>>SINGER: Hi, I’m Steve Singer, I’m the director of Education and Outreach at the Accreditation Council for Continuing Medical Education.
>>GEREIGE: My name is Rani Gereige I’m the Director of Education at Miami’s Children’s Hospital.
>>SINGER: Rani, thank you for joining us today.
>>GEREIGE: Thank you for having me.
>>SINGER: Tell me about the organization that you work with.
>>GEREIGE: I am currently the Director of Medical Education at Miami’s Children’s Hospital, so our hospital is a freestanding children’s hospital, one of two in the state of Florida. It has 289 beds. We house, I oversee, CME; I oversee GME and faculty development. So, I think I’m in a unique position, because I can link the teachers to their learners to even the audience, and the community, because.
>>SINGER: Right, it all comes through you.
>>GEREIGE: Yeah. So, It’s a little bit daunting task, but I think a lot of our graduates become our faculty. Or become our community physicians. So, we keep hopefully keep them connected and keep them under CME role. Our hospital has, we have 20 programs; we have a huge residency program, around 80 residents. We have 9 accredited fellowship programs. And we have around 600 or so geographic medical staff members. And then we also have volunteer faculty that also, teach our residents remotely.
>>SINGER: How is CME structured at Miami Children’s?
>>GEREIGE: We do have several recurrent series that happen weekly such as grand rounds. We have a multi-disciplinary conference that’s actually held through the radiology department, but it involves pathology, involves several specialists. We also have trauma courses. And we do have two major courses that happen every year CME course for the hospital. And then few specialties hold small courses throughout the year. We also, started this year a quarterly series that happen in the community. That actually basically outreach based on our needs assessment to our community providers. Outreach to the community and actually bring CME to them rather than having the old way of doing grand rounds
>>SINGER: So, these are for for community physicians
>>SINGER: Who are in practice in sort of like satellite centers to Children’s?
>>GEREIGE: Miami’s Children’s has several satellite centers sprinkled around all the way to from Miami Dade County to Broward County where Fort Lauderdale is to Palm Beach County. There are providers around that area and these are CME that have been meant to actually provide the faculty, because some of our centers serve also as training sites, they serve also as some of our some of those pediatricians are actually on medical staff. So, we try to serve their needs based on our needs assessment and to bring CME to them, because we could teleconference but they might have to come to the center, but some of them prefer live
>>SINGER: Sort of giving access.
>>GEREIGE: Instead of being able to, since they can drive to Miami everybody has to come to the hospital the old way
>>GEREIGE: So, we’re bringing CME to them. And those happen quarterly currently.
>>SINGER: OK. So, you just described the hospital structure and the way in which you know, CME is operating for different levels different kinds of programs. Tell me about your role within that and how the a, how you and and others that you work with manage the planning of CME.
>>GEREIGE: Absolutely. We, I chaired the CME committee as director of medical education also I oversee make sure that all the accreditation rules and our policies and procedures are followed. Also, I assist the program chairs in actually planning a very successful program that meets their needs. Our CME committee is a blend of program chairs we do also have some representatives form the training programs, like the residency program director, because also sometimes we do faculty development there links into CME. We do also have a brand new affiliation with Florida International University which is a new medical school in Florida that is State University. So, we also, have somebody on our CME committee from the medical school the chair of the department of pediatrics. So, my role is actually to assist the program chairs in actually achieving their goals, but also to keep bringing to our audience our target audience the needs that they want. So, we have to uncover those needs in several ways and sometimes making sure that the program is holding meaningful evaluations that can actually give you data back to actually improve the process. Also, to what’s new out there in the specialties that may be new policy statements that came out new guidelines that maybe pediatricians that the community needs to know about. Sometimes my sources could be also, from pediatricians in the community is basically and from the specialist is referral patterns, you know, is what if I’m an orthopedic surgeon and I feel like the community pediatricians keep referring me certain areas that could maybe have managed or maybe I wasn’t the right specialist to be referred to I think this is an area of education.
>>SINGER: OK. You mentioned you report to the chief medical officer and what are the chief medical officer’s expectations of what CME should do at Children’s?
>>GEREIGE: The chief medical officer is basically a member of what we call the leadership team and that includes pretty much all the VPs of the hospital of different areas. Also, it includes member from the board, so she, in her role she is actually a key person for us to not only look at the strategic planning of the hospital in general and the mission, but also, if there is anything coming at the hospital level in general or the community or the big picture. And she would actually provide us with that in that sense that if it links to education in some way that would probably our role in actually bringing that information out through our programs in away that actually meets the needs of the of our audience, but also our to provide competencies and making sure they we are making an impact on practices. And also, we are making an impact on our own achieving our own overall mission, including our CME mission. But, also the big picture. .
