CME That Reflects the Changing Practice of Medicine

Celia Smith

Celia Smith, CCMEP, Director, Continuing Medical Education

Today’s physicians integrate a dizzying amount of new information, advancing technology, shifting staff, and treatment complexity. They require CME that moves beyond the didactic and helps them to effectively address practice-specific problems.

Physicians Insurance offers Category 1-certified courses featuring formats that incorporate new standards of patient-centered care, interdisciplinary teams, and quality improvement. In other words, our CME walks the talk. We aim at nothing less than to help our members measurably improve patient safety and clinical outcomes. This article gives you a glimpse at a few of our current and upcoming programs.

Simulation Training

Effective teamwork requires practice. Physicians and nurses don’t magically overcome differences in training and communication styles when they’re thrown together in a patient emergency. The very word team is a misnomer, considering the countless configurations of personnel who might be on shift at any one time.

Simulation training provides that practice. Physicians, nurses, and technical staff work in small groups to clarify roles, then respond to a staged crisis in their hospital’s setting, using a high-tech mannequin to test skills. The exercise is videotaped to guide discussion after the drill, and to identify process improvements. Physicians Insurance has conducted 13 days of simulation training in emergency cesarean section and shoulder dystocia delivery. Planning is under way to expand the training to emergency physicians.

Communication in Anesthesiology: Making the Most of Brief Patient Encounters

“You’re not going to give me that drug they gave Michael Jackson, are you?” Anesthesiologists often meet their patient for the first time immediately before surgery. They have only a few minutes to ensure readiness for anesthesia, explain their role, and address anxious questions. Establishing trust in a compressed time frame, without the appearance of being rushed, requires distinct communication skills. This 2-hour course will help you to strengthen those skills by providing examples, practice, and feedback in a congenial, confidential setting. Participants will be able to view and debrief a patient interview. More details on these 2012 workshops will be sent to our member anesthesiologists and CRNAs.

Risk Management Essentials for the Laboratory: a Webinar for Pathologists

Most laboratory errors are not simply a matter of misjudgment. The potential for error accumulates with every person processing a specimen before it arrives in the lab for interpretation, and then in reporting results. This 1-hour webinar shows best communication practices with referring physicians, and strategies for mitigating risk. It was planned with input from our 12-member focus group, survey results from member pathologists, discussion with University of Washington faculty, and analysis of claims data.

Chronic Pain Management

The institute of Medicine (IOM) reported in June 2011 that chronic pain affects at least 116 million American adults, making it an unprecedented public health emergency. From 2003 to 2008, the death rate from prescription pain medication in Washington State increased 90 percent. In response to these alarming figures, the state legislature passed Engrossed Substitute House Bill 2876, to guide opioid prescribers towards safer treatment practices.

The e-learning module described below summarizes the pain rules and recommendations for tracking clinical progress. In addition, we have built upon our foundational 2009-2010 seminar with numerous options that all support the rules, reinforce learning objectives, and align with different learning styles.  

  • The Medical Quality Assurance Commission Pain Rules—What Washington State Physicians Need to Know . . . and All Prescribing Physicians Will Benefit From: Accessible from our Web site, this 1-hour e-learning module walks you through the rules required for treatment of chronic, noncancer pain in Washington State. Participants will be able to identify which of their patients need consultation, and how to conduct consultation electronically. The course links to tracking and assessment tools useful for organizing a treatment plan.
  • Balancing Risk in the Management of Chronic Pain: Filmed from a live seminar, this 1-hour webinar self-study gives you prescribing guidelines, recommendations for developing a care plan, and examples of effective patient coaching.
  • Simplified Management of Patients With Chronic Pain: In this 1-hour webinar you will review standards for treating and tracking the progress of patients with long-term pain. Also covered are recommendations to avoid diagnostic blind spots and tools to standardize care among providers and staff.
  • Goal Setting in Chronic Pain Management: Video vignettes are incorporated into this 1-hour e-learning module that demonstrates communication and goal-setting techniques with challenging patients. Publication is set for spring of 2012.
  • Recognizing and Responding to Addiction: This 1-hour e-learning module clarifies ways to prevent, recognize, and manage addictive behavior. It includes strategies you can use to minimize your liability risk, and illustrates common scenarios along with suggested scripts for handling difficult patient interactions.
  • Resources for Pain Rule Compliance: From the Physicians Insurance Web site, you can download a patient booklet, Structuring Your Own Management of Pain, that is filled with ideas for goal-setting and adjuvant therapies. Also available is a pocket card for quick access to key points and Web site addresses, the Washington State Agency Medical Directors’ Group Interagency Guideline on Opioid Dosing, and sample forms to help with screening and tracking.

Managing Risk with the Noncompliant Patient: Tools and Techniques to Promote Accountability and Improve Documentation

Upcoming in early 2012 is a 1-hour webinar that takes an honest, practical look at the frustrating issue of patients who don’t follow treatment instructions. Accountability tools combined with behavior modification strategies will help you to shift the balance of responsibility and negotiate reasonable goals. You will learn to phrase questions in ways that elicit information without lengthening the office visit.

Integrating Cultural Competency into your Practice

The Northwest is among the fastest-growing areas in the country, with projected increases of diverse populations expected to reach up to 150 percent in the next 20 years. Effective cross-cultural health care involves a combination of communication skills and resources for providing appropriate services. At the completion of this 1-hour e-learning module, you will have more proficiency at communicating with culturally diverse patients and those with low health literacy. You will know how to update practice forms and provide easily understood patient-related materials. Look for this Web-based program in the first half of 2012.

Adverse Event Response Team Training (AVERT)

Open communication after an adverse event requires a quick, coordinated response. This multi-faceted training incorporates a variety of media and experiential learning methodologies that will be customized upon request for different specialties and practice groups.

Incorporating New Standards

Most specialty boards have now adopted a program involving continuous professional development called maintenance of certification (MOC) as a formal means of measuring a physician’s continued competency in his or her certified specialty or subspecialty. More rigorous standards for both CME and MOC require active participation by physicians to evaluate their practice on a regular basis, to measure their performance against competency benchmarks, and to demonstrate practice improvements.

Technology and performance measures might at times feel like an infringement on your autonomy. Standardized procedures, another step in modernizing medical practice, can imply a rigid bureaucracy. But these system updates also put safeguards in place that could free more of your attention for individual patient needs.

Communication is the art that makes the science of medicine work. It’s the common thread running through each of the above course offerings. Even the practice of pathology, detached from direct patient care, depends upon communication among providers. Our CME reflects the changing practice of medicine by incorporating new standards into a foundation of interpersonal skills. In addition to the options above, additional activities are described on the Physicians Insurance Web site, We hope you’ll take advantage of them, and that you’ll integrate CME into your daily practice.