Focus on Quality
Perspective
Bridging the Medical Education and Quality Cancer Care Divide: A Call to Action By N. Lynn Henry, MD, PhD, Debra A. Patt, MD, MPH, MBA, Michael O. Meyers, MD, Monica Malik, MD, Jennifer Bretsch, MS, CPHQ, Carmen Jackson, PMP, Anne Grupe, MS Ed, and Jamie Von Roenn, MD
The ASCO mission is “conquering cancer through research, education, prevention, and delivery of high-quality patient care.”1 Keys to fulfilling this mission are highlighted in two ASCO vision statements: (1) to provide oncology providers and patients with accurate cancer information so that informed decisions can be made about prevention and treatment, and (2) to provide resources so clinicians can provide optimal patient care. In the 50 years since ASCO was founded, it has developed an extensive infrastructure to support both the educational needs of oncology providers and the resources required for those providers to provide high-quality care. However, education and quality have not been fully aligned or even integrated, but rather have been developed and continue to exist primarily in parallel. As members of the 2013 to 2014 ASCO Leadership Development Program, we were tasked by the ASCO Board of Directors to explore how to optimize integration of these key aspects of oncology care in order to facilitate continuous quality improvement for the practicing oncologist. We were asked specifically how ASCO can better leverage its educational portfolio to improve its quality improvement goals. This perspective is a synopsis of our findings and key recommendations.
Current ASCO Offerings Provider Education ASCO has developed a suite of educational offerings that are available in person, in print, and digitally (Table 1). For decades, ASCO has offeredthein-personAnnualMeetingandJournalofClinicalOncology. During the past 10 years, ASCO has greatly expanded its offerings through the establishment of multiple thematic meetings, as well as the Journal of Oncology Practice and daily and monthly news updates. In addition, ASCO University offers a wide range of digital education, including webinars and tumor boards, designed to improve knowledge about the management of cancer and practice administration, as well as products for Maintenance of Certification.2 Most recently, ASCO has expanded its offerings beyond practicing oncologists to include both Fellows and Advanced Practice Providers.
Quality Improvement ASCO resources focused on quality care include reporting programs like the Quality Oncology Practice Initiative (QOPI) and the skills-based Quality Training Program.3,4 QOPI, established 424
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Table 1. Highlights of Currently Available ASCO Educational Materials Educational Offering
Example
In-person meetings
Annual Meeting Specific tumor type (eg, breast, GI, GU Symposium) Other thematic meeting (eg, Quality Care Symposium, Palliative Care Symposium)
In print
Journal of Clinical Oncology Journal of Oncology Practice ASCO Post
ASCO University (Web based)
Cancer management (eg, tumor board, literature review) Maintenance of Certification test Practice administration Daily Medical Education
Abbreviation: GU, genitourinary.
in 2002, is a practice-based quality assessment and improvement initiative. Historically, data are abstracted twice a year by participating practices from patient records to determine compliance with specified metrics designed to assess both structures and processes of care. This system allows practices to compare their results with national data and to develop targeted practice improvement plans. In addition, practices that meet specific quality benchmarks can achieve QOPI certification, an accomplishment recognized by some external stakeholders, including some payers. The recognition that quality measurement alone does not lead to quality improvement and the perceived need for skills-based, hands-on training led to the launch of the ASCO Quality Training Program, which was pilot tested in 2013.5 Its mission is “to teach oncology providers to engage in successful quality improvement activities and to train oncologists to champion quality initiatives.”5 ASCO develops guidelines focused on specific aspects of cancer care and delivery of care in order to disseminate information about appropriate cancer care to providers quickly and efficiently.4,6 ASCO has partnered with institutions such as the National Comprehensive Cancer Network to develop and re-evaluate quality metrics to help guide oncology care.4,6,7 A number of other initiatives focus on improving the care of cancer patients and include templates for chemotherapy consent and an ASCO/Oncology Nursing Society collaboration on safe chemotherapy administration.8 More recently, ASCO has launched the Virtual Learning
V O L . 11, I S S U E 5
Copyright © 2015 by American Society of Clinical Oncology
Downloaded from jop.ascopubs.org on November 20, 2015. For personal use only. No other uses without permission. Copyright © 2015 American Society of Clinical Oncology. All rights reserved.
