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Suggested Citation:"Front Matter." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

REDESIGNING CONTINUING EDUCATION IN THE HEALTH PROFESSIONS

Committee on Planning a Continuing Health Care Professional Education Institute

Board on Health Care Services

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

THE NATIONAL ACADEMIES PRESS

500 Fifth Street, N.W. Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Contract No. B08-03 between the National Academy of Sciences and the Josiah Macy, Jr. Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

International Standard Book Number-13: 978-0-309-14078-2

International Standard Book Number-10: 0-309-14078-1

Additional copies of this report are available from the

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For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.

Copyright 2010 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested citation: IOM (Institute of Medicine). 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

“Knowing is not enough; we must apply.

Willing is not enough; we must do.”

—Goethe

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES


Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine


The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.


The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.


The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.


The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.


www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

COMMITTEE ON PLANNING A CONTINUING HEALTH CARE PROFESSIONAL EDUCATION INSTITUTE

GAIL L. WARDEN (Chair), President Emeritus,

Henry Ford Health System and

Professor of Health Management and Policy at the University of Michigan,

School of Public Health, Detroit

JAKO S. BURGERS, Harkness Fellow 2008-2009,

Harvard School of Public Health, Boston, Massachusetts, and

Senior Researcher,

Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, The Netherlands

LINDA BURNES BOLTON, Vice President and Chief Nursing Officer,

Cedars-Sinai Medical Center, Los Angeles, California

CATHERINE DEANGELIS, Editor-in-Chief and Senior Vice President,

Scientific Publications and Multimedia Applications, JAMA, Chicago, Illinois, and

Professor,

Johns Hopkins University, School of Medicine, Baltimore, Maryland

ROBERT D. FOX, Professor Emeritus of Adult and Higher Education,

University of Oklahoma, Norman

SHERRY A. GLIED, Professor and Chair,

Department of Health Policy and Management, Columbia University, Mailman School of Public Health, New York

KENDALL HO, Director,

eHealth Strategy Office,

Associate Professor,

Division of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver

EDWARD F. LAWLOR, Dean and William E. Gordon Distinguished Professor,

George Warren Brown School of Social Work at Washington University in St. Louis, Missouri

DAVID C. LEACH, Former Executive Director,

Accreditation Council for Graduate Medical Education, Asheville, North Carolina

LUCINDA MAINE, Executive Vice President and Chief Executive Officer (CEO),

American Association of Colleges of Pharmacy, Alexandria, Virginia

PAUL E. MAZMANIAN, Associate Dean for Continuing Professional Development and Evaluation Studies,

School of Medicine, Virginia Commonwealth University, Richmond

MICHAEL W. PAINTER, Senior Program Officer,

Robert Wood Johnson Foundation, Princeton, New Jersey

WENDY RHEAULT, Vice President,

Academic Affairs, and

Dean,

College of Health Professions, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois

MARIE E. SINIORIS, President and CEO,

National Center for Healthcare Leadership, Chicago, Illinois

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

IOM Study Staff

SAMANTHA M. CHAO, Study Director

BERNADETTE MCFADDEN, Research Associate

ADAM SCHICKEDANZ, Mirzayan Science and Technology Policy Fellow1

CASSANDRA CACACE, Senior Program Assistant

ROGER C. HERDMAN, Director,

Board on Health Care Services

1

Served through May 2009.

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

ROBERT B. BARON, University of California, San Francisco

PAUL B. BATALDEN, Dartmouth Institute for Health Policy and Clinical Practice

RON CERVERO, University of Georgia

COLLEEN CONWAY-WELCH, Vanderbilt University School of Nursing

THEODORE GANIATS, University of California, San Diego

LYNN GERBER, George Mason University

RICHARD KRUGMAN, University of Colorado, Denver

THOMAS J. MONAHAN, West Sand Lake, NY

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
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DONALD E. MOORE, JR., Vanderbilt University School of Medicine

MARLA E. SALMON, University of Washington School of Nursing

MIKE SAXTON, Pfizer, Inc.

DAVID N. SUNDWALL, Utah Department of Health

DAVID SWANKIN, Citizen Advocacy Center

JAMES N. THOMPSON, (former) Federation of State Medical Boards

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by NANCY ADLER, University of California, San Francisco, and SUSANNE STOIBER, Stoiber Health Policy, LLC. Appointed by the National Research Council and Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

Preface

Continuing education (CE) is the process by which health professionals keep up to date with the latest knowledge and advances in health care. However, the CE “system,” as it is structured today, is so deeply flawed that it cannot properly support the development of health professionals. CE has become structured around health professional participation instead of performance improvement. This has left health professionals unprepared to perform at the highest levels consistently, putting into question whether the public is receiving care of the highest possibly quality and safety.

