The Battle of the Eye Doctors - Bacon's Rebellion

[Paul Farkas]

Really, CE accreditation is an odd hobby. Fell into it. I’ll be retired before optometry is capable of pulling it off properly and it might not happen at all.

A great effort on your part and Dr Wang's counterpoint. Sadly too many words for most of our readers who spend an average of 15 minutes visiting the forums.

If you were C/E Czar over state boards and must come up with recommendations and no legislative roadblocks what would you advise ASCO to pass on to state boards as a universal effort for all states to follow?

Can you limit your recommendations to two minutes reading time?

Thank you both for this weekend conversation.

 

[Paul Farkas]

I don't need another lecture on diabetic retinopathy. But a lecture on diabetes would be great.
I don't need another lecture on hypertensive retinopathy. But a lecture on hypertension would be great.
I don't need another lecture on Grave's disease. But a lecture on thyroid dysfunction would be great.

Bravo!

I hope Dr Steve Silberberg is reading this so that he has enough time to carry out your wishes for CEwire2023, with the best possible presenters, sharing in plain language easily understood by ODs.

 

[Michael W Ohlson]

I don't have strong feelings about accredited vs not accredited.

I have always felt though that the biggest problem with most optometric CE is that it's not helpful for the average optometrist.

I find that it's either much too basic.....like....I don't need to hear another 90 minute lecture on the "latest therapies for allergic conjunctivitis."

-OR-

It's so incredibly over the top where you have a scenario where a doctor who works at a tertiary referral center presents a two hour lecture on obscure retinal dystrophies they saw in their clinic after the patient saw seven optometrists and four ophthalmologists until finally the patient ended up at the tertiary referral center where they were diagnosed with a condition that occurs with an incidence of one in seven million but only in Easter European Ashkenazi Jews.

Neither of those is helpful.

I don't need another lecture on a diabetic retinopathy. But a lecture on diabetes would be great.
I don't need another lecture on hypertensive retinopathy. But a lecture on hypertension would be great.
I don't need another lecture on Grave's disease. But a lecture on thyroid dysfunction would be great.

Actually, this is an excellent post.

One can slap an accredited label on anything or any group. That would be bad. However, an OD learner might care about unbiased information, addressing important topics effectively, innovation, and so forth.

So, addressing needs or knowledge/performance issues relevant to your practice matters?

So, you’re not thrilled about wasted time and money?

You’re describing the need for change. When you add the comments about diabetes, HTN, thyroid… are you citing possible discrepancies that could help with improved knowledge and performance?

Add in areas where health care struggles. The pandemic. Opioids. Alcohol use disorder. Abuse. Antibiotic adverse rxns. On and on. You’ll find that the areas I’ve covered now utilize accredited CME in attempts to address gaps in care.

I could not have described things better. It’s not just optometry. It’s not mean-spirited or incorrect. It’s not perfect. It won’t be perfect. It will continue to be a work in progress across the professions.

 

[Michael W Ohlson]

A great effort on your part and Dr Wang's counterpoint. Sadly too many words for most of our readers who spend an average of 15 minutes visiting the forums.

If you were C/E Czar over state boards and must come up with recommendations and no legislative roadblocks what would you advise ASCO to pass on to state boards as a universal effort for all states to follow?

Can you limit your recommendations to two minutes reading time?

Thank you both for this weekend conversation.

There are no simple answers for complex issues. That’s fantasy. No reading, no learning.

ASCO does not advise state boards on CE or regulatory issues.

The universal effort is already in place, in two formats both recognized as equivalent to ACCME, and approved for joint accreditation with medicine, pharmacy, nursing, PAs et al. Optometry need but utilize it. This can be confirmed on the ACCME website and here: https://www.jointaccreditation.org//

The member regulatory agencies of ARBO have been advised repeatedly. Over. Over again. Over again. And, again.

Accredited CE is not dependent upon setting (unless the learning requires a setting, e.g. wetlab), 50 minute periods, written tests per se, and more. Optometry will not magically create something better than the extensive work documented and implemented over many, many years. That would also be fantasy.

Frankly, optometry wasn’t prepared.

 

[Michael W Ohlson]

“Most physicians believe that to provide the best possible care to their patients, they must commit to continuous learning. Learning is defined by most observers as the acquisition and creation of different types of knowledge that, through complex cognitive processes, leads to the development of new understandings, skills, and capabilities. For the most part, it appears the learning activities currently available to physicians do not provide opportunities for them to develop new understandings, skills, and capabilities. Rather, current continuing medical education (CME) provides little more than documentation of attendance. Unfortunately, this situation has been reinforced for years because documentation of attendance has been all that physicians have had to demonstrate for certification by their professional associations, re-registration of their medical licenses, or credentialing for hospital staff privileges.” - Moore DE, 2009

 

[Michael W Ohlson]