University of Michigan Medical School, Ann Arbor, MI; Texas Oncology, Austin, TX; University of North Carolina School of Medicine, Chapel Hill, NC; Nizam’s Institute of Medical Sciences, Hyderabad, India; and American Society of Clinical Oncology, Alexandria, VA
Medical Education and Quality Cancer Care
Collaborative, a pilot study designed to incorporate palliative care– focused quality improvement activities into practice, including an evidence-based toolbox.4 All of these resources serve to address improvements in care of the patient with cancer across a broad spectrum that include not only improving knowledge, but also disseminating best practices, translating knowledge into practice, and assessing the quality of care delivered.
Studies have demonstrated that, in general, physicians do a poor job identifying their knowledge gaps and tend to educate themselves about their interests rather than their deficiencies.9-11 Although QOPI has represented a significant step forward in evaluating quality of cancer care through identification of poor compliance with quality metrics at the practice level, it typically does not provide data about compliance with metrics on an individual provider level.12,13 The future of provider-level reporting of knowledge deficiencies within ASCO lies in the development of CancerLinQ.14,15 This signature ASCO program is currently in development and is envisioned to be a rapid-learning system that will leverage the electronic health record and other relevant data sources by automatically accepting electronic data from participating practices, reducing the burden of repeated manual abstraction and allowing a broader scope of patients to be evaluated. This system will allow data to be analyzed at the level of the individual provider in addition to larger practice-based reporting, thereby assisting providers with the identification of both gaps in knowledge and poor compliance with practice guidelines. Overall, these changes will allow a more precise picture of cancer care and afford an opportunity to not only identify more clearly areas of educational need, but also further align educational resources with those needs in a targeted fashion, seamlessly tying education to quality improvement.
Development of Educational Offerings Targeted Toward Quality Improvement Once a knowledge gap has been identified, the provider could be directed to relevant ASCO educational offerings in order to raise the knowledge level needed to support behavioral change. This could be done in real time, allowing for immediate feedback and the potential for better contextual learning and retention. Over time, the provider and other stakeholders would be able to reassess concordance with a particular metric and would be able to determine whether the targeted education resulted in a change in behavior that translated into improvements in the quality of care. Importantly, this approach could also enable ASCO to identify recurring deficiencies in knowledge across providers to help define the topics for new ASCO educational products, including digital offerings, question banks, journal review articles, and educational sessions at meetings. In the current climate, in which people are becoming accustomed to accessing information quickly and easily on mobile platforms and at point of service, traditional lecture-based learning can be inconvenient and impractical. ASCO needs to both repackage Copyright © 2015 by American Society of Clinical Oncology
Incorporation of Quality Improvement Strategies Into Clinical Practice Pilot studies of dashboard quality reporting suggest that clinicians prefer a quality report that not only presents structured data, but also facilitates implementation of improvement efforts.24 ASCO has been a leader in improving the quality of cancer care through the development of a repertoire of resources including practice guidelines, quality metrics, a dedicated journal, and a thematic meeting.4 ASCO has begun to integrate the information and recommendations contained within new ASCO guidelines into quality metrics associated with specific QOPI measures. These metrics can be linked to concise educational products directed toward the recommendations that are accessible at point of care. In addition, Table 2. Recommendations for ASCO to Enhance the Connection Between Oncology Provider Education and Quality of Patient Care Seamlessly connect the education and quality improvement aspects of the organization Inform providers about where to focus their educational efforts, based on quality reporting systems, and provide direct links to ASCO educational resources Reformat educational offerings to make them more concise and engaging for the user. Facilitate performance of practice improvement activities for Maintenance of Certification and to improve the quality of patient care.
S E P T E M B E R 2015
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jop.ascopubs.org
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Downloaded from jop.ascopubs.org on November 20, 2015. For personal use only. No other uses without permission. Copyright © 2015 American Society of Clinical Oncology. All rights reserved.
