>>KOPELOW: I’m Murray Kopelow the CEO of the Accreditation Council for Continuing Medical Education.
>>BELEU: Hi, my name is Michele Beleu, I’m a Project Manager for Kaiser Permanente in Northern California.
>>KOPELOW: So, tell me about where it is that you work.
>>BELEU: I work for Kaiser Permanente in Northern California and we are an integrated healthcare system that incorporates healthcare with physician group and the hospitals.
>>KOPELOW: And how does Kaiser Permanente organize its continuing professional education?
>>BELEU: We, the group that I work with is regional physician education and development group and we work along with 15 other CME offices in Northern California as a peer group to share best practices and learn from each other.
>>KOPELOW: And what are you responsible for with respect to education? How much education do you put on? What kind of education do you put on?
>>BELEU: As a region we put on about 4,000 educational events a year. And that’s across the 16 CME offices. And the type of education that we put on ranges across the board. We do everything from very large conferences to Webinars, or series, or video conferences, simulation trainings, there’s quite a range.
>>KOPELOW: So, important parts of what we do in continuing medical education is to anchor the content and process to what the learners need
>>KOPELOW: that’s where we start, because those needs reflect the quality of the care, the quality of the research, the quality of the education, the quality of the executive practice that these physician learners do. So, tell me about some of the things that you’ve innovated around to identify the needs of your physician learners.
>>BELEU: Sure, well first we work in an integrated healthcare system where we’re partnering with the hospital and physician group and the insurance healthcare plan, as well. And we are fortunate to have physicians who are really centered around improving patient care. So, getting them onboard with the idea of improving patient care was never a problem for us. But, getting them to realize that was what we were talking about with CME was sometimes an obstacle. So, we started trying to get past the paperwork barrier with identifying needs and gaps and trying to get to something the physicians understood, related to and were really invested in.
>>KOPELOW: So, tell me about that. This is really a big challenge, is to convert the physicians perception of the presence of a CME person
>>KOPELOW: from paperwork to education.
>>KOPELOW: and you quickly went over that. I want to pause there for a second and say, so, how did you make that transformation? What did you do that made these docs see that this is not paperwork but
>>BELEU: That’s a great question, it’s an ongoing process for us. So, with every new physician planner we get to start over in a sense but, we’re getting better at it and it’s starting by putting the paperwork aside and really talking to the physicians about: why are you here? What do you want to accomplish? What are you trying to do? And sometimes backup a little bit and set the context for them
>>KOPELOW: Let’s hear how you do that.
>>BELEU: Sure. So, just explain to the physician what CME is all about, that continuing medical education is about improving patient care and making a change. And if you’re coming to us with interesting information, really valuable scientific information, not something that’s very rare and doesn’t happen very often that’s wonderful we love to hear about it, but it’s probably not going to be CME.
>>KOPELOW: So, are you talking about people who come to you who want to teach? Who want to initiate educational activities?
>>KOPELOW: And you sort of, you do a little history and physical on them; you do a little diagnosis
>>BELEU: that’s a great analogy
>>KOPELOW: of what it is that they are trying to teach about?
>>BELEU: Exactly. And it’s something that, that analogy is perfect because sometimes we have to put that out there for physicians who are pushing back at: Why do you want to know I’m busy I don’t have time to tell you this. Back it up and say, Well, this is just like treating a patient. We need to know what the diagnosis is. What’s the problem that you’re trying to fix before we look at
>>KOPELOW: so, what’s that
>>BELEU: the treatment.
>>KOPELOW: dialogue sound like when you sit down with someone?
>>BELEU: And I’m speaking for a large group of CME team members here
>>KOPELOW: OK. OK.
>>BELEU: from learned experiences, but, trying to break it down into less jargon and less orientation to phrases that we throw around a lot: competence, performance, patient outcomes and instead turning it into just what the physician is there for. So, finding out first, Why are you here? Are you here because someone volunteered you to be here? Are you here
>>KOPELOW: so, let’s use an example, let’s say I came to you
>>KOPELOW: and I want to do an educational activity on screening for colorectal cancer. This is what I do and this is what I want to teach.
>>KOPELOW: I want to teach, so what would you say back to me?
>>BELEU: So, start of by asking you, Well, why do you want to do this activity? Is there and actually most of it is letting the physician talk.
>>KOPELOW: So, you do it open
>>BELEU: very open ended
>>KOPELOW: just free form. That’s sort of why do you want to do this
>>BELEU: what’s the problem what do you want
>>KOPELOW: what’s the problem
>>BELEU: what do you want the results to be?
>>KOPELOW: So, in our words our language we’re really after what’s the professional practice gap this thing is trying to address.
>>KOPELOW: You’re saying, don’t use the jargon
>>KOPELOW: But, that doesn’t mean you can’t ask what clinical problem or what patient problem or what problem of yours or what problem of your colleagues is this trying to address.
>>BELEU: Exactly. And especially opening it up to, it’s not just you it’s everyone. So that you don’t feel like the physician is on the spot. But, what have you observed? What are challenges for your department.
