Conversation-starter: SQUIRE tool standards as a connection between medical communication organization: ACEhp and AMWA

There are many synergies and resources between the Alliance for Continuing Education in the Health Professions (ACEhp) and the American Medical Writers Association (AMWA), because medical educators and medical writers are all communicators ... which explains why so many of us are members of both. In today's ACEhp webinar (see www.acehp.org/p/cm/ld/fid=367), Jann Balmer replied to a question asking about the role of medical writers in publishing educational outcomes in the quality improvement reporting tool, SQUIRE (as customized by ACEhp), saying that outcomes manuscripts can be enhanced by medical writers and editors because QIE project managers may not be good writers. My colleague, Donald Harting, and I have been discussing potential organizational synergies between AMWA and ACEhp in this regard for over a year.

This is an opportune moment for our memberships to work together: AMWA celebrated 75 years with last week's Annual Conference, which started the very day on which ACEhp launched its custom SQUIRE reporting tool for clinical educational research at the annual Alliance Quality Symposium. This begs the question: What role will professional medical writers and communicators in AMWA play in publishing standardized, SQUIRE-compliant educational outcomes research in the Alliance for CE in the Health Professions custom tool?

Conversation-starter: ACEhp identified a top goal of 2015's Phase II of the Quality Improvement Education (QIE) Initiative as the "Assessment of SQUIRE to generate Case Studies that demonstrate successful integration of Education into QI." Professionals with capabilities in medical education and writing will ideally combine their skills in writing these case studies. Wouldn't you like to author a study that is eligible for later meta-analyses because the study was SQUIRE-compliant?

Extension: There is an inaugural meeting on writing research in the SQUIRE tool at Dartmouth this November 2015. MedBiquitous members, as experts in standardization in medical education technology and reporting, what can you contribute to this conversation? Members of the American Educational Research Association LinkedIn group, what are your thoughts for connecting health education research reporting to more global research agendas? 

I am promoting the SQUIRE tool because of my roles as Co-Leader of the ACEhp QIE Initiative's Building Block on "Nomenclature and Its Adoption" and Research Track faculty. In these roles, I see the needs for developing consistent wording and reporting standards for medical education research. After all, how will we report our achievements and deliberate our challenges in developing and researching CE in the Health Professions if we do not have consistent language to use in the SQUIRE reporting tool? Let's not delay a start in COMMUNICATING among health communicators. Join the discussion! I believe that this is a great opportunity for all health educators, education researchers, and writers to collaborate!

For additional information on these organizations, topics, and events, check out these links (some may have membership firewalls):

- SQUIRE (Standards for Quality Improvement Reporting Excellence) inaugural conference: squire-statement.org/news_events/squire_international_writing_conference/

- ACEhp Quality Symposium: www.acehp.org/p/cm/ld/fid=20 (see also the August 2015 issue of the Almanac: www.acehp.org/p/cm/ld/fid=52, p. 15)

- ACEhp Foundation QIE Initiative: www.acehp.org/p/cm/ld/fid=43

- ACEhp Foundation QIE Initiative's custom SQUIRE tool:

---See Slides 17 - 19 of www.acehp.org/p/do/sd/sid=864&fid=1212&req=direct

---See Webinars at www.acehp.org/p/cm/ld/fid=367

- AMWA 75th Anniversary: www.amwa.org/amwa_anniversary

- MedBiquitous: http://www.medbiq.org/ and new Performance Standard: www.medbiq.org/node/1001

Connect with me! SHBinford@FullCircleClinicalEducation.com or www.linkedin.com/company/full-circle-clinical-education-inc

ACEhp’s President Ed Dellert Co-Authored COPD CME Mayo Clinic Article With Robust Follow-Up Data

Mayo Clinic Proceedings published this free 2012 article by SG Adams (University of Texas Health Science Center) and colleagues on an educational change intervention on chronic obstructive pulmonary disease (COPD) among primary care clinic. What’s more, our own Alliance for CE in the Health Professions president, Ed Dellert, is a co-author!

There was a clear educational gap among target clinicians: The authors report that, “before the program, 173 of 320 participants (54.1%) had never used the Global Initiative for Chronic Obstructive Lung Disease recommendations for COPD.” Those of us who collect educational outcomes data can applaud the tremendous follow-up survey’s response rate of 48.7% of the 313 participants. We all struggle with the problematic use of self reported performance data in CEhp outcomes articles; the authors even acknowledge this, stating, “physician self assessment is unreliable” (Methods). Yet, this article is impressive because of its inclusion of the word “completely: “Of the follow-up survey respondents, 92 of 132 (69.7%) reported completely implementing at least one clinical practice change.” This helps us appreciate the knowledge and comprehension data reported as increasing significantly, as well as the value of improved self-confidence developed through CME/CEhp. Confidence is a measure of competence (Moore’s Level 4), and competence is, to me, “the glue that sticks” knowledge to performance-in-practice. 

