Learning in the Workplace:
Role of CME/CPD
SACME Fall Meeting 2015
Baltimore, November 13, 2015
 What does - workplace learning -
mean to you?
Panel
Moderator:
Mila Kostic, CHCP, FACEHP
Director of CME
Perelman School of Medicine
at the University of Pennsylvania
Suzanne Ziemnik, MEd
Vice President of Continuing Professional
Development
The American Society for Clinical
Pathology
Jack Dolcourt, MD, MEd
Associate Dean for CME, Medical
Graphics and Photography
Professor of Pediatrics,
University of Utah School of Medicine
Betsy White Williams, PhD, MPH
Professional Renewal Center®
Department of Psychiatry
School of Medicine, University of Kansas
Mindi McKenna, PhD, MBA
CME Division Director for
American Academy of Family Physicians
Julie White, MS, CHCP
Director, Continuing Medical Education
Boston University School of Medicine
Learning as a process, not an outcome

Learning is a process whereby knowledge is created through a
transformation of experience. (D. Kolb’s Experiential Learning
Model)
-
Formal Learning – defined goals and outcomes, usually in
canonical occupational knowledge
-
Informal Learning – largely learning from experience, no set
expectation or outcome
-
Incidental Learning – unplanned by learner or instructor, mostly
workplace learning
- Just-in-time or at the point-of-care learning
Workplace Learning

Is the way in which individuals or groups acquire,
interpret, reorganize, change, or assimilate a related
cluster of information, skills and feelings. It is also primary
to the way in which people construct meaning in their
personal and shared organizational lives. (Marsick, 1987)
(Davis DA, 2010 Lifelong Learning in Medicine and Nursing Report)

Learning and change in the health professions – Vision and
Recommendations

CE Methods, IPE, Lifelong Learning, Workplace Learning,
Learning at the point of care
Workplace Learning- Increasingly Important

“The greatest proportion – perhaps as much as 90 %
of learning occurs incidentally … including exposure
to the opinions and practices of others also working
in the same context”
Workplace Learning link to Quality, Safety and Team Work