Improving Quality Through Education Assessment of Deficiencies in Knowledge
existing educational content and develop new materials to make educational offerings more concise and effective. In addition, making the information easily accessible at point of care, such as on hand-held devices or integrated into electronic medical record systems, would facilitate implementation in the patient care setting and could also permit direct links to clinical toolkits and decision support programs. ASCO also needs to embrace new and novel educational methods as technology improves our ability to deliver content in meaningful and relevant ways. Research suggests that interactivity, flexibility, continuity, and relevance to learners’ practices are major characteristics of successful education programs.16,17 Novel interactive educational methods, such as spaced education, may enhance both access to information and retention of knowledge.18 The basic tenet underlying spaced education is that information repeated over spaced intervals is better learned and more effectively retained than when it is presented only once. In addition, long-term retention is significantly improved by repeatedly testing learners.19-22 ASCO has recently implemented learning using these principles in its Daily Medical Education program, which is currently being tested to educate fellows about palliative care.23 It could be further expanded to include programs specifically designed to reinforce new knowledge, enhance dissemination of new guidelines, address common deficiencies in quality metrics, and advance international educational initiatives using a variety of technologydriven delivery platforms. Ultimately, the goal is to link compliance with quality metrics to relevant educational tools in order to promote efficient, directed learning. In turn, that knowledge can be directly applied to improve the quality of patient care.
Henry et al
clinical toolkits and decision support tools can be developed to help facilitate adoption of guidelines.4 ASCO also launched the Practice Guidelines Implementation Network (PGIN), a working group that focuses on the dissemination and implementation of ASCO guidelines and provides perspectives on guideline implementation in a variety of practice settings.25 Through development of these resources, ASCO can enable more rapid adoption and implementation of guidelines and other quality improvement measures to enhance the care of patients with cancer.
In summary, ASCO serves as a tremendous resource for oncology providers as they seek to provide the highest quality care for patients with cancer. ASCO has already developed extensive educational offerings and quality improvement programs. In addition, the new initiatives that ASCO is pursuing, such as CancerLinQ and the Virtual Learning Collaborative, afford great opportunities to achieve these goals. However, success will require prioritizing education, increasing resources, thinking in novel ways, and being willing to deviate from traditional paradigms. In our assessment, there are several key steps required to attain these goals (Table 2). In particular, in order to seamlessly connect the education and quality aspects of the organization ASCO should devise a system to foster collaboration and integration between its education and quality improvement efforts. This could be accomplished through either the creation of a new committee linking these two ASCO endeavors—education and quality improvement—or by designating staff members to serve as a permanent connection between the two existing groups. In addition, the educational offerings must be restruc-
Acknowledgment N.L.H. was supported in part, through her institution, by a National Cancer Institute Clinical Cancer Investigator Team Leadership Award (supplement to Grant No. 3-P30-CA04592). We thank the ASCO Leadership Development Program for its support. Authors’ Disclosures of Potential Conflicts of Interest Disclosures provided by the authors are available with this article at jop.ascopubs.org.
Author Contributions Conception and design: All authors Collection and assembly of data: All authors Data analysis and interpretation: All authors Manuscript writing: All authors Final approval of manuscript: All authors Corresponding author: N. Lynn Henry, MD, PhD, 1500 East Medical Center Dr, Med Inn Bldg C450, Ann Arbor, MI 48109-5843; e-mail: [email protected].
DOI: 10.1200/JOP.2015.004242; published online ahead of print at jop.ascopubs.org on June 30, 2015.
