The Risks and Challenges of Artificial Intelligence in Endocrinology.

Artificial intelligence (AI) holds the promise of addressing many of the numerous challenges healthcare faces, which include a growing burden of illness, an increase in chronic health conditions and disabilities due to aging and epidemiological changes, higher demand for health services, overworked and burned-out clinicians, greater societal expectations, and rising health expenditures. While technological advancements in processing power, memory, storage, and the abundance of data have empowered computers to handle increasingly complex tasks with remarkable success, AI introduces a variety of meaningful risks and challenges. Among these are issues related to accuracy and reliability, bias and equity, errors and accountability, transparency, misuse, and privacy of data. As AI systems continue to rapidly integrate into healthcare settings, it is crucial to recognize the inherent risks they bring. These risks demand careful consideration to ensure the responsible and safe deployment of AI in healthcare.

Paving the Way Forward for Evidence-Based Continuing Professional Development.

ABSTRACT: Continuing professional development (CPD) fosters lifelong learning and enables health care providers to keep their knowledge and skills current with rapidly evolving health care practices. Instructional methods promoting critical thinking and decision making contribute to effective CPD interventions. The delivery methods influence the uptake of content and the resulting changes in knowledge, skills, attitudes, and behavior. Educational approaches are needed to ensure that CPD meets the changing needs of health care providers. This article examines the development approach and key recommendations embedded in a CE Educator's toolkit created to evolve CPD practice and foster a learning experience that promotes self-awareness, self-reflection, competency, and behavioral change. The Knowledge-to-Action framework was used in designing the toolkit. The toolkit highlighted three intervention formats: facilitation of small group learning, case-based learning, and reflective learning. Strategies and guidelines to promote active learning principles in CPD activities within different modalities and learning contexts were included. The goal of the toolkit is to assist CPD providers to design educational activities that optimally support health care providers' self-reflection and knowledge translation into their clinical environment and contribute to practice improvement, thus achieving the outcomes of the quintuple aim.

The Role of Specialty Certification in Career-Long Competence.

Across the medical profession there is broad acceptance of the critical role of continuing medical education (CME) in enabling physicians to adapt to both new information and evolving expectations within the profession. In the presence of widespread participation in CME, some have attempted to question, discredit, or marginalize the role of ongoing lifelong assessment of physician knowledge and skills through specialty continuing certification, advocating instead for a participatory standard based only on engagement with CME. This essay outlines the limitations of physician self-evaluation and clarifies the need for external assessments. Certification boards' role is to set specialty-specific standards for competence, assess to those standards, and assure the public that certified physicians are adequately maintaining their skills and abilities; doing so credibly necessarily requires, in part, independent assessments of physician competence. In these contexts, the specialty boards are taking approaches to identify performance gaps and leverage intrinsic motivation to facilitate physician engagement in targeted learning. Specialty board continuing certification plays a unique role, distinct from and complementary to the CME enterprise. Calls to eliminate continuing certification requirements beyond self-directed CME are contradictory to the evidence and fail the profession and the public.

Incentivising Higher Level Outcome Achievement in Continuing Education: Five-Year Experience from the ACCME Commendation Criteria.

The Accreditation Council for Continuing Medical Education (ACCME®) Menu of Criteria for Commendation was created to incentivise a variety of behaviours and outcomes from accredited providers. ACCME analysed data from among the 1,053 accreditation decisions made between November 2017 and March 2022, of which 122 had applied for commendation. Accredited providers plan for higher level outcomes in their activities at an increasing rate over the past five years. Since 2017, 49 (40%) of the 122 organisations that applied for commendation under ACCME's new Menu of Criteria for Commendation were awarded this distinction. Of the organisations applying for commendation, 62%, 48% and 31% sought commendation using the "performance", "quality" and "community health" criteria, respectively. The success rate for each of these criteria was 78%, 68% and 66% respectively. Accreditation incentives can change the performance of educational providers and augment the quality and efficacy of continuing education.

Effect of the COVID-19 Pandemic on Accredited Continuing Medical Education in the United States.

INTRODUCTION: The pandemic created new demands on the accredited continuing medical education (CME) community. Facing economic, resource, and personal challenges, educators had to cancel or repurpose in-person learning, and design and deliver effective online education. This short report analyzes the effect of this pandemic on CME in the United States. METHODS: Organizations accredited by the Accreditation Council for Continuing Medical Education are required to submit detailed data about their educational programs annually. This report compares 2019 and 2020 data sets to evaluate pandemic-related changes in the availability, formats, and participation in CME. RESULTS: After years of comparative stability, 2020 saw significant shifts in CME. Compared with 2019, the number of accredited organizations, activities, hours of instruction, and revenue declined in 2020. In contrast, engagement in CME by physicians and other health care professionals increased to the record levels. Virtual learning formats predominated. Almost half of accredited organizations delivered activities addressing pandemic-related topics, mostly in online formats. DISCUSSION: Educators anticipate continuing to offer activities in online and hybrid formats. This transformation presents new challenges and opportunities for CME. It is important that institutional leaders appropriately resource CME staff and faculty to design and deliver education targeting ongoing pandemic-related issues such as vaccine hesitancy, medical misinformation, and clinician burnout.

