Every day, CME staff and volunteers are working to make a difference for clinicians, teams, and patients. We are sharing examples of real-world exemplary practices to help build a community of practice that enables CME providers to learn from each other, continually improve their education, and demonstrate how accredited CME measurably improves healthcare.
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.
Peter Angood, MD, FRCS(C), FACS, MCCM
President and CEO
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.
Mary Carol Badat, MAdEd
Senior Director of Learning Solutions
Raising Awareness of Physical Inactivity: We developed the ACSM American Fitness Index® (Fitness Index) in partnership with the Anthem Foundation to raise awareness of high levels of physical inactivity nationwide. The Fitness Index ranks America’s 100 largest cities on a composite of health behaviors, health outcomes, community infrastructure, and local policies that support a physically active lifestyle. With the help of the Fitness Index, local officials, community groups, health organizations, and individual citizens can assess factors contributing to their city’s fitness, health, and quality of life. The rankings and scores serve as an annual evaluation tool for measuring progress at the community level. We share the rankings, scores, and indicators at our annual meeting, through a summary report, and in an online city comparison tool.
The feedback we have received is that most physicians are aware of our signature program, Exercise is Medicine, but they are less aware of how population health connects to individual health and the built environment, and they want more programs and content like the Fitness Index.
Senior Director of Education and CME Activities
Sandra J. Hoffmann, MD, FACSM
Advocacy for CME – Meeting State Requirements: In 2018, the Florida legislature passed the Controlled Substances Bill (HB 21), which required certain registered practitioners to complete a specified board-approved continuing education course to obtain authorization to prescribe controlled substances by January 2019 and as part of their biennial license renewal. This bill defined authorized CE providers as “statewide physician associations,” a definition that excluded hospitals/health systems, universities, and other provider types.
Unwilling to accept that Baptist Health South Florida (BHSF) would not be permitted to provide a state-approved version of this required course to its own physician learners, I headed to Tampa for the Florida Board of Medicine’s (FBOM) June 2018 meeting, where I made an appeal for approval of BHSF’s course. I demonstrated that physicians across the state of Florida look to Baptist Health for education that improves practice efficiencies, delivery of care, and patient outcomes. We were successful in securing approval from the Board, which supported subsequent approvals from the Boards of Podiatry, Osteopathic Medicine, and Dentistry. By the initial January 2019 deadline, Baptist Health, through our CME Program, had educated over 15,000 prescribers to help address this public health concern. We continue to offer distance learning opportunities at no charge as a service to our community—improving the delivery of care through accredited CME.
Marie Vital Acle, MPH, MCHES
Manager, CME Programs and Online Learning
Baptist Health South Florida
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.” Click here to download a PDF about our case study.
Anita Prockish, RN, BA
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.
Maxwell T. Vergo, MD and Amelia M. Cullinan, MD
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.
Addressing Opioid Abuse in Ohio: We participate in the Governor’s Cabinet Opiate Action Team (GCOAT), which was established to address the continuing epidemic of misuse, abuse, and overdose from prescription opioids. The GCOAT consists of five working groups: (1) Treatment; (2) Professional Education; (3) Public Education; (4) Enforcement; (5) Recovery Supports. Additionally, as a follow-up to state initiatives and resolutions adopted by the House of Delegates, the policymaking body of the OSMA, we provide educational activities focused on the prescribing of opioids. Our SmartRx online educational activity keeps prescribers up to date as Ohio continues to address the prescription drug abuse epidemic. To supplement our SmartRx activity, we provide additional resources for physicians and other prescribers to inform them about appropriate prescribing and clinical treatment. Our BeSmart online resources help raise awareness about Ohio’s prescription opioid misuse and addiction problem, providing links to prescribers and distributing preventative information to patients as well as information about addiction and recovery. In response to positive feedback, we recently partnered with the Ohio Hospital Association, so they can make SmartRx available to all their member hospitals in Ohio. Additionally, we recently received confirmation from five of the seven Ohio medical schools that they will start to incorporate SmartRx into their curriculum.
Director, Educational Development & Services
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.
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.
Laura Worrall, MS
Director, Office of Continuing Professional Development
Overcoming Barriers to Caring for Transgender Patients: We identified barriers to caring for transgender patients living with HIV that included both unclear institutional policies and clinicians' discomfort. Our institutional systems were not flexible enough to fully accommodate patients whose gender identity differs from their assigned sex at birth. Furthermore, some clinicians were unsure how to interact with these patients and their families in a compassionate and appropriate way. To overcome these barriers, we invited a speaker from a regional transgender equality group to our HIV lecture series to directly address specific issues, including communications, housing, and restroom facility protocol. We also invited a national expert to help us educate our clinical staff on what it means to be transgender, how young people realize that they are transgender, what medical treatments are available, and how to interact with transgender patients and families.
Our clinicians responded positively to these educational initiatives, reporting that their confidence and competence in treating and interacting with young transgender patients increased as a result. Specifically, they learned communication strategies that helped treat these patients with more compassion. Clinicians also requested additional training and discussion in this area, especially in how to handle caregivers who are resistant to using the patient’s preferred name and pronoun.
Jennifer Alessi, MA, CHCP
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.
Tymothi M. Peters
Director, Office of Continuing Medical Education
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.