References 1. American Society of Clinical Oncology: ASCO Profile and Mission Statement. www.asco.org/about-asco/asco-profile-and-mission-statement 2. American Society of Clinical Oncology: ASCO University. http://university. asco.org/ 3. Neuss MN, Desch CE, McNiff KK, et al: A process for measuring the quality of cancer care: The Quality Oncology Practice Initiative. J Clin Oncol 23:6233-6239, 2005 4. ASCO Institute for Quality: Welcome to the Institute for Quality. www.institute forquality.org/ 5. Jacobson JO, Quinn D, Gilligan T, et al: The ASCO Quality Training Program: Designing and implementing a Medical specialty society-based quality improvement training program. J Oncol Pract 10:203-205, 2014 6. Somerfield MR, Einhaus K, Hagerty KL, et al: American Society of Clinical Oncology clinical practice guidelines: Opportunities and challenges. J Clin Oncol 26:4022-4026, 2008 7. Desch CE, McNiff KK, Schneider EC, et al: American Society of Clinical Oncology/National Comprehensive Cancer Network quality measures. J Clin Oncol 26:3631-367, 2008 8. Neuss MN, Polovich M, McNiff K, et al: Updated American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards including standards for the safe administration and management of oral chemotherapy. J Oncol Pract 9:5s-13s, 2013 9. Davis DA, Mazmanian PE, Fordis M, et al: Accuracy of physician self-assessment compared with observed measures of competence: A systematic review. JAMA 296:1094-1102, 2006 10. Duffy FD, Holmboe ES: Self-assessment in lifelong learning and improving performance in practice: Physician know thyself. JAMA 296:1137-1139, 2006 11. Kruger J, Dunning D: Unskilled and unaware of it: How difficulties in recognizing one’s own incompetence lead to inflated self-assessments. J Pers Soc Psychol 77:1121-1134, 1999
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12. Bienstock JL, Katz NT, Cox SM, et al: To the point: Medical education reviews–providing feedback. Am J Obstet Gynecol 196:508-513, 2007 13. Wiggins G: Seven keys to effective feedback. Ed Leadership 70:10-16, 2012 14. Sledge GW Jr, Miller RS, Hauser R: CancerLinQ and the future of cancer care. Am Soc Clin Oncol Educ Book 430-434, 2013 15. American Society of Clinical Oncology: CancerLinQ. www.cancerlinq.org/ 16. Zeiger RF: Toward continuous medical education. J Gen Intern Med 20:9194, 2005 17. Spencer JA, Jordan RK: Learner centered approaches in medical education. BMJ 318:1280-1283, 1999 18. Kerfoot BP, DeWolf WC, Masser BA, et al: Spaced education improves the retention of clinical knowledge by medical students: A randomised controlled trial. Med Educ 41:23-31, 2007 19. Karpicke JD, Roediger HL 3rd: The critical importance of retrieval for learning. Science 319:966-968, 2008 20. Kerfoot BP, Baker H, Pangaro L, et al: An online spaced-education game to teach and assess medical students: A multi-institutional prospective trial. Acad Med 87:1443-1449, 2012 21. Kerfoot BP, Baker H: An online spaced-education game for global continuing medical education: A randomized trial. Ann Surg 256:33-38, 2012 22. Kerfoot BP, Baker H: An online spaced-education game to teach and assess residents: A multi-institutional prospective trial. J Am Coll Surg 214:367-373, 2012 23. American Society of Clinical Oncology: Daily Medical Education. http:// dme.asco.org/info/howitworks 24. Jung E, Schnipper JL, Li Q, et al: The coronary artery disease quality dashboard: A chronic care disease management tool in an electronic health record. AMIA Annu Symp Proc 999, 2007 (abstr) 25. American Society of Clinical Oncology: ASCO Guidelines Practice Guidelines Improvement Network. www.asco.org/sites/www.asco.org/files/pgin_flyer_031014_ final.pdf
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Summary
tured to reflect new research about effective medical education and changing learning styles of the new generation of providers. This will require prioritization, as well as allocation of staffing and resources to meet the increasing demands of ASCO’s constituents. Through this transformation, ASCO will be well positioned to further its ongoing mission of conquering cancer through research, education, prevention, and delivery of high-quality patient care.
