify opportunities to enhance those interactions with information, technology,
Make mentorship and matchmaking resources available to health professionals. As Lave and Wenger described, communities of practice don't place limits on membership in order
to ensure that any and all human resources can contribute to solutions for the community. CME providers have a much greater
ability, as compared with their learners, to help clinicians build relationships with others to expand their living curriculum.
In this regard, there simply isn't room for competitive isolation—providers should actively seek partners who can help them
provide more to their learners.
Motivate change by including patients. Clinical communities of practice revolve around patient care. If educational needs
are defined in terms of where care is suboptimal, consider including patients in the solution. In its recent white paper,
"What Did the Doctor Say?" Improving Health Literacy to Protect Patient Safety, the Joint Commission, a healthcare evaluation and accrediting group, provides many examples of how educational initiatives
help both clinicians and patients to achieve better health outcomes.
Make technology work for the community. Again, CME providers may have valuable resources and perspectives to provide (or enhance) technology tools that may help
communities of practice to go about their collective work more effectively. Several providers and CME stakeholders are already
advancing this approach through point-of-care CME, performance-improvement e-portals, and connections with quality-improvement