“However, CME in its current form may not be able to help physicians meet these new requirements. In the early nineties, there were calls in the CME profession to develop a new paradigm for CME that focused more on performance data and outcomes than documenting attendance. More recently, to meet these new challenges of MoC, MoL, and competency-based privileging, the Accreditation Council for CME (ACCME) has revised its accreditation standards to focus on improvement of physician competence, physician performance, and patient health status. In addition, research on CME has demonstrated that while most CME activities, in and of themselves, do not contribute to improved physician competence, physician performance, or patient health status, CME activities that are planned according to certain principles can demonstrate improvement in these areas. The evidence reported by this research is complex, but compelling.” - Moore DE, 2009

 

[Michael W Ohlson]

“Practicing physicians typically are in a continuous search for information to use to solve problems or improve their practice. When physicians select learning resources in their self-directed learning projects, one of the features im- portant to them is this focus on clinical issues. They do not necessarily want a detailed description of the basic science or clinical research that led to findings that have clinical implications. This is useful to consider when planning formal CME activities where physicians may be in any one of the 5 stages of learning that were described earlier in this article.” - Moore DE

 

[Michael W Ohlson]

“At the beginning of this article, we described the quality of health care in the United States as a major concern. Many groups inside and outside organized medicine have suggested ways to address the place of physician education in this concern. Among these groups, the Institute of Medicine has issued a challenge to reform health professions education, the ABMS and FSMB have begun initiatives to address issues of physician competence and performance, and the ACCME has established a new set of criteria that focuses more forcefully on improving physician competence, physician performance, and patient health status. We believe that current approaches to planning and assessing CME will not measure up to the new requirements and the expectations of society, and change will be required if CME planners expect to participate as full partners in efforts to address physician competence, physician performance, and patient health status.” - Moore DE, 2009

 

[Michael W Ohlson]

The above are bite-sized bits from one author/expert. I can’t read it for people. You cannot force someone to learn.

i went back and placed some items in bold. Less to read.

This train left the gate long, long ago. The world is tougher. I’m not the etiology.

 

[Mike Alvarez]

A great effort on your part and Dr Wang's counterpoint. Sadly too many words…..

Where have I heard this before?

 

[Michael W Ohlson]

Where have I heard this before?

Good one.

 

[Michael W Ohlson]

Paul’s right. People don’t read.

Years back, I wrote an outline on CE accreditation aimed at CE providers. I pared it down, pared it down again, pared it down a third time and used simple diagrams. I’ve turned it over to COPE. Due to the amount of material, one still has to read and study. Think. Reflect. This is the way of it.

Discussions are a bit similar. Just as we have our own jargon, education and physician learning have theirs. That’s just the way of it. No one can spoon feed this.

If readers reject new concepts outright, demand no nuance, doubt, or risk be present, demand no reading or effort, refuse to pay fees or to volunteer, feel everyone has an angle, seek paths of least resistance, or simply pay little-to-no attention to the rest of health care out of having virtually no actual desire… okay. It‘s ‘Murica and I’m old, thank God. But, I think that’s how we got here, right?

 

[Michael W Ohlson]

Just popped up on Facebook:

 

[Steve Silberberg]

I don't have strong feelings about accredited vs not accredited.

I have always felt though that the biggest problem with most optometric CE is that it's not helpful for the average optometrist.

I find that it's either much too basic.....like....I don't need to hear another 90 minute lecture on the "latest therapies for allergic conjunctivitis."

-OR-

It's so incredibly over the top where you have a scenario where a doctor who works at a tertiary referral center presents a two hour lecture on obscure retinal dystrophies they saw in their clinic after the patient saw seven optometrists and four ophthalmologists until finally the patient ended up at the tertiary referral center where they were diagnosed with a condition that occurs with an incidence of one in seven million but only in Easter European Ashkenazi Jews.

Neither of those is helpful.

I don't need another lecture on diabetic retinopathy. But a lecture on diabetes would be great.
I don't need another lecture on hypertensive retinopathy. But a lecture on hypertension would be great.
I don't need another lecture on Grave's disease. But a lecture on thyroid dysfunction would be great.

First of all great stuff Dr. Ohlson and to answer your problem DR. Elder events such as CEwire are diverse enough to give a person choice. I'm sure meetings such as The Academy and VEE and VEW might also

 

[Michael W Ohlson]

First of all great stuff Dr. Ohlson and to answer your problem DR. Elder events such as CEwire are diverse enough to give a person choice. I'm sure meetings such as The Academy and VEE and VEW might also

Dr. Elder rocked desires from physician learners. Factor in time, cost, etc. and you have most of it covered.

There are other stakeholders. Health care orgs/employers want bang for their dollars/time. ODs coordinate/co-manage with other professions. CE providers should want to learn, be part of a wider community, and improve. State boards have duties of assuring continuing competency for the public welfare, their mission; CE is required for relicensure. The patients are the primary stakeholders. They expect and deserve results.

The more you read, the more you’ll see it. But, really, one (or optometry) has to want it. It’s a bit like taking on tough patients and growing; you have to rise to it. Half-assing accreditation would just be another embarrassing debacle.