Medical Education and Quality Cancer Care
AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Bridging the Medical Education and Quality Cancer Care Divide: A Call to Action The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I ⫽ Immediate Family Member, Inst ⫽ My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO’s conflict of interest policy, please refer to www.asco.org/rwc or jop.ascopubs.org/site/misc/ifc.xhtml. N. Lynn Henry Research Funding: Sanofi Aventis, BioMarin, Celldex Travel, Accommodations, Expenses: Celldex
Monica Malik No relationship to disclose
Michael O. Meyers No relationship to disclose
Copyright © 2015 by American Society of Clinical Oncology
Jennifer Bretsch No relationship to disclose Carmen Jackson Employment: Professional Healthcare Resources Anne Grupe No relationship to disclose Jamie H. Von Roenn No relationship to disclose
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Debra A. Patt Employment: Texas Oncology, McKesson Specialty Health, MedNax (I) Leadership: McKesson Specialty Health, MedNax (I) Stock or Other Ownership: MedNax (I) Travel, Accommodations, Expenses: McKesson Specialty Health
Perspective
Bridging the Medical Education and Quality Cancer Care Divide: A Call to Action By N. Lynn Henry, MD, PhD, Debra A. Patt, MD, MPH, MBA, Michael O. Meyers, MD, Monica Malik, MD, Jennifer Bretsch, MS, CPHQ, Carmen Jackson, PMP, Anne Grupe, MS Ed, and Jamie Von Roenn, MD
The ASCO mission is “conquering cancer through research, education, prevention, and delivery of high-quality patient care.”1 Keys to fulfilling this mission are highlighted in two ASCO vision statements: (1) to provide oncology providers and patients with accurate cancer information so that informed decisions can be made about prevention and treatment, and (2) to provide resources so clinicians can provide optimal patient care. In the 50 years since ASCO was founded, it has developed an extensive infrastructure to support both the educational needs of oncology providers and the resources required for those providers to provide high-quality care. However, education and quality have not been fully aligned or even integrated, but rather have been developed and continue to exist primarily in parallel. As members of the 2013 to 2014 ASCO Leadership Development Program, we were tasked by the ASCO Board of Directors to explore how to optimize integration of these key aspects of oncology care in order to facilitate continuous quality improvement for the practicing oncologist. We were asked specifically how ASCO can better leverage its educational portfolio to improve its quality improvement goals. This perspective is a synopsis of our findings and key recommendations.
Current ASCO Offerings Provider Education ASCO has developed a suite of educational offerings that are available in person, in print, and digitally (Table 1). For decades, ASCO has offeredthein-personAnnualMeetingandJournalofClinicalOncology. During the past 10 years, ASCO has greatly expanded its offerings through the establishment of multiple thematic meetings, as well as the Journal of Oncology Practice and daily and monthly news updates. In addition, ASCO University offers a wide range of digital education, including webinars and tumor boards, designed to improve knowledge about the management of cancer and practice administration, as well as products for Maintenance of Certification.2 Most recently, ASCO has expanded its offerings beyond practicing oncologists to include both Fellows and Advanced Practice Providers.
Quality Improvement ASCO resources focused on quality care include reporting programs like the Quality Oncology Practice Initiative (QOPI) and the skills-based Quality Training Program.3,4 QOPI, established 424
JOURNAL
OF
ONCOLOGY PRACTICE
•
Table 1. Highlights of Currently Available ASCO Educational Materials Educational Offering
Example
In-person meetings
Annual Meeting Specific tumor type (eg, breast, GI, GU Symposium) Other thematic meeting (eg, Quality Care Symposium, Palliative Care Symposium)
In print
Journal of Clinical Oncology Journal of Oncology Practice ASCO Post
ASCO University (Web based)
Cancer management (eg, tumor board, literature review) Maintenance of Certification test Practice administration Daily Medical Education
Abbreviation: GU, genitourinary.
in 2002, is a practice-based quality assessment and improvement initiative. Historically, data are abstracted twice a year by participating practices from patient records to determine compliance with specified metrics designed to assess both structures and processes of care. This system allows practices to compare their results with national data and to develop targeted practice improvement plans. In addition, practices that meet specific quality benchmarks can achieve QOPI certification, an accomplishment recognized by some external stakeholders, including some payers. The recognition that quality measurement alone does not lead to quality improvement and the perceived need for skills-based, hands-on training led to the launch of the ASCO Quality Training Program, which was pilot tested in 2013.5 Its mission is “to teach oncology providers to engage in successful quality improvement activities and to train oncologists to champion quality initiatives.”5 ASCO develops guidelines focused on specific aspects of cancer care and delivery of care in order to disseminate information about appropriate cancer care to providers quickly and efficiently.4,6 ASCO has partnered with institutions such as the National Comprehensive Cancer Network to develop and re-evaluate quality metrics to help guide oncology care.4,6,7 A number of other initiatives focus on improving the care of cancer patients and include templates for chemotherapy consent and an ASCO/Oncology Nursing Society collaboration on safe chemotherapy administration.8 More recently, ASCO has launched the Virtual Learning
V O L . 11, I S S U E 5
Copyright © 2015 by American Society of Clinical Oncology
Downloaded from jop.ascopubs.org on November 20, 2015. For personal use only. No other uses without permission. Copyright © 2015 American Society of Clinical Oncology. All rights reserved.