“To raise quality, health care managers will reposition
CPD from a developmental tool for individuals to a
strategic tool for the care delivery unit”.
(Cervero RM, 2000)
Stephen Billett, Readiness and learning in health care
education, THE CLINICAL TEACHER 2015; 12: 1–6
Learning as an experience
Readiness refers to an individual’s ability to learn from what they
know, can do and value (i.e. their conceptual, procedural and
dispositional capacities).
Conceptual knowledge
(what individuals know)
Procedural knowledge
(what individuals can do)
Dispositional knowledge
(what individuals value)
Interdependence amongst conceptual, procedural and dispositional knowledge
Aligning experience is critical
We must pay attention to assessing readiness to learn at all 3 levels
 Is there a role for us to play
learning?
in the workplace
 What are we already doing?
The Huddle
Society for Academic CME
Panel: Role of CME/CPD in the Workplace Learning
November 13, 2015
Jack Dolcourt, MD, MEd
Associate Dean for CME, Medical Graphics and Photography
Professor of Pediatrics
University of Utah School of Medicine
Daily Huddle – Census Rounds
•
•
10+ years in 3 Newborn ICU (NICU) in
SLC
Predictable start time & location
– Expectation: drop everything and show up
•
Evolution
– Nursing: bed availability for new admissions
– Administration: anticipated discharges and
staffing
– Rounding strategy
Evolution to include Safety
•
•
Q1 2014 Zero Harm Initiative
Culture change
– All meetings begin querying safety issues
– Empowering
•
Identifying safety issues beginning of
NICU census rounds
– Interdisciplinary team (physician, APRN,
dietician, pharmacist, discharge planner,
social work, head nurse, team leaders etc)
Examples of Types of Issues
Mostly no physical harm resulted
• Communication
• System structure
• Medication or feeding errors
• Laboratory errors and mistiming
• Staff safety
• Parents inconvenienced by outside
vendors
Opportunity for certified CIPE
•
Formal instruction component
– Dynamic & relevant to workplace
– Relatively consistent group of participants
– Interprofessional learners and teachers
» Team function
» Interaction and opportunity for reflection
– Track changes – PDSA cycle
About Credit?
 Is
it in the way?
 Does it help?
How AAFP’s Credit System
Supports Workplace
Learning
panel presentation at the Society for Academic CME (SACME) fall meeting
Baltimore November 13, 2015
Mindi McKenna, PhD, MBA
CME Division Director for AAFP
Mindi McKenna, PhD, MBA
Context for My Comments
(Disclosure)
CME Division Director
American Academy of Family Physicians
Disclosure: AAFP manages one of the USA’s 3 CME credit systems,
which reviews and approves thousands of learning activities each year for AAFP
credit.
Author of 2 books: “High Tech Medicine” and “Physicians as Leaders” with P. Pugno, MD
Previous Affiliations / Responsibilities:
•
Executive Director, Healthcare Leadership Group
•
Faculty, Rockhurst University, Health Care Leadership MBA Program
•
VP of Business Development & Marketing, Cerner Corporation (medical software)
•
Director, Marion Laboratories / Marion Merrell Dow (pharmaceutical research and
manufacturing)
Myths and misconceptions about CME credit
(health care is changing … is CME?)
• MYTH: “Certified / accredited" CME must be costly and
complex.
• FACT: Small, basic, practice-relevant activities can qualify
for CME credit.
• MYTH: CME must be “formal.”
• FACT: Some informal learning activities qualify for CME.
18
Misconceptions and myths about CME credit
(health care is changing … is CME?)
• MYTH: CME doesn’t align with workplace learning.
• FACT: Point of Care (POC-CME) credits HCPs for
learning and improving in practice.
• FACT: CME credits “learning-from-teaching /
scholarship.”
• FACT: Simulation activities often qualify for CME credit.
19
Misconceptions and myths about CME credit
(health care is changing … is CME?)
• MYTH: CME doesn’t align with QI or health system
priorities.
• FACT: PI-CME credits HCPs for measuring patient
care; for learning and changing; then re-measuring.
• FACT: PI-CME often meets MOC Part IV
requirements.
20
Misconceptions and myths about CME credit
(health care is changing … is CME?)
• MYTH: CME doesn’t align with HCP’s other requirements.
• FACT: AAFP tracks which ACGME/ABMS core
competencies are addressed by the many thousands of
CME activities we certify each year.
• MYTH: CME hasn’t changed in decades.
• FACT: AAFP is launching “t2p” which credits HCPs for
“Translating To Practice” what they are learning through
commitment to change, barrier mitigation, reminders and
support.
21
 What more could we be doing?
Or differently?
A-B-C, Think – Pair - Share