>>SINGER: OK. So, going from the big picture to the specifics of your activities, you shared with me an activity planning tool that you use which is based on the plan, do, study, act PDSA model. Can you explain a little bit about how that tool is used in, in developing your activities?
>>GEREIGE: Absolutely. I was using that tool initially as a kind of a, as a sort of a medical education in the sense that at the committee with the committee only initially to almost our self-assessment to make continuous improvement. But, I found this tool very useful in the sense also to convey to maybe some of the program chairs that might have sometimes for a time as they’re filling the application our CME application, when we talk about gaps. When we talk about you know, bridging the gaps, bridging the needs, impact, evaluations, sometimes it’s hard to grasp or to kind of especially, especially people who are in their physicians who are not have a education background might not get us what we want. And we might have to go and reiterate that back and forth. I found the tool very helpful in actually walking them through that process. I think, the way I use now the tool is if an activity is being planned originally I actually have them walk through it so as they’re doing, for example, the planning and you know, the tool asks them for you know, what are you trying to achieve? And technically if it’s a recurrent series, you know, or a yearly event that happened, you know, where did you get your sources to plan this activity? Is this, you know, if it’s a new program that’s established and or basically you look at, why did you feel the need to hold this program? And just because, also, if it is a recurrent one it will help them improve it. You know, kind of are you planning it and you realize OK that part of the planning part last year did not work so, this year here’s what I’m trying to achieve.
>>SINGER: OK. Yeah yeah.
>>GEREIGE: Achieve it.
>>SINGER: So, I see a bunch of layers here. So, one layer sort of going back to what you said about your senior leadership and the CMO that you report to is the strategic mission of the organization connected to your CME mission and saying what’s important to the organization for the organization to achieve it’s mission, for the hospital to achieve its mission may sort of come into what’s important for you to do in CME
>>SINGER: To contribute. OK that’s sort of one layer. Another layer is this idea of, of working with physicians and putting on sort of as a, a template on top of the planning process, Plan, Do, Study, Act. And it’s interesting you mentioned it sort of in two different ways, one way is Plan, Do, Study, Act, and tell me if I’m wrong, but according to their practice, you know, what am I, why am I doing this? Why do I need this education?
>>SINGER: What am I trying to solve? Or what issue am I trying to address? How, you know, am I going to use education to sort of enhance that? But then you said some of the physicians are not they may not be educators they may not have an educational background, they may not be familiar with that sort of language or that approach. And, but then you switched to talk about the sort of program improvement to say How did you do the educational program last time and how do we make it more effective this time? So, let’s sort of divide those a little bit let’s talk about the first one. About gaps and problems what I think is particularly interesting is, you’re a physician, and you work in pediatrics. And the people that you plan activities with are also physicians, people on these committees, I would assume a mixture?
>>GEREIGE: Sure, of physicians, program planners,
>>SINGER: OK. So, returning to this first part, this first concept about activity planning talking about the gap the problem that we’re trying to get addressed with education. You mentioned that that not all of those folks that you’re working with are educators or have the educational perspective so with them you’re using this Plan, Do, Study, Act template as a way to communicate with them about, what are we trying to do with this education? I would imagine that that part of you’re, the skills that you bring to being able to that facilitation come from your own background in education quality and I know that you’re also involved in public health. Tell me a little bit about your own background so that the, I don’t know if it was before you got involved in CME or sort of along the way. What are some of the things that, some of the skills acquired that you think are helpful to the role that you have now?
>>GEREIGE: Sure. Prior to my current role at Miami Children’s Hospital I was initially involved in education more at the graduate medical education level and also, at the undergraduate medical education level, medical students and residents. However, several of my other interests, one of them has also been faculty development, because as a residency director you kind of also kind of a little bit are responsible for
>>SINGER: Thrown into
>>GEREIGE: A faculty’s role as educators. So, you might have a new faculty who joined a certain practice and their teaching the residents and they’re actually maybe the medical knowledge is great but the style the evaluation, so, that’s when my interest initially kind of in faculty development for continuing education for faculty started. I was fortunate that during that time, because of my role of being residency director I was asked to sit on the CME committee of the hospital I was working at at that university. And that’s when I was more involved with CME and at that time the hospital was planning , when they were planning their big conferences other than providing input I was you know, I had a little bit more of insight on kind of a faculty needs. And that was before even I was very familiar with when the language of the ACCME related to continuing medical education. And I think with my public health, I was able to use some of my public health skills on program planning and evaluation. I look at them all at the same time, similar to planning a curriculum or to instituting any change in a community let’s say public health I was always in that kind of mind that you don’t do anything just to do it without evaluating is that making any difference. And, or is that making the difference that you intended it to make when you implemented it. So, many times I used to push the faculty when they start, I want to start the rotation on this, well fine, what are the curriculum objectives how you going to evaluate
>>SINGER: Yeah, why you’re doing this in the first place.