University of Michigan Medical School, Ann Arbor, MI; Texas Oncology, Austin, TX; University of North Carolina School of Medicine, Chapel Hill, NC; Nizam’s Institute of Medical Sciences, Hyderabad, India; and American Society of Clinical Oncology, Alexandria, VA
Medical Education and Quality Cancer Care
Collaborative, a pilot study designed to incorporate palliative care– focused quality improvement activities into practice, including an evidence-based toolbox.4 All of these resources serve to address improvements in care of the patient with cancer across a broad spectrum that include not only improving knowledge, but also disseminating best practices, translating knowledge into practice, and assessing the quality of care delivered.
Studies have demonstrated that, in general, physicians do a poor job identifying their knowledge gaps and tend to educate themselves about their interests rather than their deficiencies.9-11 Although QOPI has represented a significant step forward in evaluating quality of cancer care through identification of poor compliance with quality metrics at the practice level, it typically does not provide data about compliance with metrics on an individual provider level.12,13 The future of provider-level reporting of knowledge deficiencies within ASCO lies in the development of CancerLinQ.14,15 This signature ASCO program is currently in development and is envisioned to be a rapid-learning system that will leverage the electronic health record and other relevant data sources by automatically accepting electronic data from participating practices, reducing the burden of repeated manual abstraction and allowing a broader scope of patients to be evaluated. This system will allow data to be analyzed at the level of the individual provider in addition to larger practice-based reporting, thereby assisting providers with the identification of both gaps in knowledge and poor compliance with practice guidelines. Overall, these changes will allow a more precise picture of cancer care and afford an opportunity to not only identify more clearly areas of educational need, but also further align educational resources with those needs in a targeted fashion, seamlessly tying education to quality improvement.
Development of Educational Offerings Targeted Toward Quality Improvement Once a knowledge gap has been identified, the provider could be directed to relevant ASCO educational offerings in order to raise the knowledge level needed to support behavioral change. This could be done in real time, allowing for immediate feedback and the potential for better contextual learning and retention. Over time, the provider and other stakeholders would be able to reassess concordance with a particular metric and would be able to determine whether the targeted education resulted in a change in behavior that translated into improvements in the quality of care. Importantly, this approach could also enable ASCO to identify recurring deficiencies in knowledge across providers to help define the topics for new ASCO educational products, including digital offerings, question banks, journal review articles, and educational sessions at meetings. In the current climate, in which people are becoming accustomed to accessing information quickly and easily on mobile platforms and at point of service, traditional lecture-based learning can be inconvenient and impractical. ASCO needs to both repackage Copyright © 2015 by American Society of Clinical Oncology
Incorporation of Quality Improvement Strategies Into Clinical Practice Pilot studies of dashboard quality reporting suggest that clinicians prefer a quality report that not only presents structured data, but also facilitates implementation of improvement efforts.24 ASCO has been a leader in improving the quality of cancer care through the development of a repertoire of resources including practice guidelines, quality metrics, a dedicated journal, and a thematic meeting.4 ASCO has begun to integrate the information and recommendations contained within new ASCO guidelines into quality metrics associated with specific QOPI measures. These metrics can be linked to concise educational products directed toward the recommendations that are accessible at point of care. In addition, Table 2. Recommendations for ASCO to Enhance the Connection Between Oncology Provider Education and Quality of Patient Care Seamlessly connect the education and quality improvement aspects of the organization Inform providers about where to focus their educational efforts, based on quality reporting systems, and provide direct links to ASCO educational resources Reformat educational offerings to make them more concise and engaging for the user. Facilitate performance of practice improvement activities for Maintenance of Certification and to improve the quality of patient care.
S E P T E M B E R 2015
•
jop.ascopubs.org
425
Downloaded from jop.ascopubs.org on November 20, 2015. For personal use only. No other uses without permission. Copyright © 2015 American Society of Clinical Oncology. All rights reserved.
