Trip of a Lifetime – LSD

This May 1 article in The Independent (U.K.) outlines the history and some of the highlights (or lowlights) of the LSD era: Trip of a lifetime: How LSD rocked the world

If you are old enough to remember the 60s, you might enjoy watching these videos from that time. The first records an experiment with British troops, and the second shows an extremely stoned Jim Morrison singing Light my Fire. (Of course, you know what they say about remembering the 60s …)

How physicians learn and how to design learning experiences for them (Don Moore)

Final Report
This chapter is from the final report of Continuing Education in the Health Professions: Improving Healthcare Through Lifelong Learning, the Macy Foundation report on continuing health education.

Moore DE Jr. How physicians learn and how to design learning experiences for them. From: Continuing Education in the Health Professions: Improving Healthcare Through Lifelong Learning. New York: Josiah Macy, Jr. Foundation, 2008, p. 30-62.

Excerpt: Researchers from multiple studies over the past several years have reported that there are distressing gaps between the healthcare services that patients receive and those that they could be receiving. These studies show that many patients do not receive the best possible care, receive suboptimal care, or are victims of errors, despite the fact that approaches to care are improving and demonstrating enhanced outcomes. A variety of approaches have been suggested to address this gap. Continuing medical education (CME) has been a longstanding suggestion. For many years, however, people have expressed concerns about the effectiveness of CME. As a result, confidence in the ability of CME to address the identified gaps in healthcare delivery was not high. But significant work over the past 20 years has demonstrated the effectiveness of CME, if it is planned and implemented according to approaches that have been shown to work.

This interpretive essay reviews the evidence that describes how physicians learn and proposes six principles from that evidence and research from other fields that can be used to plan formal educational activities designed to facilitate physician learning. Next, the essay proposes an instructional design approach for designing effective formal CME activities. Finally, the essay briefly discusses assessment of formal CME activities.

Table 1. Stages of Learning
Table 2. Questions Physicians Have at Each Stage of Learning
Table 3. CME Planning that is Responsive to Questions that Physician Have at Each Stage of Learning
Table 4. Educational Methods in Formal CME
Table 5. Planning Pre-disposing CME Activities
Table 6. Planning Enabling CME Activities
Table 7. Planning Reinforcing CME Activities
Figure 1. Systems Overview of CME as an Intervention
Figure 2. Levels of Physician Learning and Assessment
APPENDIX A: How Nurses and Pharmacists Learn

Continuing Education in the Health Professions: Improving Healthcare Through Lifelong Learning (Macy Foundation) – the monograph

Final Report
The final report is available as of May 16, 2008:
Continuing Education in the Health Professions: Improving Healthcare Through Lifelong Learning. A Conference Sponsored by the Josiah Macy, Jr. Foundation. Chaired by Suzanne W. Fletcher, M.D., M.Sc. Bermuda,  November 2007. Edited by Mary Hager, Sue Russell, and Suzanne W. Fletcher, M.D., M.Sc. New York: Josiah Macy, Jr. Foundation, 2008.

How Physicians Learn and How to Design Learning Experiences for Them
—Donald E. Moore, Jr, PhD (p. 30-62)
Transforming Continuing Medical Education Through Maintainence of Certification
—F. Daniel Duffy, M.D.
Internet Continuing Education (p. 82)
—Denise Basow, M.D
Informatics Skills Needed!
—Donald A.B. Lindberg, M.D
—David C. Slawson, M.D.

Financial Support for Continuing Education in the Health Professions
—Robert Steinbrook, M.D.
—Jordan J. Cohen, M.D.

Continuing Health Professional Education Delivery in the United States
—David A. Davis, M.D., and Trina Loofbourrow, B.A.
—Pamela Mitchell, Ph.D., M.S., B.S.
Learning to Work Together to Improve the Quality of Healthcare
—Maryjoan D. Ladden, Ph.D., R.N.
—Carol Havens, M.D

—Grant S. Fletcher, M.D., M.P.H.
—James A. Clever, M.D.
—Susan W. Wesmiller, M.S., R.N.
—Regina Benjamin, M.D., M.B.A.

Continuing Medical Education: Some Important Odds and Ends
—David C. Leach, M.D.

Discussion Highlights (p. 216)
Conference Conclusions and Recommendations (p. 219)
Additional References Suggested by Conference Participants
Biographical Sketches and Statements of Potential Conflicts of Interest of Conference Participants

For reactions to the chairman’s summary of this report, see this page.

Accreditation, certification, and licensure: How six general competencies are influencing medical education and patient care

Journal of Medical Licensure and Discipline  The article below was recently published in the Journal of Medical Licensure and Discipline. This is the journal of the Federation of State Medical Boards. Copies of the article may be ordered from the journal Web site.

