 Thank you very much. It's an honor to be here. I promise I'll finish on time. My wife says I'm like a gas I can expand and contract to fill any available space. We'll try to do that It's an honor to follow dr. Nasko and I've especially for him. I have to have a renal model This is the countercurrent mechanism that that the important message from us in continuing education is that practice informs the continuum of medical education and as we progress along the continuum of training and enter practice then down the other way comes the information about practice informing the continuum I think Eugene was right to have us here continuing education here. We change that we start the planning process for changing the medical school curriculum practice will change in 2025 If we change the residency practice will change in 2018 If you change what happens in continuing education practice might change next week. It might change next year So the people around this room I I Try to bring you to the position of educators think of yourselves as the continuing education enterprise in the united states The model has changed An article by danny class in academic medicine from june 2000 We used to train and practice in this ballistic model where we got launched into practice and sort of had this decay curve, which hopefully Hopefully what we got to incompetence just after retirement That's really moved to this trajectory model that that tom drew the picture of not only do we move from novice to master But things change in our in our lives that in the in the period that we are practicing and this becomes The material that you become competitive with that you need to think about that is going on in the life of the practitioners We need to acquire What we never knew when we entered practice I don't know about you, but I didn't know it all when I when I when I entered practice I could only learn so much I had to make that up in practice What was not known at the time so that which you have invented and discovered has added to the mix And what should now be forgotten? needs to be We need to spend time american board of internal medicine Foundation has a project about choosing wisely But that which must be removed so our life as professionals We do have a baseline a minimally acceptable practice. We have our own personal standard of what's acceptable But there is a wide range in which you can Alter and impact what it is that people do Using the continuing professional education Systems that exist in the country Others have found this out The other agencies of the federal government are using continuing professional education to address public health imperatives The food and drug administration office of national drug control policy National institutes of drug addition are all using continuing professional education much of it put on by organizations that are represented in this room To address the opioid addiction and the overuse and misuse of opioids Second most common cause Of accidental death in the united states today is due to prescription drugs one in ten of us Are abusing a prescription medication in some manner Agency for health research and quality has used continuing education To deal with a comparative effectiveness research and get that word out So there's there's there is lot one of the only agencies Dr. Green I draw this to your attention the only federal agency To give up its acc me accreditation in the last decade is the NIH So it's if the others have come on board and started so there is an opportunity For this organization to to deal with there are others in the private sector That are also using continuing professional education some of them You probably have something to do with the the world of interprofessional collaborative practice patient safety the opioid prescriptions All of these people have started to use continuing professional education as a strategic asset in the fulfillment of their mission And what we need to recognize if we are from the social science literature If we're actually going to change what people do We need to make these behaviors Both their intention and their habit of do them when people see people In practice it needs to be their intention to address the issues of genetics It needs to be their habit and that comes about through motivation. We talked about About about payment and we talked about morbidity and mortality But we need to create the facilitating conditions for this to occur And education and continuing professional education is one of those opportunities If you think of your touch points in your professional life Of organizations that do accredited continuing medical education that you could impact How many how many physicians in practice could the american medical association the university of chicago? baler harvard hopkins, how many of places could you had you impact well? There are 20 million professional individuals Who participate in the accredited continuing medical education enterprise in a year? Those are a lot of touch points. There are 130,000 activities that occur in the academic medical centers But they occur in the community hospitals and in the clinics where people teach University of chicago has an interesting program for their fellows and residents called beyond the walls Where the residents and fellows in critical care and anesthesia Go out of the university into the community to talk to organizations that impact their professional life Somebody mentioned about getting beyond the walls Eugene of the centers, but 20 million participants Two million people participate in the continuing education programs of the people that are around the inside of this table I didn't know about all of you being here that number probably goes up three or four times So you as individuals Can impact the continuing professional education systems Of the organizations that you operate in and you can change what your learners know And how they interact with people Accredited continuing medical education the system that i am the ceo of Changed and created the facilitating conditions in 2006 for you to do this We focused our rules and regulations On supporting change in knowledge strategies and performance and practice Necessary to provide optimal patient care Accredited education doesn't need to be convinced of anything. It is not the barrier To this the barrier is getting the material into the point of care education and then deliver You have CME providers who are would be delighted for you to phone One of the things that that happened i spent six months As a special advisor to the office of national drug control Policy in the executive office of the president early and president obama's first term and it was a real honor to have this opportunity to to Show to people where the opportunities were for accredited continuing education To be picked up and to be used by others in the system And one of the things that they said was When we