Encouraging Alliance Members to Be Agents of Change

By Dennis K. Wentz, MD

Editor’s Note: This speech was delivered on Jan. 28, 2017, at the Alliance Annual Conference Award Ceremony. Dennis was one of the two recipients of the 2017 Lifetime Achievement Award.

I join Lew Miller in extending sincere thanks to this incredible organization, the Alliance — its leadership, board and all its members — for this profound honor. Lew and I both hope that this Lifetime Achievement Award will send a signal that it is most rewarding to be involved in continuing education over a lifetime, helping healthcare learners deal with their individual continuing professional development, remembering that continuing education is the bedrock of that process.

I want to add a loud “amen” to Lew’s call for a new vision for the Alliance. We need to focus on what matters for patients, and identify what the healthcare system of our country needs during this time of change when questions can be asked of our national leaders. This is a goal that needs our attention now. Our mission need not be limited to CME, or assisting in CPD, but should encompass the finding of ways to be agents of change for improving healthcare quality and delivery.

Lew recounted the 1975 meeting that led to the founding of this Alliance. It was momentous, and was perhaps not appreciated at the time, but this conference is proof that it was not forgotten. Good ideas endure, and that’s what happens to ideas whose time has come.

I wasn’t there in 1975 because I was very new to the formal structure of CME at that time. As a new assistant dean at the University of Maryland School of Medicine, I found myself responsible for the department of CME, and not only that, facing a re-accreditation visit by the LCCME, the predecessor to the ACCME, when I could hardly mouth the correct words for “CME,” much less act as an expert. But we made it through the process, and I was hooked for life. Fortunately for my personal professional development, I got involved with another very small organization, the SMCDCME, The Society of Medical College Directors of CME, that today we know as SACME, the Society for Academic CME. 

What we delivered at Maryland was very traditional CME, breaking few bounds. Our mission was simple, trying to “keep physicians up to date, for the benefit of better patient care.” Just four years earlier, I had been on the front lines as the chief resident of the Department of Medicine at Maryland trying to keep the weekly grand rounds cutting edge and useful. Now I was responsible for an entire university’s approach.

As I gradually met other members of the SMCDCME, I found kindred spirits; they were largely physicians, most of them working part time with many other clinical responsibilities. I soon learned that our common goal was to have our area of medical education recognized and supported by our deans. We said over and over, usually to deaf ears, that CME was the third phase of an educational continuum. In fact, CME was, and remains, the phase that represented the longest slice of education in any doctor’s life.

I still remember a phrase coined by Jim Leist, Ph.D., well known to the Alliance, who said in a paper that those of us trying to provide CME from a medical school were “margin-dwellers,” meaning that we lived with a foot planted in the practicing medical community and the other in the medical school with the faculty. In fact, we existed at the interface.

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Sometimes, one doesn’t know where a career is going to go. But, in retrospect, I can say thank goodness that the challenge of working in CME came my way. I eventually left my chosen medical field of gastroenterology to be full time in the dean’s world and medical administration, and I’ve never looked back. 

I moved from Chicago to Baltimore to Memphis to Nashville and back to Chicago — each of these steps was a profound turn in the road. One fortuitous turn occurred at Vanderbilt University School of Medicine where I served both as medical director of Vanderbilt University Hospital and as associate dean for clinical affairs, with responsibility for both graduate and continuing medical education. It was a remarkable opportunity to observe and interact with the continuum of medical education.

I must admit, in preparing for these remarks 30 years later, that though I worked together closely at Vanderbilt with great colleagues in nursing and pharmacy and several allied health professions, rarely did we plan or work together in our educational programs. I never dreamed that today we would be members of an Alliance for Continuing Education in the Health Professions, and that the field would finally recognize that we’re all in this journey together.

In 1988, another turn led to an opportunity to join the American Medical Association and lead the division of CME. By then I knew that CME had to change. From that national vantagepoint, it was obvious there might be some ways to re-energize the CME system — perhaps using the AMA PRA rules could forge ways of recognizing self-directed learning, striving to make CME more relevant by highlighting and rewarding what doctors did in their daily work. I was fortunate enough to have an amazing team to help me, including two members of the current Alliance board, and one incredible former member.

My 16 years at the AMA were wonderful in so many ways. We catapulted into the controversies besetting CME as we knew it and tried hard to make a difference. There were international opportunities, as other countries came to visit to examine what we had done in the USA to create our unified CME system. I must recall the work that the National Task Force on CME Provider/Industry Collaboration did, when facing a huge challenge from politicians in Congress, specifically televised hearings held by Senator Ted Kennedy, and then later trying to educate the FDA. It was that task force, industry representatives working hand-in-glove with continuing educators, who crafted a document outlining “Guidelines for Commercial Support of CME” that eventually were adopted by the ACCME, with editing and word-crafting done by ACCME board member Kevin Bunnell (later a president of the Alliance) to become the first iteration of the ACCME Standards for Commercial Support.

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But as I end these remarks, I also have regrets. We have come up short in making the continuum of education and learning a going concept — not only in medical education but also in nursing education, in pharmacy education and for all allied health professions.

We are not doing enough, in my view, to instill in our student-learners, especially at undergraduate and graduate levels, the knowledge and desire to be lifelong learners — humble but critical lifelong learners, never satisfied that we have it all under control.

Our “discipline” of continuing education — let’s celebrate the fact that it is a discipline — can provide guidance for not only the goals of individual continuing professional development, but we can use and share our knowledge to create a better patient care system that connects measurement of healthcare results to continuing education to ultimately improved performance in the delivery of quality healthcare to patients and populations. Perhaps some of you heard the presentation about MACRA yesterday from the CME Region 9 medical director. Quite a few of the audience noted the complete absence of continuing education in the CMS list of “recognized improvement activities.” We were not, we are not, at the table when and where these key decisions are being made, and that must change.

I agree with, and second, Lew’s call for a new vision and perhaps name for this organization.

We need to position ourselves to be take-charge change agents. We must be involved in the discussion. We have the understanding, the background, and now the credibility to do it. We should press ahead to be present when the future organization of healthcare delivery is decided: educated professionals have knowledge that can control costs; CE should be a given, imbedded in and paid for by the healthcare system. The discipline of continuing education will demonstrate its value by being a part of the solution; without it, I firmly believe the best patient care possible can’t happen. 

Thank you.

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