Improving Quality Through Education Assessment of Deficiencies in Knowledge
existing educational content and develop new materials to make educational offerings more concise and effective. In addition, making the information easily accessible at point of care, such as on hand-held devices or integrated into electronic medical record systems, would facilitate implementation in the patient care setting and could also permit direct links to clinical toolkits and decision support programs. ASCO also needs to embrace new and novel educational methods as technology improves our ability to deliver content in meaningful and relevant ways. Research suggests that interactivity, flexibility, continuity, and relevance to learners’ practices are major characteristics of successful education programs.16,17 Novel interactive educational methods, such as spaced education, may enhance both access to information and retention of knowledge.18 The basic tenet underlying spaced education is that information repeated over spaced intervals is better learned and more effectively retained than when it is presented only once. In addition, long-term retention is significantly improved by repeatedly testing learners.19-22 ASCO has recently implemented learning using these principles in its Daily Medical Education program, which is currently being tested to educate fellows about palliative care.23 It could be further expanded to include programs specifically designed to reinforce new knowledge, enhance dissemination of new guidelines, address common deficiencies in quality metrics, and advance international educational initiatives using a variety of technologydriven delivery platforms. Ultimately, the goal is to link compliance with quality metrics to relevant educational tools in order to promote efficient, directed learning. In turn, that knowledge can be directly applied to improve the quality of patient care.
Henry et al
clinical toolkits and decision support tools can be developed to help facilitate adoption of guidelines.4 ASCO also launched the Practice Guidelines Implementation Network (PGIN), a working group that focuses on the dissemination and implementation of ASCO guidelines and provides perspectives on guideline implementation in a variety of practice settings.25 Through development of these resources, ASCO can enable more rapid adoption and implementation of guidelines and other quality improvement measures to enhance the care of patients with cancer.
In summary, ASCO serves as a tremendous resource for oncology providers as they seek to provide the highest quality care for patients with cancer. ASCO has already developed extensive educational offerings and quality improvement programs. In addition, the new initiatives that ASCO is pursuing, such as CancerLinQ and the Virtual Learning Collaborative, afford great opportunities to achieve these goals. However, success will require prioritizing education, increasing resources, thinking in novel ways, and being willing to deviate from traditional paradigms. In our assessment, there are several key steps required to attain these goals (Table 2). In particular, in order to seamlessly connect the education and quality aspects of the organization ASCO should devise a system to foster collaboration and integration between its education and quality improvement efforts. This could be accomplished through either the creation of a new committee linking these two ASCO endeavors—education and quality improvement—or by designating staff members to serve as a permanent connection between the two existing groups. In addition, the educational offerings must be restruc-
Acknowledgment N.L.H. was supported in part, through her institution, by a National Cancer Institute Clinical Cancer Investigator Team Leadership Award (supplement to Grant No. 3-P30-CA04592). We thank the ASCO Leadership Development Program for its support. Authors’ Disclosures of Potential Conflicts of Interest Disclosures provided by the authors are available with this article at jop.ascopubs.org.
Author Contributions Conception and design: All authors Collection and assembly of data: All authors Data analysis and interpretation: All authors Manuscript writing: All authors Final approval of manuscript: All authors Corresponding author: N. Lynn Henry, MD, PhD, 1500 East Medical Center Dr, Med Inn Bldg C450, Ann Arbor, MI 48109-5843; e-mail: [email protected].
DOI: 10.1200/JOP.2015.004242; published online ahead of print at jop.ascopubs.org on June 30, 2015.
