The current state of continuing medical education J.L. CHOUINARD*
In the main, continuing medical education (CME) is a euphemism for credit or noncredit courses offered by medical schools or professional associations. The World Health Organization recently characterized continuing medical education as "often unsystematic, poorly supported, little influenced by contemporary educational science, episodic, focused more on transmitting new information than on improving competence and only incidentally related to health needs and national health priorities." A glance at formalized CME in Canada, as revealed in this journal (pages 1145 to 1172) certainly supports this statement and makes one wonder whether a list such as published herein prompted the WHO comments. Most CME programs are organized and taught by medical school faculty. They teach as they were taught, and their programs largely exhibit four traits: * The purpose is to transmit information. * They reflect technical presentations by subject-matter experts. * They take the form of lectures or panel discussions. * Active physician-learner participation in program needs determination or the program is limited. These traits may underlie the limited popularity of CME, which at present competes poorly for the time of a busy physician. What is needed is adult education, not a grafting process in which rigid, undergraduate-type programs are offered in the name of adult education. There does not seem to be any theory of teaching or learning that permeates the educational activity and acknowledges the adult status of the student body. More effective methods, which link new medical knowledge with patient care, may prove more inviting, but they are only now in their infancy. Too little research is under way to explore new methods or to maximize the success of the few proven existing *Mr Chouinard is coordinator of the CMA Council on Medical Education.
methods. CME remains a marginal appendage to the other tasks of medical education's accrediting organizations, provider institutions and physicianteachers. In the United States a situation is rapidly developing that may require physicians to document participation in CME for continued licensure and professional association membership. As of mid-1976, 14 state medical associations have decided as policy to require CME as a condition of membership.
All 22 medical specialty boards have established a policy to provide recertification; 10 of these have set dates on which recertification will begin. In 14 states licensing bodies have legal power to require evidence of CME as a condition of reregistration. In Canada, influence from professional societies, stimulated by activities in the United States, may be pressing ds toward a similar future. Canadian physicians may periodically be required to demonstrate either their participation in CME or their continued competence. Given present CME deficiencies, it seems illogical that physicians should be required to participate in CME. The Federation of Provincial Medical Licensing Authorities of Canada has recently been seriously discussing the subject of required CME for continued registration. Rather than discussing the pros and cons of requiring CME for continued licensure, it would be more fruitful and reasonable to encourage the development and evaluation of effective methodologies linking education to patient care. Continuation of current trends, without rationalization and coordination, may lead to a future in which individual Canadian physicians will be re-
quired to 1) document attendance at organized CME programs for medical and specialty society membership as well as for licensure, 2) pass examinations periodically for recertification by The Royal College of Physicians and Surgeons of Canada or The College of Family Physicians of Canada, 3) be subject to professional review schemes ostensibly aimed at quality assessment as a condition of his or her hospital's accreditation by CCHA and 4) participate in government professional review aimed at cost containment. The time and money this would involve would no doubt be substantial; there is no proof such a situation would result in better physician performance. If CME is to become a significant link between medical education and medical practice, well-defined, measurable, educational objectives must be selected and coordinating mechanisms established. The CMA Council on Medical Education recognizes that changes in the continuing education segment of the continuum of medical education are lagging behind those of other phases. In some cases, attention seems to be directed to improving traditional course distribution, but too little is done to improve the material presented or correlate this material with practice. This can be done through developing needsdeterminant techniques such as patient care appraisal (PCA) mechanisms, a position advocated by the CMA. PCA is viewed as the adhesive that will bond continuing medical education to medical practice. It is not possible to overstress the importance of incorporating, in the medical care system, needs-determinant techniques for CME that will respond both to patient satisfaction and to review by the medical profession. Coupled with this should be emphasis on CME and life-long learning in medical school, since it is in undergraduate medical education that professional habits of thought are initially acquired; this is when future physicians are most receptive and sensitive to the views of their teachers. At present CME remains a euphemism.E
