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MAKING CME WORK FOR ALL

 

Continuing Medical Education (CME) represents the third and longest phase of the practicing doctors’ education, the other two being the undergraduate medical education (UME) and the graduate medical education (GME) phases.

CME should ideally be a co-ordinated continuum from GME to CME (Waxman & Kimball, 1999). Taken in this context, a practitioner pursuing a graduate medical education programme such as a Master degree or Diploma Course from the Graduate School of Medical Studies (GSMS) should be able to gain CME points for his or her educational efforts. Similarly, a doctor looking for a CME activity could be allowed to choose to participate in activities intended for graduate medical education and receive CME points.

The CME phase is the focus of the Singapore Medical Council’s current three initiatives to realise its vision of maintaining a high standard of medical practice and continuing competence of doctors in Singapore.

SMC Initiatives
The three SMC initiatives are:

  • The setting up of a SMC CME Co-ordinating Committee for it to work closely with the Academy of Medicine (AM), the College of Family Physicians (CFPS), the Singapore Medical Association (SMA) and medical institutions to accreditate CME activities and put in place a more structured CME programme for all. The CFPS, AM will respectively focus on domain specific CME for the family physician and the hospital based specialist. The SMA will focus on practice related CME that is relevant to all practitioners. The Internet technology will be used to offer more opportunities for distance learning and to reach out to doctors more efficiently.
  • SMC together with the professional bodies AM, CFPS and SMA will review CME coverage of all doctors in various fields of medicine as a step towards more comprehensive needs assessment for clinical practice and patient care.
  • The SMC has restructured the accreditation and monitoring of CME activities. The Online CME system expands the scope of the current manual system of recording participation in CME activities and maintains the calendar of local CME activities. This new system allows doctors to record their CME activities at their convenience, check the available CME and make their learning plans. It was launched on 22 Jan 2000.
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Professional support
The professional bodies have voiced their support for the SMC initiatives. The time and opportunity has come for the whole medical profession to plan and develop a more integrated and structured CME programme. The grouse in the past has been that CME is irrelevant, piecemeal and driven by pharmaceutical companies. It is likely that this will be a relic of the past as the medical profession puts its act together.

Already, the professional bodies are making plans to work towards CME activities that are proven to positively impact professional development. Such activities have been alluded to by more than one medical opinion leader in the current medical literature (Waxman and Kimball, 1999; Donen, 1999; Fox & Bennet 1998; Davis et al, 1995).

Academy of Medicine
The AM, besides the usual didactic activities (e.g. lectures), is in the process of developing the Maintenance of Professional Standards programme as a strategy to promote CPD for specialists in Singapore. Their Maintenance of Professional Standards programme will include: Continuing Medical Education activities like Scientific Meetings, Self-education activities and Practice related CME; Teaching and Research; Quality Assurance; and Hospital Credentialing.

The College of Family Physicians
The College of Family Physicians aims to provide CME that is practice based; structured and yet flexible; and utilises different learning methods to cater to the different needs and aptitude of its members. Its Family Medicine Training Programme used for graduate medical education (the MMed (FM)) has in place a workable syllabus that covers the wide terrain of general practice. This syllabus framework can also be used as the CME syllabus framework to satisfy the structured and yet flexible coverage of clinical topics.

The structured and yet flexible coverage of clinical topics need elaboration because it is a very central concept on how to work through the whole terrain of family medicine in a cycle of two years. Essentially, its syllabus framework consists of 8 modules and each module focuses on three categories of clinical topics: population based (e.g. women’s health), systems based (e.g. neurology, Eye or ENT) and practice based (e.g. financial planning). Since the practice related CME will be a focal area of the SMA’s CME programme, it will leave this to be taken care of by the SMA and concentrate on the other two. If a quarterly change of module is made and a spread of clinical topics is chosen from each module then, as the modules rotate over time, the topics chosen will together touch on some aspects of the whole terrain of family medicine in a cycle of two years. This is the structured aspect of its programme. The flexible part is that within the module, there are many clinical topics that can be chosen, depending on the focus of a particular doctor or group of doctors or a CME provider.

CME providers adopting the structured syllabus framework to plan its CME programme based on the three monthly themes could be given enhanced publicity and more CME points because such activities will synergise with the structured programme of the College.

The College has planned its CME activities to make use of different learning methods:

  • Distance learning - from various sources - such as the College’s Family Physician, Annals of Medicine, Singapore Medical Journal and other accredited publications for Category III CME
  • Skills courses (e.g. the Minor Surgical Procedures course) & workshops (e.g. the Diabetes Course) for Category I CME
  • Conferences, ward rounds and meetings for Category I CME.

The College has in its plans to introduce other CME activities such as research courses & practice based research projects and Practice audit projects with the publication of original papers in Journals (as Category II CME).

Also, different focus and levels of practice exist within primary care. Consequently, the nature of CME to support such practitioners will need to be considered. One such example is step-down care mentioned in the Inter-Ministerial Committee’s Report on care of the elderly. Family physicians who wish to participate in the step-down care for complex patients may find it necessary to prepare himself or herself by undergoing more defined CME activities. Such activities could be co-jointly organised by the College, Academy and Departments of Geriatric Medicine.

The Singapore Medical Association
The SMA will strive to play a key role in practice related continuing medical education (CME). Practice related CME is common to each practicing doctor. The practice related syllabus covers four areas: practice management, doctor-patient relationship (DPR) issues, medical errors, and professionalism. They represent topics that are less taught in the Undergraduate and Graduate Medical Education phases of the doctor’s learning career. The CME activities will be conducted as half-day/one-day seminars & workshops (to earn category I CME points); distance learning articles on practice related topics (to earn Category III CME points), and practice audit projects (to earn Category II CME points) in collaboration with AM/CFPS.

An important activity related to practice related CME will be the launch of the SMA Centre for Professionalism and Ethics in June 2000. The aims of the Centre are to spearhead practice related CME; publish papers on practice related topics; and organise workshops, seminars and conferences on practice related topics.

Together we will achieve
The stage is set for making CME work for all. The College is confident that it will be able to provide a new approach of CME that is practice based, hands-on and relevant. The Academy has a programme to encourage the maintenance of professional standards in specialist case. The SMA believes that the outcome of its effectiveness in its CME efforts will be reflected in the reduction of complaints & medical errors, and enhanced professionalism. The leaders of the medical profession have together taken a big step forward in the CME initiative. The SMA will want to rally members to participate actively and if possible far exceed the bottom line of the annual 25 CME points set by the Singapore Medical Council. Together we will achieve.

References

  1. Waxman H, Kimball H. Assessing Continuing Medical Education. Am J Med, Jul 1999; 107(1):1-4.
  2. Donen N. No to mandatory continuing medical education. Yes to mandatory practice auditing and professional educational development. CMAJ Apr 1998; 158(8):1044-1046.
  3. Fox RD, Bennett NL. Continuing medical education: Learning and change: implications for continuing medical education. BMJ Feb 1998; 316(7129):466-468.
  4. Davis DA, et al. Changing Physician Performance: A systematic review of the effect of continuing medical education strategies. JAMA Sep 1995; 274(9):700-705.
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