The initiative featured systematic instructional design methods using the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) approach. This construct was followed by a team of educators and medical experts from multiple disciplines, particularly from the American College of Chest Physicians and American Academy of Nurse Practitioners. Especially interesting for us instructional designers, the team used “self-directed learning” and “case and problem-based learning” before ever beginning “lecture-based learning” (Table 1), indicating that they incorporated the benefits of exploration in scientific learning that ideally occurs before the didactic introduction of terms (per the Learning Cycle teaching model). 

To challenge medical educators, I ask that we all continue to look for and share CEhp studies that feature professional instructional design that other clinical sites and educational teams can reproduce. This will help us highlight Why We Matter. So I close with the image that my educational outcomes colleague, Wendy Turell, tweeted (@WTevalu8), showing Ed Dellert discussing Why We Matter at the Alliance Industry Summit in May 2015. 

PubMed: http://www.ncbi.nlm.nih.gov/pubmed/22958990
PubMed Central: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538496/
MeSH *Major* terms: Clinical Competence; Education, Medical, Continuing; Physicians, Primary Care/education; Pulmonary Disease, Chronic Obstructive/diagnosis; Pulmonary Disease, Chronic Obstructive/therapy

Back to School: See How Clinical Continuing Education Has Improved Health Care Quality – Proven in Peer-Reviewed Journals!

We often hear that there is little evidence of CME’s success in teaching clinicians relevant strategies for better patient care, for changing practice through education, and for connecting with the quality improvement (QI) movement. Witness the current initiatives of the Alliance for Continuing Education in the Health Profession (ACEhp), “Why We Matter” and the 10-year Roadmap and 10 complementary Building Blocks of the Quality Improvement Education (QIE) Initiative. While Davis and others have noted historical effectiveness of CEhp, such as in this 1992 article, later articles by Bloom, Davis, and Ratanawongsa have questioned CME effectiveness (e.g., in 1995 and 2005) and identified reporting inconsistencies that reduce the validity of CME outcomes reports.

It is true that our reporting of CEhp methods and outcomes has need of greater readership and better reporting. Yet CME, performance improvement (PI), interprofessional education (IPE), and education-driven QI projects already have many achievements reported, in both initiative-level outcomes reports and the published, peer-reviewed literature. Going beyond JCEHP, where articles feature methods and case studies for improving clinical education, and CE Measure, which reports on-the-ground initiatives and specific outcomes data, we see that clinical journals and meetings are publishing increasing numbers of CEhp studies. What’s more, reporting of these achievements is certain to grow after the ACEhp QIE Initiative launches its custom version of the SQUIRE tool this month, at September 2015’s Alliance Quality Symposium. The SQUIRE tool, created by the group developing Standards for Quality Improvement Reporting Excellence, will help all of us doing CEhp research design our studies and publish our findings in a standardized manner … for later meta-analyses of into CME/CEhp effectiveness as a mechanism for quality improvement.

Today our goal is to show the past effectiveness of CEhp initiatives in published educational outcomes studies, as we prepare—as a profession—to begin reporting CME and IPE initiatives with greater rigor, and to illustrate the effectiveness of certified clinical education by accredited providers on a greater scale. Therefore, Don Harting, my friend and colleague who specializes in medical education needs assessments, and I have embarked on a “Back-to-School” campaign to highlight published articles where CME, IPE, PI, and QI initiatives worked to change clinicians’ behavior or improve performance in routine, clinical practice. Don featured 15 of our 30 articles on Twitter (@CME_Scout) and his blog from August 17 – August 31, 2015, and I will be posting to publicize another 15 articles at @SHB_CMEedit and this blog from September 1 – September 15, 2015. You can sign up to receive a summary report of the published studies we feature by following fullcirclece.blogspot.com, or find me in person at the Alliance Quality Symposium at the end of September.

We want you to take away these messages from this campaign, so let me encourage you to put yourself in the first person and say these motivational statements:

• I can talk about CEhp initiatives that were effective in improving the quality of health care
• There is evidence in the peer-reviewed literature to prove CEhp effectiveness
• I am ready to read CEhp outcomes studies, to help me learn to prepare my own (if you are not sure you’re ready, check out the 12-article research and statistics series in the ACEhp Almanac, which started in February 2015)
• My group’s CEhp outcomes data do not have to show change to be worth publishing, i.e., it’s okay to publish negative findings because I am a dispassionate researcher of clinical education
• I can find clinical and educational journals to whom to submit my CME outcomes data
• My CEhp work in content and faculty development, instructional design, and outcomes analysis matters

Now don’t you feel better? Not sure? Ready to go? Follow our tweets, read the articles or their abstracts, and then say these points to yourself again. 

Finally, to promote articles showing the achievements of the continuing education profession in improvement health care quality, we have a contest where you can Retweet to Win (see rules) by sharing our featured articles with your network of CEhp professionals. Harting Communications LLC is offering a $100 Amazon gift card as first prize, and Full Circle Clinical Education, Inc, is offering a $50 Amazon gift card as second prize!

Remember to follow us on Twitter @SHB_CMEedit and @CME_Scout so that you can notified via direct message if you win! And tell Don and me whether this service campaign supporting awareness of CEhp effectiveness was helpful to you. 

Good luck, happy reading, and enjoy! 

Best wishes, and thanks for viewing my updates, 

Sandra