CMA JOURNAL/DECEMBER 4, 1976/VOL. 115 1121
In the main, continuing medical education (CME) is a euphemism for credit or noncredit courses offered by medical schools or professional associations. The World Health Organization recently characterized continuing medical education as "often unsystematic, poorly supported, little influenced by contemporary educational science, episodic, focused more on transmitting new information than on improving competence and only incidentally related to health needs and national health priorities." A glance at formalized CME in Canada, as revealed in this journal (pages 1145 to 1172) certainly supports this statement and makes one wonder whether a list such as published herein prompted the WHO comments. Most CME programs are organized and taught by medical school faculty. They teach as they were taught, and their programs largely exhibit four traits: * The purpose is to transmit information. * They reflect technical presentations by subject-matter experts. * They take the form of lectures or panel discussions. * Active physician-learner participation in program needs determination or the program is limited. These traits may underlie the limited popularity of CME, which at present competes poorly for the time of a busy physician. What is needed is adult education, not a grafting process in which rigid, undergraduate-type programs are offered in the name of adult education. There does not seem to be any theory of teaching or learning that permeates the educational activity and acknowledges the adult status of the student body. More effective methods, which link new medical knowledge with patient care, may prove more inviting, but they are only now in their infancy. Too little research is under way to explore new methods or to maximize the success of the few proven existing *Mr Chouinard is coordinator of the CMA Council on Medical Education.
methods. CME remains a marginal appendage to the other tasks of medical education's accrediting organizations, provider institutions and physicianteachers. In the United States a situation is rapidly developing that may require physicians to document participation in CME for continued licensure and professional association membership. As of mid-1976, 14 state medical associations have decided as policy to require CME as a condition of membership.
All 22 medical specialty boards have established a policy to provide recertification; 10 of these have set dates on which recertification will begin. In 14 states licensing bodies have legal power to require evidence of CME as a condition of reregistration. In Canada, influence from professional societies, stimulated by activities in the United States, may be pressing ds toward a similar future. Canadian physicians may periodically be required to demonstrate either their participation in CME or their continued competence. Given present CME deficiencies, it seems illogical that physicians should be required to participate in CME. The Federation of Provincial Medical Licensing Authorities of Canada has recently been seriously discussing the subject of required CME for continued registration. Rather than discussing the pros and cons of requiring CME for continued licensure, it would be more fruitful and reasonable to encourage the development and evaluation of effective methodologies linking education to patient care. Continuation of current trends, without rationalization and coordination, may lead to a future in which individual Canadian physicians will be re-
quired to 1) document attendance at organized CME programs for medical and specialty society membership as well as for licensure, 2) pass examinations periodically for recertification by The Royal College of Physicians and Surgeons of Canada or The College of Family Physicians of Canada, 3) be subject to professional review schemes ostensibly aimed at quality assessment as a condition of his or her hospital's accreditation by CCHA and 4) participate in government professional review aimed at cost containment. The time and money this would involve would no doubt be substantial; there is no proof such a situation would result in better physician performance. If CME is to become a significant link between medical education and medical practice, well-defined, measurable, educational objectives must be selected and coordinating mechanisms established. The CMA Council on Medical Education recognizes that changes in the continuing education segment of the continuum of medical education are lagging behind those of other phases. In some cases, attention seems to be directed to improving traditional course distribution, but too little is done to improve the material presented or correlate this material with practice. This can be done through developing needsdeterminant techniques such as patient care appraisal (PCA) mechanisms, a position advocated by the CMA. PCA is viewed as the adhesive that will bond continuing medical education to medical practice. It is not possible to overstress the importance of incorporating, in the medical care system, needs-determinant techniques for CME that will respond both to patient satisfaction and to review by the medical profession. Coupled with this should be emphasis on CME and life-long learning in medical school, since it is in undergraduate medical education that professional habits of thought are initially acquired; this is when future physicians are most receptive and sensitive to the views of their teachers. At present CME remains a euphemism.E
CMA JOURNAL/DECEMBER 4, 1976/VOL. 115 1121