>>KOPELOW: So, if I observe that in my clinic only a small number of the people who need to get screened for colorectal cancer are getting screened for colorectal cancer and I want to teach about that.
>>BELEU: We’d probably do a little bit more probing into: Well. why do you think only a small number of people are getting screened? And let the physician talk.
>>KOPELOW: Great. So, this is actually a sort of a person-to-person approach to eliciting that which we’ve done in continuing medical education for a long time, which is establishing the need.
>>KOPELOW: But, you’re not doing it with a piece of paper and you’re not doing it with a form, you’re doing it with an interview.
>>BELEU: And it varies. Sometimes we try to do it with a form, but if we find that the form wasn’t filled out with enough information to really give us what the need is and what those gaps are, then absolutely, picking up the phone and calling them and saying, You know, I see this and it’s not quite enough information, but I thought maybe if we could talk for five or ten minutes and get a little bit more down. Sometimes we use online tools to share that just put it up on the screen for both people and start typing. And say OK, I’m hearing you say this, is this what you meant? Does that sound right? And kind of hash that out and get that information agreed upon and kind of more clear and go from there.
>>KOPELOW: So, tell me about going from there. I mean now that you’ve helped clarify for me why I’m doing this, and what my goals and objectives are
>>KOPELOW: what do you do about help translating that into the right educational design? Or what to measure or how to help this person contribute to that process?
>>BELEU: Going from there is the fun part, because once you’ve figured out what the problem is and what the contributing factors are to it you can kind of parse out who needs to be involved, what piece of that is related to education. And a lot of times we’ve been finding we in the last couple of years can explore a little bit more with different formats. Instead of saying here’s a problem I want to do a conference, which we had a lot of physicians come to us, I want to do a video conference or I want to do a whole days session on this. We can play around with multiple interventions throughout the year. We can bring in their colleagues within their departments, or within their specialty to contribute to that education.
>>KOPELOW: So, you moved from a meeting planner to an educational consultant, I mean that’s what you’re describing. Is that instead of writing down the time and place and what the meals should be
>>KOPELOW: you’re interaction with these people is one of intervention, of support, of professional development of them, as a teacher and educator.
>>KOPELOW: Why did you do this? Did you do this because you thought this was a good idea? Did you do this because the people in your workplace thought this was the kind of role you should take? Why did this come to be?
>>BELEU: We did this for a couple of reasons. One was, about five years ago we stopped accepting commercial support and that really freed us up to be able to ask physicians anything that they wanted to cover in terms of need. We didn’t have to worry as much about meeting a funding, something that’s fundable. And that changed the nature of the conversation, a little bit more open. The second kind of driving factor was physician learning preferences survey that we did about two years ago. Where we had some hunches that conferences might not be the best way to get information across to physicians, it was in the literature; we’d been hearing it outside of our own target audience. What we wanted to really look at what our physicians wanted. What their preferences were.
>>KOPELOW: So, what did they tell you?
>>BELEU: They told us, told us that there is a big range in our learners. We found that depending on age, gender and other issues there were certain groups of our physician group, who really didn’t want to attend conferences that were in remote locations that took a whole day or two days away from practice. A lot of the feedback that we got was that they were very time limited; they were very stressed in terms of fitting everything in to their practice. They really didn’t want to take time away on the weekend away from their families for their education. They preferred to get it in a lot of other formats. They wanted to be able to get it at their desks; they wanted to be able to do it at lunchtime or do it on their own time. And we also found that different formats were preferred by different groups within our physician audience. So, it really raised our awareness about not just that we should be doing multiple interventions, but that we would be reaching different people and their learning styles by doing different formats.
>>KOPELOW: You know the CME literature talks about success being associated with doing things in the real world in which the learners operate
>>KOPELOW: and that’s what you’re really saying back is that your, this diagnostic approach, which you started to frame as just asking questions about the need and why and what the professional practice gap, that’s just really the tip of the iceberg. Is that you individualize this educational activity around the teacher that comes in, but you’re also talking about your learners and that you’re acting as a broker of matching learning opportunities and teaching opportunities that fit. And this idea of knowing that your audience wants to learn at home is important. They want to learn in their workplace is important and this, I think, a big part of the message that you’re talking about here is this individualization. That you’re
>>KOPELOW: this is a learner-centered approach. That you’re, when I come in as a teacher, I’m still a learner. Creating a situation where I’m learning how to create and think about an educational activity a little better. So, your faculty are getting faculty development from that encounter. That’s my observation.
>>BELEU: That’s our goal.
>>KOPELOW: that’s your goal
>>BELEU: trying to go there and I think by really engaging our physician planners who come to us with an idea in identifying the gaps and the needs and giving them the language that allows them to do that, because often that information is already in their heads or at their fingertips. It frees us up to really focus on the educational intervention and do what we’re best at doing, which is not the clinical information, but the educational development.
>>KOPELOW: Thank you.
>>BELEU: You’re welcome.
This is a transcript of Effective Communication with Physician Planners.
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