References 1. American Society of Clinical Oncology: ASCO Profile and Mission Statement. www.asco.org/about-asco/asco-profile-and-mission-statement 2. American Society of Clinical Oncology: ASCO University. http://university. asco.org/ 3. Neuss MN, Desch CE, McNiff KK, et al: A process for measuring the quality of cancer care: The Quality Oncology Practice Initiative. J Clin Oncol 23:6233-6239, 2005 4. ASCO Institute for Quality: Welcome to the Institute for Quality. www.institute forquality.org/ 5. Jacobson JO, Quinn D, Gilligan T, et al: The ASCO Quality Training Program: Designing and implementing a Medical specialty society-based quality improvement training program. J Oncol Pract 10:203-205, 2014 6. Somerfield MR, Einhaus K, Hagerty KL, et al: American Society of Clinical Oncology clinical practice guidelines: Opportunities and challenges. J Clin Oncol 26:4022-4026, 2008 7. Desch CE, McNiff KK, Schneider EC, et al: American Society of Clinical Oncology/National Comprehensive Cancer Network quality measures. J Clin Oncol 26:3631-367, 2008 8. Neuss MN, Polovich M, McNiff K, et al: Updated American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards including standards for the safe administration and management of oral chemotherapy. J Oncol Pract 9:5s-13s, 2013 9. Davis DA, Mazmanian PE, Fordis M, et al: Accuracy of physician self-assessment compared with observed measures of competence: A systematic review. JAMA 296:1094-1102, 2006 10. Duffy FD, Holmboe ES: Self-assessment in lifelong learning and improving performance in practice: Physician know thyself. JAMA 296:1137-1139, 2006 11. Kruger J, Dunning D: Unskilled and unaware of it: How difficulties in recognizing one’s own incompetence lead to inflated self-assessments. J Pers Soc Psychol 77:1121-1134, 1999
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12. Bienstock JL, Katz NT, Cox SM, et al: To the point: Medical education reviews–providing feedback. Am J Obstet Gynecol 196:508-513, 2007 13. Wiggins G: Seven keys to effective feedback. Ed Leadership 70:10-16, 2012 14. Sledge GW Jr, Miller RS, Hauser R: CancerLinQ and the future of cancer care. Am Soc Clin Oncol Educ Book 430-434, 2013 15. American Society of Clinical Oncology: CancerLinQ. www.cancerlinq.org/ 16. Zeiger RF: Toward continuous medical education. J Gen Intern Med 20:9194, 2005 17. Spencer JA, Jordan RK: Learner centered approaches in medical education. BMJ 318:1280-1283, 1999 18. Kerfoot BP, DeWolf WC, Masser BA, et al: Spaced education improves the retention of clinical knowledge by medical students: A randomised controlled trial. Med Educ 41:23-31, 2007 19. Karpicke JD, Roediger HL 3rd: The critical importance of retrieval for learning. Science 319:966-968, 2008 20. Kerfoot BP, Baker H, Pangaro L, et al: An online spaced-education game to teach and assess medical students: A multi-institutional prospective trial. Acad Med 87:1443-1449, 2012 21. Kerfoot BP, Baker H: An online spaced-education game for global continuing medical education: A randomized trial. Ann Surg 256:33-38, 2012 22. Kerfoot BP, Baker H: An online spaced-education game to teach and assess residents: A multi-institutional prospective trial. J Am Coll Surg 214:367-373, 2012 23. American Society of Clinical Oncology: Daily Medical Education. http:// dme.asco.org/info/howitworks 24. Jung E, Schnipper JL, Li Q, et al: The coronary artery disease quality dashboard: A chronic care disease management tool in an electronic health record. AMIA Annu Symp Proc 999, 2007 (abstr) 25. American Society of Clinical Oncology: ASCO Guidelines Practice Guidelines Improvement Network. www.asco.org/sites/www.asco.org/files/pgin_flyer_031014_ final.pdf
V O L . 11, I S S U E 5
Copyright © 2015 by American Society of Clinical Oncology
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Summary
tured to reflect new research about effective medical education and changing learning styles of the new generation of providers. This will require prioritization, as well as allocation of staffing and resources to meet the increasing demands of ASCO’s constituents. Through this transformation, ASCO will be well positioned to further its ongoing mission of conquering cancer through research, education, prevention, and delivery of high-quality patient care.
Medical Education and Quality Cancer Care
AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Bridging the Medical Education and Quality Cancer Care Divide: A Call to Action The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I ⫽ Immediate Family Member, Inst ⫽ My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO’s conflict of interest policy, please refer to www.asco.org/rwc or jop.ascopubs.org/site/misc/ifc.xhtml. N. Lynn Henry Research Funding: Sanofi Aventis, BioMarin, Celldex Travel, Accommodations, Expenses: Celldex
Monica Malik No relationship to disclose
Michael O. Meyers No relationship to disclose
Copyright © 2015 by American Society of Clinical Oncology
Jennifer Bretsch No relationship to disclose Carmen Jackson Employment: Professional Healthcare Resources Anne Grupe No relationship to disclose Jamie H. Von Roenn No relationship to disclose
S E P T E M B E R 2015
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Debra A. Patt Employment: Texas Oncology, McKesson Specialty Health, MedNax (I) Leadership: McKesson Specialty Health, MedNax (I) Stock or Other Ownership: MedNax (I) Travel, Accommodations, Expenses: McKesson Specialty Health