Facilitating Flexibility: The Role of CPD Regulators and Accreditors during a Crisis.

The COVID-19 pandemic has transformed healthcare systems - including CPD learning environments - around the world. Rarely has there been a time in recent history when almost the entire healthcare profession urgently needed to learn new skills. At the same time, education providers endured new personal and professional stressors. In the US, the Accreditation Council for Continuing Medical Education shifted its position from regulator to facilitator to give CPD providers the guidance, resources, and flexibility that would empower them to help healthcare professionals respond to the pandemic. Despite unprecedented challenges, the CPD community rapidly shifted from live to virtual learning environments to offer critical training, significantly increasing engagement with clinicians and teams, and demonstrating that CPD is an important part of the solution. As the healthcare system continues to undergo stress, it is important that institutional and health system leaders appropriately resource CPD programmes, enabling them to address evolving pandemic-related issues. Regulatory bodies in the CPD sphere should continue to take a leadership role on three fronts: facilitating innovation in education design and delivery; evolving data-reporting systems to reduce burdens on clinicians; and standing up for science by countering medical misinformation and ensuring that education provides valid content.

Learning Together: Engaging Patients as Partners in CPD.

ABSTRACT: The goal of continuing professional development (CPD) is to improve patient care. However, traditionally, CPD has been planned and taught by clinicians, for clinicians, who tend to be protective of the professional-only environment for learning and are wary of the contributions and participation of patients. Although patients are sometimes included as guest speakers, this role has not typically extended to planning, content development, or serving as key faculty-ultimately excluding the patient perspective from the development and delivery of CPD. The absence of the patient perspective in CPD creates an inadvertent blind spot, hindering the opportunity for clinicians to hone patient-centric skills that are learned and practiced through training. As shared decision-making rises in importance among expected clinician competencies, the involvement of patients is becoming more essential. Patients can be our best teachers, and their inclusion in CPD can engage clinicians' hearts as well as minds and reinforce the reasons why our work matters. Patients are often more willing to engage in clinician education than we may realize, but educators must take the first step and invite them to participate and collaborate. This article will describe how to create a plan for engaging patients as partners, including guidance for gaining buy-in from leadership and faculty; recruiting, training, and nurturing patients; determining roles and responsibilities; and creating a safe space for patient participation.

Continuing Board Certification: Seeing Our Way Forward.

BACKGROUND: Traditionally the role of certifying boards has been to hold physicians accountable for demonstrating standards of competence. In recent years, the authority of continuing board certification has been challenged, due to multiple factors that have shifted the dynamics. The breadth and depth of new information, combined with the pressures of system barriers and administrative burdens, can make it challenging for clinicians stay current and maintain their own competency. Absent feedback about their performance, physicians presume they're practicing effectively. The resulting gap between confidence and competence can also lead physicians to make errors of which they may be unaware. In this environment, assessment and accountability are more important than ever. FOUR KEY AREAS: The authors present four key areas to address to move forward with a board certification system that is effective, relevant, and respected. First, boards should set and communicate the specific expectations of specialists. Second, boards should use technology to create practice-relevant assessments. Third, they should collaborate with educators, while maintaining their distinct role as assessors. Fourth, boards need to establish and meet standards for professionalism and ethics that reflect their position as regulatory bodies. CONCLUSION: Boards have a critical role in professional self-regulation. They should not compromise on their primary responsibility to set and evolve standards for competence and to conduct rigorous assessments of physicians. The methods boards use for assessments should evolve to meet the changing needs of physicians. Collaboration between educators and assessors provides more educational choice, relieves burdens, and supports physicians' commitment to lifelong learning. By working together with physicians, educators and assessors advance their shared goal of supporting physicians to work at the top of their capability and ultimately, optimize patient care.

Comparison of Continuing Medical Education at U.S. Medical Schools and Other Accredited Organizations: A 20-Year Analysis.

PURPOSE: To describe a long-term overview of accredited continuing medical education (CME) at M.D.-granting medical schools in the United States. METHOD: Self-reported data about type, duration, and numbers of learner participants of accredited CME activities and income for CME units from each medical school were compiled annually by the Accreditation Council for Continuing Medical Education (ACCME) between 1998 and 2017. Comparisons were made with data from all other ACCME-accredited organizations. RESULTS: Between 1998 and 2017, medical schools represented 18%-19% of all ACCME-accredited organizations. CME activities, hours of instruction, learner participants, and income increased gradually until reaching the highest levels between 2008 and 2011 before remaining constant. In 2017, each school generated a median of 132 activities (interquartile range [IQR]: 66-266), of which 44% were courses and 31% were regularly scheduled series (RSS), and a median of 29,824 learner interactions (IQR: 8,464-46,255). Total income rose gradually until 2010 before declining. In 2017, each school reported a median annual income of $1.0 million (IQR: $0.2 million - $2.9 million) from CME activities, comprising 44% from registration fees, 39% from commercial support, and 14% from advertising and exhibits. Compared with other accredited organization types, medical schools generally developed more RSS activities and proportionally fewer interprofessional and online activities. CONCLUSIONS: While medical schools represent less than 20% of all ACCME-accredited organizations, their role is pivotal and their influence far-reaching. For medical schools to fulfill their responsibility as education leaders, they need to prioritize support for CME offices and faculty development and implement new approaches to teaching and learning.