Redesigning Continuing Education in the Health Professions is the result of the work by the Institute of Medicine (IOM) Committee on Planning a Continuing Health Care Professional Education Institute. This report does not recommend specific details about the operations of an institute—instead it illustrates a vision for a better system through a comprehensive approach of continuing professional development and a framework upon which to develop a new, more effective system. The report also offers principles to guide the creation of an institute. Refocusing the lens from CE to a system of continuing professional development supports health professionals in achieving the goal of high quality, safe health care.

CE is one of many strategies to strengthen and retool the health care workforce and just one of many pieces necessary to improve health care quality and patient safety. Yet it is a critical piece—one

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

that has been overlooked for too long. In the current era of health reform, transformation of CE offers an actionable agenda to begin the alignment of learning with public expectations and the needs of health professionals.

I would like to extend my gratitude to the members of the committee for their commitment and dedication in developing a report based on the evidence and sound reasoning. I would also like to thank the many individuals and organizations who contributed their time to provide input to the committee’s deliberations. Finally, I would like to express my appreciation to the IOM, in particular IOM senior staff and Samantha Chao, study director, for their tireless efforts.


Gail L. Warden

Chair

Committee on Planning a Continuing Health Care Professional Education Institute

December 2009

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

Acknowledgments

Many individuals and organizations contributed to this study. Most specifically, the committee and staff would like to thank those experts who testified at the public workshop held on December 11, 2008, and February 12, 2009, in Washington, DC:

Cathryn Clary, Pfizer, Inc.

Linda Coogle, North American Association of Medical Education and Communication Companies

Jeanne Floyd, American Nurses Credentialing Center

David Gibson, Association of Schools of Allied Health Professions

Dwight Hymans, Association of Social Work Boards

John T. James, Patient Safety Advocate

Murray Kopelow, Accreditation Council for Continuing Medical Education

Patricia Lane, National Black Nurses Association and Inova Fairfax Hospital

Michael A. Moore, Danville Regional Medical Center

Lisa Robin, Federation of State Medical Boards

Mike Saxton, Pfizer, Inc.

Rebecca Snead, National Alliance of State Pharmacy Associations

David Swankin, Citizen Advocacy Center

Peter Vlasses, Accreditation Council for Pharmacy Education

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

We would also like to acknowledge the individuals who provided insight and expertise, supporting the committee’s efforts throughout the report process:

Karen Adams, National Quality Forum

Neese Boston, American Psychological Association

Ashley Byrd, American Psychological Association

Stephanie J. L. Chambers, National Association of Social Workers Credentialing Center

Richard Cole, Federation of Chiropractic Licensing

Todd Dorman, Johns Hopkins University

Bill Dubbs, American Association for Respiratory Care

Martin Eccles, Cochrane Effective Practice and Organisation of Care Group

Thomas W. Elwood, Association of Schools of Allied Health Professions

Kelly Evans, American Therapeutic Recreation Association

Michelle Fiander, Cochrane Effective Practice and Organisation of Care Group

Jan Frustaglia, Association of Occupational Health Professionals in Healthcare

Marc Goldstein, American Physical Therapy Association

MaryAnn Gruden, Association of Occupational Health Professionals in Healthcare

Karen M. Hart, American Dental Association

Sarah D. Hertfelder, American Occupational Therapy Association

Norman Kahn, Council of Medical Specialty Societies

Gabrielle Kane, University of Washington

Alain D. Mayhew, Cochrane Effective Practice and Organisation of Care Group

Kathleen McGovern, Cochrane Effective Practice and Organisation of Care Group

Mindi McKenna, American Association of Family Physicians

Sherry Merkur, London School of Economics and Political Science

Greg J. Neimeyer, American Psychological Association

Karen L. Niles, American Speech-Language-Hearing Association

Elizabeth J. Paulsen, Cochrane Effective Practice and Organisation of Care Group

Laure Perrier, University of Toronto

Joan Polancic, American Society for Clinical Laboratory Science

Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
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Kate Regnier, Accreditation Council for Continuing Medical Education

Lisa Robin, Federation of State Medical Boards

Robert Rogers, Institute for Health Policy, Harvard Medical School

Corina Schmidt, American Society of Radiologic Technologists

Marcia Segura, American Psychological Association

Greg Thomas, American Academy of Physician Assistants

Dimitra V. Travlos, Accreditation Council for Pharmacy Education

Emma L. Wong, Nuclear Regulatory Commission

We extend special thanks to David Blumenthal and Eric Campbell, Institute for Health Policy, Harvard Medical School, and Dave Davis, Association of American Medical Colleges, who were unpaid consultants to the committee in their capacities as grantees of the Josiah Macy, Jr. Foundation. Drs. Blumenthal and Campbell offered support and advice about the financing of continuing education, most specifically about estimating the costs of continuing medical education; Dr. Davis provided guidance on lifelong learning.