Tom Weber, EdM
Associate Director, Center for Continuing Medical Education
Immunization for Immunocompromised Patients: We developed a partnership with several pediatric specialists who care for patients with conditions that compromise their immune systems (e.g., transplant, lupus, HIV). Because of their immunocompromised condition they cannot follow the immunization standard guidelines recommended by the Centers for Disease Control and Prevention and American Academy of Pediatrics. However, these patients are at higher risk of serious consequences if they are not fully immunized. The baseline assessment found immunization rates for several vaccines to be very low (around 20%). We designed and implemented a quality improvement/performance improvement (QI/PI) protocol that included all-staff education and systems changes to identify the immunization status of patients as they arrived for appointments. The project included several PDSA cycles (Plan Do Study Act) in order to reach the goal of 80% immunization rate. The final immunization rate was approximately 88%. The project also included a meeting with community Primary Care Providers (PCPs) to discuss monitoring the immunization status of their immunocompromised patients and to improve collaboration between PCPs and specialists. We generated run charts to provide feedback to the clinics and to track the impact of the protocol. The system changes and run chart feedback have been permanently integrated into most clinics.
The participants (physicians, nurses, and other clinicians) have made permanent changes in their high-risk clinics, adding standing orders to review all patients’ vaccination status. They are proud of their high immunization rates. Immunization status is part of the orientation for all new clinical staff in these units. Participants are happy with the results and view this project as part of the culture of quality at Cincinnati Children’s Hospital.
Jack Kues, PhD
Associate Dean for Continuous Professional Development
Susan P. Tyler, MEd, CHCP, PhD Candidate
Director, Continuing Medical Education
Addressing Human Trafficking: Our conference/webinar, “Human Trafficking: Training Healthcare for Policy and Prevention,” was designed to train healthcare professionals to identify, treat, and advocate for victims of human trafficking. Children who are sexually abused and neglected are at significant risk for becoming trafficking victims. There are tens of thousands of victims and survivors in the United States and more than half will see a healthcare professional, some while in captivity. Our intention was to raise awareness in the healthcare community by shifting the focus from trafficking as a criminal activity to trafficking as a psychosocial issue, and to highlight the social determinants of health. Several speakers with legal, legislative, and law enforcement expertise provided a framework of the commercial sex trade. A survivor gave her personal narrative. Psychiatrists, child psychiatrists, obstetricians, and gynecologists and the Dean of the medical school emphasized the need for such training. They provided key identifying signs and symptoms, risk factors, treatment engagement and advocacy efforts. A recording of the conference/webinar is available here (password: healthcareagainsttrafficking).
Vivian B. Pender, MD
Clinical Professor of Psychiatry
Addressing Clinician Burnout: We have held several “Leading Healthy Work Systems” workshops. This multi-session, small group activity, which takes place over the course of three months, is designed to give learners the necessary skills to recognize the physical, social, technological, and cultural attributes in their work environment that impact productivity and occupational well-being. It also aims to provide physician leaders with tools and strategies to proactively understand the systems in which they work.
Leading Healthy Work Systems is comprised of three areas of focus—system, self, and team. The system component involves a review of the overall work system, the big picture with its interdependencies, particularly the work structure and how it affects people. The second part, focusing on self, includes conversations about one’s own occupational health and well-being, reflecting on the reasons one chose to become a physician and how work life is living up to expectations. The third component, team, focuses on the needs of the health care team, with emphasis on the importance of intentional team design and resourcing.
The workshops have been well received by learners. One participant said, “Although I have participated in many leadership training programs, this one was unique in the sense that I was able to interact with physician leaders from across the entire state of Wisconsin. This experience is a must for all physician leaders during a difficult time in health care. It allows you to step back and remember why we went into medicine.”
Medical Education and Professional Development Coordinator
Improving Health Literacy: Health literacy is an individual's ability to obtain, understand, and use health information. Low health literacy is a widespread problem that can result in poor health outcomes for the individual as well as increased costs to healthcare systems.
To help clinicians better serve their patients with limited health literacy skills, we developed a Patient Education curriculum within UpToDate that facilitates clinician-patient communication. Our Patient Education content ensures that the information given to patients is aligned with the evidence-based material included in our UpToDate CME activities. We offer two levels of materials written for individuals without a medical background, covering a wide range of medical conditions including asthma, heart disease, cancer, chronic obstructive pulmonary disease (COPD), and diabetes, as well as many acute illnesses. We also offer Patient Education handouts related to pregnancy, childbirth, breastfeeding, children’s health, mental health, frequently prescribed medications, and common surgical procedures. There are more than 1,000 "Basics" articles, which are short overviews written in plain language, and more than 500 "Beyond the Basics" articles, which are longer and intended for patients seeking more detailed information. These articles are reviewed and updated regularly; they cover a wide variety of medical conditions and procedures and include illustrations, tables, and other visual aids to enhance patient understanding. The content can be reviewed with patients in the exam room, engaging patients and facilitating shared decision-making, and can also be printed or emailed for patients to review at home. By using UpToDate's Patient Education materials, clinicians can be confident that they are providing their patients with current, accurate, trustworthy information, enabling them to better understand their condition and care for themselves.
Clinicians have listed Patient Education materials as a tool that has helped change their patient management, and approximately 69 percent of UpToDate individual participants surveyed reported using our Patient Education content.
Kelly Crowley, Director of Patient Education Content
Wendy Walsh, MPH, Senior Manager of CME/CPD
Denise Gilpin, MA, VP Content Editing