Continuing professional development to foster behaviour change: From principles to practice in health professions education.

Healthcare professionals need to continuously improve their knowledge, skills and performance to effectively function in an ever-changing healthcare environment. They depend on continuing professional development programs (CPD), either within or outside their institutions, to reflect on and update their clinical practice. Professional growth requires more than knowledge transfer; it requires curiosity, humility, self-awareness and a motivation for mastery. Educators can build on these factors and create effective learning experiences to develop complex skills including communication, interprofessional collaboration, teamwork, leadership and reflective practice. CPD program leaders should adopt an evolved approach to program design that leverages adult learning principles, active learning and longitudinal curricula, while identifying and overcoming system barriers to change, and targeting meaningful behaviour and health outcomes. In this article, we describe principles and strategies that CPD leaders can apply to their own programs, categorized under three steps: (1) Program design, (2) Program implementation and (3) Program evaluation. Under each step, we provide theoretical principles as well as practical tips, focusing on strategies that can motivate and facilitate change.

Navigating Tumultuous Change in the Medical Profession: The Coalition for Physician Accountability.

Collaboration among the national organizations responsible for self-regulation in medicine in the United States is critical, as achieving the quadruple aim of enhancing the patient experience and improving population health while lowering costs and improving the work life of clinicians and staff is becoming more challenging. The leaders of the national organizations responsible for accreditation, assessment, licensure, and certification recognize this and have come together as the Coalition for Physician Accountability. The coalition, which meets twice per year, was created in 2011 as a discursive space for group discussion and action related to advancing health care, promoting professional accountability, and improving the education, training, and assessment of physicians. The coalition offers a useful avenue for members to seek common ground and develop constructive, thoughtful solutions to common challenges. Its members have endorsed consensus statements about current topics relevant to health care regulation, advanced innovation in medical school curricula, encouraged a plan for single graduate medical education accreditation for physicians holding MD and DO degrees, supported interprofessional education, championed opioid epidemic mitigation strategies, and supported initiatives responsive to physician workforce shortages, including the Interstate Medical Licensure Compact, an expedited pathway by which eligible physicians may be licensed to practice in multiple jurisdictions.

The Role and Value of Public Members in Health Care Regulatory Governance.

American medicine has progressively embraced transparency and accountability in professional self-regulation. While public members serving on health care regulatory boards involved with the accreditation, assessment, certification, education, and licensing of physicians provide formal opportunities for voicing public interests, their presence has not been deeply explored. Using 2016 survey and interview data from health care organizations and public members, the authors explore the value and challenges of public members. Public members were often defined as individuals who did not have a background in health care and provided a patient perspective, but in some instances prior health care experience did not automatically exclude these individuals from serving as public members. Public members served on the majority of national health care regulatory boards and constituted an average 9% to 15% of board composition, depending on how rigidly the organizations defined "public member." Public members were valued for their commitment to the priorities and interests of the public, ability to help boards maintain that public focus, and various professional skills they offer to boards. A main challenge that public members faced was their lack of familiarity with and knowledge of the health care field. The authors suggest several considerations for improved public member integration into health care regulatory organizations: clearly defined roles of public members, including evaluating whether or not previous health care experience either contributes or hinders their role within the organization; greater visibility of opportunities for the public to serve on these boards; and potentially a more intensive orientation for public members.

Translating evidence into practice: Lessons for CPD.

BACKGROUND: Failure to translate best evidence into practice often generates inappropriate, unsafe, and costly healthcare. The continuing professional development (CPD) of physicians and other health professionals represents a widely underutilized strategy to improve both clinician performance and healthcare quality and safety. The evidence: Despite the clear evidence of the potential impact of CPD based in learning theory and science, some CPD providers, health systems, and clinicians themselves implement less-than-effective effective learning strategies. This phenomenon is the product of several factors: within health systems, a lack of recognition of the importance of ongoing, system-linked professional education; among CPD providers, an adherence to old but easy-to-deliver "one-and-done" methods CPD; and even among clinicians themselves, choosing less engaging learning activities, uninformed by objective performance data. RECOMMENDATION: Suggestions to improve this lack of translation of best evidence into practice fall into four groups. Academic medical institutions, employers and educators need to embrace principles and practices of self-directed learning; health systems must share responsibility for the physician learning and the performance data and feedback on which such learning is best-based; physician specialty societies and licensing boards must undertake meaningful re-licensure and re-certification processes; and CPD planners must seek out partnerships with health system leadership and quality improvement managers as they create engaging, integrated, and impactful CPD activities.