Many within the Institute of Medicine were helpful to the study staff. The staff would like to thank Susan McCutchen, William McLeod, Janice Mehler, Joi Washington, and Benjamin Wheatley for their time and support to further the committee’s efforts.

Finally, the committee would like to thank and recognize the support from George Thibault of the Josiah Macy, Jr. Foundation for sponsoring the study.

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Boxes, Figures, and Tables

Summary Box

S-1

 

Statement of Task,

 

2

Chapter 1 Table

1-1

 

Comparing Training, Education, and Professional Development,

 

18

Box

1-1

 

Statement of Task,

 

24

Chapter 2 Figures

2-1

 

Accredited methods of CE by hours of instruction,

 

32

2-2

 

Closing the research-practice gaps for health care professionals and continuing education professionals,

 

37

Tables

2-1

 

Methods of CE Reported by Social Workers,

 

33

2-2

 

Common Approaches to Providing CE,

 

34

2-3

 

Examples of e-Learning,

 

35

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Suggested Citation:"Front Matter." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
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2-4

 

Continuum of Outcomes for Planning and Assessing CE Activities,

 

36

2-5

 

Overview of Select Theories of Learning,

 

42

2-6

 

Theoretical Assumptions of Andragogy: “The Art and Science of Helping Adults Learn,”

 

44

Chapter 3 Figures

3-1

 

Average number of annual CE hours for physicians (M.D.s) (top) compared to physical therapists (bottom),

 

57

3-2

 

Hours of directly sponsored CME by organization type,

 

68

3-3

 

A convergence-of-interest model of commercial support,

 

74

Tables

3-1

 

Examples of CME Activities by Category,

 

58

3-2

 

Comparison of CE Providers, Activities, Requirements, and Consequences of Failing to Meet Those Requirements in Four Health Professions,

 

60

3-3

 

Overview of Current CE Financing in Medicine,

 

67

3-4

 

Financial Support of CME for Different Types of Organizations, 2007,

 

70

Boxes

3-1

 

History: Development of the ACCME,

 

64

3-2

 

Example of Accreditation Criteria,

 

65

Chapter 4 Table

4-1

 

Overview of the Alternatives,

 

82

Chapter 5 Figure

5-1

 

The continuing professional development cycle and system,

 

97

Boxes

5-1

 

CPD: One Surgeon’s Performance and Value,

 

99

5-2

 

Examples of Technology-Enabled CPD,

 

102

5-3

 

Interprofessional Team-Based Learning and Care,

 

106

5-4

 

Example of a Collaborative on Continuing Medical Education,

 

108

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

Chapter 6 Figure

6-1

 

Suggested process for the development of a CPDI,

 

124

Boxes

6-1

 

Trusted Agent Model: Compiling Evidence to Support CPD,

 

120

6-2

 

Competencies for Planning Committee Membership,

 

127

Chapter 7 Table

7-1

 

Criteria Adopted by Select Organizations,

 

137

APPENDIX A Tables

A-1

 

Summary of Systematic Reviews on Effectiveness of CE Methods,

 

150

A-2

 

Literature Review on the Effectiveness of CE Methods,

 

166

APPENDIX B Table

B-1

 

Health Care Occupations Identified in the Bureau of Labor Statistics’ Occupational Outlook Handbook 2008-2009,

 

228

APPENDIX C Tables

C-1

 

Continuing Medical Education—An International Comparison,

 

236

C-2

 

Synthesis of Models for Assessing Continuing Competence,

 

240

C-3

 

Continuing Dental Education—An International Comparison,

 

247

C-4

 

Continuing Pharmaceutical Education—An International Comparison,

 

249

Boxes

C-1

 

An Integrated System for CE,

 

243

C-2

 

The Role of Industry Funding,

 

245

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Today in the United States, the professional health workforce is not consistently prepared to provide high quality health care and assure patient safety, even as the nation spends more per capita on health care than any other country. The absence of a comprehensive and well-integrated system of continuing education (CE) in the health professions is an important contributing factor to knowledge and performance deficiencies at the individual and system levels.

To be most effective, health professionals at every stage of their careers must continue learning about advances in research and treatment in their fields (and related fields) in order to obtain and maintain up-to-date knowledge and skills in caring for their patients. Many health professionals regularly undertake a variety of efforts to stay up to date, but on a larger scale, the nation's approach to CE for health professionals fails to support the professions in their efforts to achieve and maintain proficiency.

Redesigning Continuing Education in the Health Professions illustrates a vision for a better system through a comprehensive approach of continuing professional development, and posits a framework upon which to develop a new, more effective system. The book also offers principles to guide the creation of a national continuing education institute.

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