Can a CME Case Conference Series Create a Community of Practice in a Group of Hospitalist Physicians?
Abstract
Objective/Purpose: To develop and describe a community of practice amongst a group of hospitalist physiciansthrough a longitudinal structured continuing medical education (CME) activity.Need for Innovation: National studies which were confirmed by local survey, reveal that adult medicine hospitalistshave reported feelings of isolation, poor socialization with limited forums to collaborate and learn together ascolleagues (e.g., structured case discussions, morbidity and mortality conferences). They struggle with clinical andteaching workloads and the stress of keeping up-to-date. CME has been the traditional mechanism to supportcontinuous learning, yet there is limited data regarding the impact of CME case conference on physicians’socialization and isolation.Instructional Methods/Materials Used: A CME approved case conference series for Internal Medicine hospitalists wasdesigned using Communities of Practice principles and Harden’s CRISIS criteria for effective CME (makingparticipation voluntary, choosing topics relevant to their role in the workplace, encouraging peer-to peer learning,scheduling the program). The hospital leadership was approached for resources to support a CME endeavor, and theyprovided administrative support for CME documentation, along with a meeting space and refreshments. The 1-hourclinical conference series was scheduled every two months and selected clinical cases are presented by a hospitalist.A case is selected on the basis of its rare presentation, complicated diagnosis or challenging management. Thepresenter, through a powerpoint discussion, provides the group with the session’s educational objectives, followed bythe presentation of the patient, and poses clinical questions at strategic points. An open format for discussion allowsattendees to offer their opinions, ask questions and reflect on each others’ experiences.Educational Outcomes: Attendees complete an end of session evaluation to gauge their reaction. In future events, wewill gather narratives from attendees with regards to their changes in behavior a few months following the session. Wehave had five sessions since November 2015. Some examples of presented cases are management of atypical chestpain and approach to severe hyponatremia. Narrative comments on a post conference anonymous survey indicatedparticipants valued ‘prompted audience participation’, ‘the discussion and debate to improve practice based onevidence based guidelines’. Despite potential scheduling challenges, each session has had at least 8 participants(75% of this hospitalist group).Strengths/Areas for Improvement: Our CME series helps fill the void of professional isolation and provides a collegialpeer-to-peer learning opportunity that community hospitalists seem to value. Since it is situated in social learning andcommunities of practice, the case conference accommodates practitioners of varying levels of experience in sharedlearning from each another. Moreover, this program is not resource intensive. Since we have had 5 sessions in thepast year, we hope to expand our audience to hospitalists and specialists from other facilities in other health caresystems (which lack structured local CME activities).Feasibility of Program Maintenance/Transferability: With leadership support, we propose that a program such as ours,grounded in social learning theory, is reproducible in comparative settings. Although designed keeping the uniquecharacteristics of hospitalist physicians in mind, it can be replicated in other settings where physicians do notnecessarily meet each other on a regular professional basis such as primary care. In addition, physicians working inshift-based specialties such as critical care and emergency medicine will likely find value in engaging in this form ofcommunity of practice.