Don't look now, but the world of continuing medical education (CME) as we know it is about to change. The way you think about CME, the way you participate in it, how we measure the effectiveness of it, and how it is funded are all changing. These changes have been in motion for several years in both the physician and PA worlds. You may not have seen any changes yet, but you will soon. This article is a brief overview of what you can expect.


"The current system of continuing education for health professionals is not working." This is one of the blunt conclusions the Institute of Medicine noted in its December 2009 report, Redesigning Continuing Education in the Health Professions.1 The report made several observations that were very critical of the conduct, science, focus, and culture of CME. It endorses a new vision for CME based on continuing professional development (CPD) that emphasizes lifelong learning skills instilled in the classroom through point-of-care opportunities encountered as clinically practicing PAs. Lack of an effective means for continuously updating the clinical knowledge and skills of health professionals can jeopardize the quality of patient care.


AAPA has responded by revising its policies on CME to better incorporate a new emphasis on CPD. For PAs, CPD is defined as "a process that includes ongoing identification of learning needs, development of a learning plan, acquisition of new knowledge and skills, application to practice, and reassessment."2 A description of each step in the process and how it might apply to you as a practicing PA is presented here.


Identification of learning needs This first step is the most important in many ways. Skills such as self-assessment, clinical performance measurement, and self-reflection can provide the means for identifying your needs. Many different types of formal self-assessment tools are already available. Clinical performance measurement is an extensive topic in and of itself. Certainly, formal or informal assessment of patient outcomes via patient surveys or peer reviews can be a valuable way to assess your needs. Finally, honest, thoughtful self-reflection effectively identifies knowledge deficits and also uncovers any behaviors or attitudes that need to be changed.


Development of a learning plan First, you have to identify a particular knowledge, skill, or behavior deficit; then you have to develop a proactive plan for addressing those needs. Planning your conference CME sessions or using point-of-care learning systems to find evidence-based articles that 
are specific to your needs are two methods for creating a learning plan that is uniquely your own.


Acquisition of new knowledge and skills Lecture-based CME has been the centerpiece of CME, and it makes up a disproportionate amount of educational activities despite there being only poor-quality evidence to support its effectiveness. Although a 2007 Agency for Healthcare Research and Quality report found that CME was "generally effective not only in the acquisition or achievement of knowledge, attitudes, skills, behaviors, and clinical practice outcomes, but also in their retention,"3 the report acknowledged that some techniques and methods are more effective than others. For example, live media is more effective than print, multimedia is more effective than a single channel, and multiple exposures are more effective than a single exposure. Scenario-based learning and simulations showed particular promise.


Application to practice Acquiring new knowledge and skills has little benefit for your colleagues and patients unless what you learn is properly applied. The new knowledge needs to be integrated into local practice guidelines and protocols. Using information technology to ensure the consistent delivery of proper care through reminders and prompts is even better.


Reassessment This is the "continuing" part of CPD. True CPD is not a once-a-year, once-every-2-years, or once-
every-6-years process; CPD is dynamic and ever changing, much like the scientific and clinical information we need to integrate into our practice.


Clinicians who have fully engaged in CPD report that it has brought the joy back to learning and clinical practice. When learning is no longer limited to a dark lecture hall but is directed at specific needs with measureable improvements in patient outcomes and professional relationships, we begin to appreciate that many of our daily activities present opportunities for learning. By integrating our new knowledge into everyday practice through the process of CPD, PAs can be assured of continued competence throughout their careers. JAAPA


P. Michel Statler, MLA, PA-C, on behalf of the 2009-2010 Professional Education and Development Council of the AAPA.

REFERENCES


1. Institute of Medicine. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press; 2010.


2. AAPA 2009-2010 Policy Manual. Alexandria, VA: American Academy of Physician Assistants; 2009. http://www.aapa.org/images/stories/documents/about_aapa/policymanual/Profession.pdf. Accessed April 21, 2010.


3. Marinopoulos SS, Dorman T, Ratanawongsa N, et al. Effectiveness of Continuing Medical Education. Rockville, MD: Agency for Healthcare Research and Quality; 2007. Evidence Report/Technology Assessment No. 149. (Prepared by the Johns Hopkins Evidence-based Practice Center, under contract no. 290-02-0018.) http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hserta&part=
A234741. Accessed April 21, 2010.