>>GEREIGE: Exactly. So, that’s how I initially got involved in it and then it became more a natural trend. Now, I feel like with the whole continuing education throughout the continuum medical students to residents to faculty or even to practicing physicians I think it’s all almost a template, it’s the same, I mean you’re just, you’re just kind of trying to achieve a competence or a certain type of skill set or a, an impact even if you look at the long term impact on a wider population from a public health standpoint, you know, you taught them to do something and it reflected on the general population. This was always an interest for me.
>>SINGER: Yeah, so the a, you know it’s fascinating in our conversations we’re talking about something else now, but I like this, the direction that it’s going, because what I’m seeing is that when you talk in your introduction about your responsibilities at the hospital, you know you talked about the responsibilities over these different you know graduate medical education as well as CME. And then you talked about the planning and the different people that you’re working with and now I’m seeing in your perspectives a master plan that what you’re doing is that you’re talking the template of what you have studied and the things that you know about faculty development so that for you CME planning in your committee work with these other health professionals is both about helping them to develop CME, but is also, helping them to become educators.
>>GEREIGE: Yes helping
>>SINGER: Helping them to become better educators.
>>GEREIGE: Absolutely. I think my the PDSA model I was initially, I was using it for my own within my own committee for our CME program improvement in general at the hospital I felt that would be useful not only at the program level or at the activity level, but also it is a very useful educational tool for this maybe this physician whose been chairing this activity for the past 20 years. To actually help them, walk the through them steps of the making meaningful changes, and maybe the changes were always there and maybe the program was achieving exactly the outcome that it was intended to achieve, but maybe it was never captured or used when you’re really doing another PDSA cycle on that program was never used to say, how am I going to make any change based on another cycle of activity. So, I started now using it more as, one way it’s a selfish way it’s getting me what I need, because I’m trying to convey to the program chairs, here’s how you kind of do it, but without being too prescriptive. I think the form helps them almost like a self-reflection form and but also, I think, for some of them who maybe that’s the first time they hear the word PDSA or QI or even some of the languages that are in the formulated to the CME Criteria, ACCME Criteria I think it’s also even a, I look at it also as it’s almost a faculty development for those faculty, who maybe they have the interest in CME that’s why they keep holding their CME programs every year or they want to improve their own skills and in holding CME meetings making them more valuable.
>>SINGER: A lot of CME professionals in the role, the kind of roles that you have spend a lot of time interacting with physicians and you being a physician gives me opportunity to ask you about how what advice you would have for them in how best to engage physicians that they work with or physicians on their committee around this PDSA model, you know, in this context of becoming better educators what are some of the ways to try to recruit physicians to embracing that and carrying that forward?
>>GEREIGE: I think the key is to maybe the first step is maybe to reach out to maybe every division, because my need a wide variety of specialties specialty I’m only in pediatrics so my Children’s Hospital, so, but somebody might be in a big university where CME could bridge several specialties. Is to reach out to every division maybe have a champion from that division who might be interested or maybe have the interest or maybe the background, that maybe that CME director doesn’t know that there is somebody in the division of otolaryngology with a education background . First reaching out and bringing those champions together and letting them come onboard in different ways. I f they need more education or a little faculty development on the PDSA cycle process and the tool and using them more as going back to their division and kind of as they’re planning their programs or any curricula activity of using that model and kind of spreading it. Now, if there is, if that doesn’t work the next way the next thing to maybe do is to appeal to what the physicians are looking for and when you talk about physicians, who are interested in education especially and is basically meeting the needs of the of their specialty in the sense from the educational standpoint. And I like that you mentioned earlier about the idea of interviews face-to-face with the division I think maybe the division the CME director could maybe put ask to be take maybe 10 minutes or 15 minutes from one of the division meetings agenda and kind of talk about CME; talk about, look at the needs of that division and what from the CME medical education standpoint and do more like a SWAT analysis, you know, to see where they are, is there interest is there and then , and then they might be able to recruit somebody.
>>SINGER: So in that transition, because you mentioned before you and me graduate education graduate medical education that the performance or practice based concerns at those different levels evolve, right? Graduate education has its own sort of construct about achieving competence.
>>SINGER: Generally or specifically. But, as you move from, from GME to CME that the offering the value that you’re suggesting that you’re bringing is to say that the needs the educational needs of those physicians evolved not only to helping to solve problems in practice sort of the broader picture of CME but very specifically that there’s a need for them to evolve as educators as participants in an educational way of life.
>>SINGER: You know, so that and you’ve shared some very interesting perspectives about how you’re able to sort of bridge them from GME to practice you know, from graduate medical education to practice in that endeavor. Thank you very much.
>>GEREIGE: thank you, thank you very much.
This is a transcript of Using CME to Engage Community Physicians in Quality and Teaching.
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