come to undergraduate and graduate education We get told there's no room in the in the curriculum There's no time for it But accredited continuing education Every year almost wipes the slate clean The delivery system continues, but the content gets renewed every year So your opportunity to participate and engage and change You need to know some of the lingo If you go to the accredited education systems with a professional practice gap And not much of that has been clearly articulated yet here But if you can address what it is that the practitioners are not doing And if you can articulate what it is that you want to change in the people out there You're going to have a very welcome audience. You're going to be very well received and embraced An example a concrete example about what you can do Is if you go to someone and say the professional practice gap Is that the family docs the pediatricians someone is failing to check the genetic history or failing to explain Properly why genetic testing is that's the professional practice gap They need to know well, why is that? Well because they don't know what is known about genetics or genetic screening That's what we want to affect their knowledge The competency to to to affect medical knowledge or communication perhaps The educational format that you want to use Mira talked about point of care learning But there's other formats you might want to use something didactic followed by the use of standardized patients And measurement of their success in the context of standardized patients or practice profile You can change the facilitating conditions change how they practice There is unequivocal Educational literature evidence for the impact of using this process to change what it is that you want to change Which may be what people do maybe what their strategies are or maybe simply what they know. Thank you Thank you very much. Yeah, absolutely great and um a couple comments and one question and then we'll we'll open it up I'm assuming at least taking a lead from dr. Naska that you must be a pulmonologist Since we heard a bit about Boyle's law right at the beginning there. So no, I'm married to an anesthesiologist Even better. All right So this I also heard a takeaway there, which is I think we need to go back to NIH related to The accreditation and cme issue. I noticed Terry furiously typing on that one already So I think that may have been a bit of a game changer I'm I'm I was curious in the sense. Uh, I had really hadn't appreciated the impact of Having information flow back the bidirectionality of the information And I guess I'd like you to expand if you would just a bit about given our content area How you think we who have generally not been Embedded within practice could more effectively Communicate a practice level need back to our cme any suggestions that you might have for that Well, when I asked that question I was given the bloomberg article from september 2006 the you know the the business about the misdiagnosis I was also given your article from last year or two years ago about what we could do and the about impacting and changing practice Embedded in the in the bloomberg article is is the failure to have proper management systems or to Know how to interpret results. That was the professional practice gap Those are concretes and I think that that it would be immensely valuable if you spend some time Pulling out of your literature or out of from what you already know The a clear articulation of that so that you can go to the accredited providers because in each of your shops There is an accredited provider and if you can put on the table, this is a professional practice gap that we want to change They will be the strategic asset of how to do it what what educational format and et cetera Great. Thank you. I'll again just to highlight something that I took away from that is that that's a potential role In terms of Synthesizing all of the gaps that we know exist in literature that that type of literature review and putting in one place Could be a potential utility. There was a question up front right so Hi, katie germansson taber from the american medical association since you you brought up the the example of the tying the being able to prescribe opioids to some sort of educational certification I wondered if there's a lesson that we can learn from that because there was a bit of backlash and and the AMA was one of the groups that opposed Making education mandatory in order to to have a DEA license or to be able to prescribe certain types of medication and the reason for that opposition was a bit of a worry that it would it would Create access problems for patients who did legitimately need this type of medication and You know for some reason their physician had decided not to undergo the Education just didn't want to deal with it didn't want to have to jump through all of the hoops So is there some sort of lesson that we can learn from? that type of situation where if if there was a way to to Um tie education to the ability to order a genetic test or or some other way to participate in practicing genetic services Is there a way to keep it from seeming like we're being Exclusionary or or possibly creating an access problem. It's important to learn a lesson And in my perception the the lesson with respect to the opioids Is why didn't we listen a decade ago? This conversation Is occurring about something which is 10 years away From the Food and Drug Administration or someone saying Here is how genetic testing must be used because the patients and the public health is being jeopardized By the way we are practicing So here we are 10 years away from that and we have the opportunity to say yes We have we have the educate the I as the CEO of the of the accrediting body for continuing education separate from any advocacy positions of any of your organization Is saying We're we're living in let's learn from the past and from the experience of something Where the profession didn't respond to this rising Number of deaths or that and do something and that that's the that's the opportunity So we got we're way early from in the heels So bruce while you're moving up to the podium one quick question Oh, thank you mark I I really appreciate the organizers putting both the graduate medal medical education and the cme Both front and center at the beginning of the meeting from the american heart associations perspective We deal with both these rare conditions that would require very specialized care as well as common diseases that Effects large segments of our population and so when you think about how we're going to actually Care for these common diseases where you know 70 million americans have hypertension or two-thirds of our populations obese We're really going to have to expand through cme The educational level of multiple levels of practitioners from physicians to nurses to be able to deal with these common conditions Thank you