Mazmanian PE, Galbraith R, Miller SH, Schyve PM, Kopelow M, Thompson JN, Aparicio A, Davis DA, Kahn NB Jr. Accreditation, certification, and licensure: How six general competencies are influencing medical education and patient careJournal of Medical Licensure and Discipline 2008; 94(1):8-14.

Abstract: Lifelong learning and self-assessment are tenets of medical education and health care improvement; patient safety and quality care are essential to the accreditation of organizations providing either continuing medical education (CME) or patient care. Accredited CME providers must assess the learning needs of physicians. Accredited health care organizations must document physician participation in education that relates to the nature of care, treatment and services provided by the hospi tal. The credentialing and privileging of medical staff requires ongoing focused professional practice evaluation based on six general competencies, including compassionate care, medical knowledge, practice-based learning and improvement, effective communication, demonstrated professionalism and coordinated systems-based practice.

As those charged with assessment and program evaluation are challenged to produce valid and reliable results to improve education and health care, United States licensing authorities are defining good medical practice and considering competency-based maintenance of licenses. The present paper offers a framework to advance the discussion of relative value credits for gains assessed in knowledge, competence and performance of physicians. A more synchronized and aligned consortium of medical licensing boards, specialty boards and organizations granting practice privileges is recommended to inform the design of education and physician assessment to assure patient safety and quality improvement.

From the same issue:
What’s That Knocking?
Medical licensing boards, if they existed in a state, were unable to measure physician competence because there was no agreement on the core knowledge or skills required to be a competent physician . Medical practice has seen some profound transitions during the past few decades …

State Medical Board Responses To An Inquiry On Physician Researcher Misconduct
Misconduct in clinical research jeopardizes the integrity of medical science. Physician researcher misconduct that produces flawed results has consequences, including the subsequent inability of other physicians who rely on erroneous data to provide informed consent and/or accurate assessment of pharmaceutical and medical device efficacy and safety. This deviation from acceptable medical practice can directly harm patients. How state medical boards address this clinical problem is uncertain. To examine this issue, we asked 51 U.S. medical boards to search their databases for disciplinary action in response to physician researcher misconduct (PRM) from 1996 thru early 2007. We compared their responses with data from federal agencies responsible for disciplinary actions against clinical researchers. Our results demonstrated:
 i) a high percentage (45 percent) of U.S. medical boards indicated that they did not have or could not provide access to data adequate to address whether or not disciplinary action for PRM had been levied in their states and
 ii) of respondents able to make relevant information available, we identified only 13 cases of physician disciplinary action for PRM. In contrast, several dozen examples of disciplinary action against physicians for serious clinical research misconduct could be readily documented in publicly accessible data from federal regulatory agencies.

The effectiveness of self-assessment on the identification of learner needs, learner activity, and impact on clinical practice

beme.jpg   This new BEME Guide was just published in Medical Teacher:

Colthart I, Bagnall G, Evans A, Allbutt H, Haig A, Illing J, McKinstry B.  The effectiveness of self-assessment on the identification of learner needs, learner activity, and impact on clinical practice: BEME Guide no. 10. Med Teach 2008 Mar;30(2):124-45. [subscription required]
Read the full abstract       View the full issue

Background: Health professionals are increasingly expected to identify their own learning needs through a process of ongoing self-assessment. Self-assessment is integral to many appraisal systems and has been espoused as an important aspect of personal professional behaviour by several regulatory bodies and those developing learning outcomes for clinical students. In this review we considered the evidence base on self-assessment since Gordon’s comprehensive review in 1991. The overall aim of the present review was to determine whether specific methods of self-assessment lead to change in learning behaviour or clinical practice. Specific objectives sought evidence for effectiveness of self-assessment interventions to:
a. improve perception of learning needs;
b. promote change in learning activity;
c. improve clinical practice;
d. improve patient outcomes.

Practice points:
*There is no solid evidence base within the health professions’ literature which establishes the effectiveness of self-assessment in: identifying learner needs; influencing learning activity; changing clinical practice.
*The accuracy of self-assessment in clinical training may be improved by increasing the learner’s awareness of the standard to be achieved.
*There is some indication that practical skills in clinical training may be better self-assessed than knowledge-based activities.
*Self-assessment needs to be used as one tool amongst other sources of feedback to provide a more complete appraisal of competence in health care practice.
*Future research should address the role that self-assessment plays in the everyday practice of health care decision-making.

See also   BEME Guides in Medical Education: the series