Reimagining Education

Offering MOC: We saw offering Maintenance of Certification points as a great opportunity to give something to our physicians without burdening them with extra work. It’s important for us to engage our physicians with relevant education, and they were very excited to take advantage of the opportunity to receive CME and MOC at the same time. We were able to offer MOC for a wide variety of topics including pediatric trauma, digestive health, emergency and critical care ultrasounds, and longitudinal progression of complex trauma and addiction. Plus, offering MOC was relatively easy for us, as an organization, too. We were already providing CME activities, so all we had to do was ensure the education meets the boards’ requirements, register the activities in the Program and Activity Reporting System (PARS) for MOC, and ask the learner for his or her birthday (month and day) and learner ID. Then, following the activity, we reported the learner data in PARS. Learn more.

Collaborating to Address Postpartum Hemorrhage: In the US, hemorrhage is a leading cause of maternal death, yet many of these deaths are preventable. The need for real-life training is especially great in rural areas, where the maternal death rate is up to 64 percent higher than in urban areas. To address that need, we formed a collaboration with Heartland Health Alliance, Bryan College of Health Sciences, Bryan Medical Center, and Benjamin Byers, DO, Center for Maternal & Fetal Care, to present an interdisciplinary OB Simulation for Postpartum Hemorrhage onsite at 12 rural communities across Nebraska. The activity utilized assigned prework reading on the American College of Obstetricians and Gynecologists (ACOG) clinical guidelines, didactic lecture, hands on simulation with a fully functioning OB mannequin, and a physician roundtable debrief. The activity reached 34 physicians, 10 advanced-practice providers, and 107 additional OB team members at their own facilities. Following the activity, physicians across the communities reported plans to develop and implement healthcare quality improvement measures. Jared Kramer, MD, Howard County Medical Center, stated, “A week after our OB team completed the simulation training program, we put our training to work in a postpartum hemorrhage requiring a massive transfusion protocol. The simulation was invaluable.” Read more. 

Improving Access to Data: Studies have shown that by analyzing complex data sets, clinicians can identify patterns that can improve patient care, yet institutional surveys showed a lack of clinician knowledge regarding access to quality data. In response, our team collaborated with the Center for Quality to develop educational sessions that increase clinicians’ engagement with big data. Topics such as “UCM Data: What's Available & How Can I Get It?” and “Avoiding Simple Solutions for Complex Healthcare Problems” are chosen based on needs identified by QI professionals in their interactions with clinicians. Evaluation results have shown participants are now more likely to use evidence-based data in their clinical decision making, and several QI projects have originated from these sessions. Average attendance has more than doubled since the project’s inception, and we hope to continue to expand its reach to encourage clinician interaction with big data. Learn more.

Promoting Patient Safety: We worked with the National Patient Safety Foundation to produce “Championing Patient Safety,” a video about how leadership is the key to patient safety. The video highlights five key themes: education, care integration, patient engagement, workforce safety, and transparency. By doing so, this video reinforces the need for physician leaders to ensure these topics are considered in their daily work. Learn more.

Addressing Prejudice: We recognized that clinicians’ prejudices were preventing them from improving their practice and patient care. During our Annual Diversity week, we conducted a series of presentations and panels on topics such as gender identity, gay and lesbian communities, and care of transgender patients. Speakers included Southern Illinois University School of Medicine (SIU SOM) faculty or staff, a transgender teen who spoke about his experiences as a patient in a local pediatric clinic, and several members of local community organizations, including a team from The Phoenix Center, a local LGBTQ Community Center. Diversity Week began in 2009 and has steadily increased in attendance each year. No longer confined to just one week in October, additional educational opportunities on diversity issues have been added throughout the year. Following the activity, many participants shared that they intended to make specific changes in their work processes as a result of the education they received, from changing language used on patient intake forms and during a patient history interview to increased sensitivity when treating LGBTQ+ patients. Learn more.

Improving Cultural Competencies: We developed several ongoing CME activities that teach competencies in the treatment of patients from diverse cultures, including a regular monthly series on caring for vulnerable populations, a recurring course addressing care in the Asian population, a recurring course on developmental disabilities for clinicians and families, and a biennial Transgender Health Summit. After participating in these CME activities, clinicians reported increased abilities to deliver care in a culturally-aware manner, with humility, empathy, and sensitivity. One clinician stated, “This was a refreshingly human look at medicine, really important to remind ourselves of the humanity of both our patients and ourselves and I think the course did a really great job of that, while addressing the specific needs of this population.” At a 90-day follow-up, learners at one of the courses reported that they had implemented at least one policy change in their care of Asian patients; improved their diagnosis and treatment of thyroid cancers; reduced the excessive use of antibiotics; and increased Hepatitis B screening for Asians. Learn more.

Monitoring the Healthcare Landscape: We use surveys of our members and our advocacy council to monitor the national healthcare landscape and identify factors outside of our control that impact patient outcomes, such as reimbursement and insurance issues, obstacles with ineffective electronic health records systems, organizational culture and systems-based issues at healthcare institutions, and a general lack of resources. In one instance, member feedback identified issues with billing and reimbursement for allergen extracts. The Practice Management Committee viewed this as a perfect opportunity for using education as a strategy for improving practice around this issue. We responded by developing webinars and toolkits to improve understanding among clinicians and their teams. As a result, patients’ access to allergen extract treatments increased through better billing and reimbursement practices. Learn more.

Training Faculty as Mentors and Coaches: Research has shown that most doctors avoid having advance care planning conversations, largely because they don’t feel confident in leading them. In response, we used mentoring to improve internal medicine residents’ skills in advance care planning conversations to elicit seriously ill patients’ values and goals, and to guide their patients towards treatments that will match those preferences. We trained hospitalist and ambulatory faculty mentors to observe and coach the residents through practicing these conversations with their patients. Mentors were chosen based on their demonstrated commitment to resident education and interest in improving their own communication skills. We trained the mentors in a full-day CME activity, first training them in the Serious Illness Conversation Guide, a structured interview tool to help clinicians have high-quality advance care planning conversations with their patients, using simulated patients, and then training them in mentoring, using simulated learners. The mentors were taught to provide feedback to their learners powered by VitalTalk bedside coaching methodology. After this training, faculty were likely to change their clinical and teaching practices, frequently use the communication and teaching skills, and regularly encourage other faculty to use these skills. They greatly value the individualized feedback they received as clinicians and educators. As a result of participating in this activity, internal medicine residents gained significant skills in serious illness conversations, which were maintained through the 6-month duration of the program. Learn more.

Preventing Medical Errors: We identified a lack of skills in interprofessional teamwork and communication as a contributing factor to medical errors. To address this barrier, we present CME that incorporates strategies for improving communications, such as root cause analysis, cross-referencing written directions, verifying verbal directions in writing, enhancing rapport, and validating written prescriptions that may be misread, incorrect, or inappropriate. One focus of this activity is to teach participants how to implement a series of steps to mitigate potential errors by sharing facts, inviting dialogue, and developing a mutual plan among HCPs and with patients. This is done by reviewing multiple real case examples then developing strategies to respond to such problems and prevent them in the future. Strategies include implementing surgical safety and pharmacy checklists, and disclosing a medical error by expressing concern and empathy, but not blaming, and presenting a plan. Participants reported that as a result of the activity, they intended to make changes in their practice, including the following: communicate with other clinicians involved in the patient’s care, contact the patient’s pharmacy to reconcile the medication list, communicate clearly with patients, improve documentation and checklists, and have patients bring all medication bottles to each clinical visit. Learn more.