“A” How may that look like in academic CPD practice?
“B” What skills, values and resources do we have that
can support us?
“C” Is there anything we need from other CPD
stakeholders and how do we get it?
Silent Reflection (2 minutes)
Table Sharing (8 minutes)
Large Group Sharing (10 minutes)
Julie White, MS, CHCP
Director, Continuing Medical Education
Boston University School of Medicine
Boston University School of Medicine | Continuing Medical Education
Experience from 20 PI CME Programs
• Insert ourselves into the workflow
• Provide on-going project management
• Facilitate identification and implementation of
interventions
• Assemble resources – clinicians from other
departments, students, external services
• Offer CME/CNE credit and garner MOC IV approval
• Assistance with grant development and publications
• Making it meaningful to practice – encourage team
participation
Experience from the Sim Lab and OSCEs
•
•
•
•
•
Offer credit
Promote event
Educational design
Project management
Resource acquisition (space,
equipment, staffing, food)
Online Educational Resources
• Curriculum design
• Application of adult education principles
• Promotion/consumer behavior
consultation
• Offer credit
• LMS
Visionaries …
• Aligning MOC, OPPE, MOL, CLER, QI
• Bring in expertise from other fields – education,
management, public health, …
• Overcome barriers, align resources, see beyond
the silos
Workplace Learning (Virtually):
Is there a role for CPD?
Suzanne Ziemnik
Vice President of Continuing Professional Development
SACME
November 13, 2015
Workplace Learning
• “The way in which individuals or groups acquire,
interpret, reorganize, change or assimilate a related
cluster of information, skills and feelings, and a means by
which health professionals construct meaning in their
personal and organizational lives” (Marsick, 1987)
• Contextual learning
• Not necessarily designated for credit in traditional CE
frameworks
Opportunities in Pathology
• Pathology is becoming digital
• Full Slide Scans -3gb an image
• Crowdsourcing & sharing have become mainstream
• Virtual Training
• Shared Viewing
• Image Annotations
• Machine Learning
• Image Comparison
• Clinical Decision Support
PathInsights GI: Tools for Creation, Content for
Consumption
PathInsights GI includes dynamic learning and collaboration
resources:
• Comprehensive information set with personalized curation
tools
• Peer collaboration tool
• Master class online microscope
• Expert teaching collections
• Related study materials
• GI specific CME
• Case studies in presentation mode
Peer Collaboration Tool
• Pathologists virtually share their diagnostic problems directly
with each other
• Peer dialogue on problematic details of the patient case
• Tool allows for the permanent capture and subsequent reuse
of the teachable moment
Communities of Practice
Communities of Practice
Workplace Learning:
What is the Role of
CME/CPD
Betsy White Williams, Ph.D., M.P.H.
Professional Renewal Center®
Department of Psychiatry
School of Medicine, University of Kansas
University of Kansas
Workplace Learning
Social Cognitive Theory
• Learning occurs in a social context with a dynamic and
reciprocal interaction between the person, the
environment and behavior.
• There is an emphasis on social influence and its
influence on external and internal reinforcement.
• Considers how people acquire and maintain behavior
while considering the social environment in which the
individual behaves.
• Recognizes past experiences which play a role in
whether behavior will occur.
Bandura, 1986
37
Workplace Learning
• In the research of each
of the bases of
performance:
Organizational, Team, Individual
Performance
• Cognitive
• Behavioral, and
• Environmental
• The whole cannot be
fully understood
without reference to
the linkages among the
three
Behavioral
Factors
Cognitive
Factors
Environmental
Factors
Workplace Learning
• Basic dichotomy
• Formal Learning
• Attendance at CPD
event at workplace
• Completion of on-line
training module
• Informal Learning
• Happens through
experience and
interactions
• Is indirectly judged as to
outcome
Workplace
Learning
Formal
Learning
Informal
Learning
Workplace Learning
• Learning organization (Sengue, 1990)
…...”organizations where people continually expand their
capacity to create the results they truly desire, where
new and expansive patterns of thinking are nurtured,
where collective aspiration is set free, and where people
are continually learning to see the whole together.”
…. “in situations of rapid change only those that are
flexible, adaptive and productive will excel. For this to
happen, it is argued, organizations need to ‘discover how
to tap people’s commitment and capacity to learn at all
levels’
40
Workplace Learning
System
Team
Interpersonal
Skills
Knowledge/
Procedure
• Each area of the organization has
a place for, indeed should be a
focus of, CME/CPD
• To date we have focused on
personal mastery
• There has been increased
focused on
interprofessional/team
learning
• More opportunity for
CME/CPD exists at higher
levels of the organization
In Summary
 What does - workplace learning - mean to you?
 Some ideas about what we are already doing




Case conferences and quality rounds, huddles
QI work, faculty development
Danger of hidden curriculum
Contributing in non-credited practice improvement
 What we have to pay attention to
Context of the workplace – learning environment
Assessing readiness to learn (change) in all 3
domains of knowledge
 Dispositional readiness is central to the quality of
engagement and learning through clinical practice to
secure appropriation of healthcare knowledge
(beyond superficial engagement)


To learn more
- Valsiner J, van der Veer R. The social mind: The construction of an idea.
Cambridge, UK: Cambridge University Press; 2000.
- Cole M. The zone of proximal development where culture and cognition create
each other. In: Wertsch JV (ed.) Culture, communication and cognition: Vygotskian
perspectives. Cambridge, UK: Cambridge University Press; 1985: pp. 146–161.
- M. W. J. van de Wiel et al. Exploring deliberate practice in medicine: how do
physicians learn in the workplace? Adv in Health Sci Educ (2011) 16:81–95 DOI
10.1007/s10459-010-9246-3
- Davis DA, 2010 Lifelong learning in Medicine and Nursing report
- Stephen Billett, Readiness and learning in health care education, THE CLINICAL
TEACHER 2015; 12: 1–6
- John Parboosingh FRCSC, FRCOGJ, Workplace Learning, First Regional
Conference and 9th National Workshop on Continuing Professional
Development (CPD) of Physicians
- E. Wenger, 1999 Communities of Practice
- Ericsson KA, Deliberate Practice, 2004, 2006
- Wertsch JV. Mind as action. New York: Oxford University Press; 1998.