Dermatology CME Focuses on Performance Improvement

NEW YORK – Since its introduction in 2007, performance-improvement CME has become a key part of dermatology’s maintenance of certification, but many dermatologists still need to set up their personal program.

"Don’t wait to start on point-of-care and performance-improvement [PI] CME projects," Dr. Erik J. Stratman said at the meeting. "If you’re not yet in the first phase of a PICME program, you better do it. It may take a while to accumulate enough patients to run an analysis," said Dr. Stratman, a dermatologist and medical director of the division of education at the Marshfield Clinic of the University of Wisconsin–Madison.

Dr. Stratman also advised dermatologists to "take control" of their maintenance of certification (MOC) timeline, and to be patient as new forms of CME programs roll out in the near future. "In 2009, there were at least four major overhauls to the MOC requirements. "The MOC dermatology program continues to change with time," he said.

PICME arrived on the CME scene as part of a trend toward programs that do a better job of closing practice gaps, the difference between optimal practice and what physicians actually do. Closing practice gaps involves four steps, he said: changing physician knowledge, changing their competence, changing physician performance, and changing patient outcomes. Measuring changes in performance and changes in patient outcomes requires a patient-oriented program like PICME. "When there is a gap in performance there is an opportunity to improve, and that is the future of CME," he said. Physicians "need to become more practice-gap savvy and more alert when they read the literature, by asking themselves whether it contains something that changes practice."

A PICME program has three phases. First is measurement of what is done in the practice at baseline, second is devising a plan to improve performance, and third is later measuring how well the CME program worked to improve practice. A PICME can satisfy 20 CME credits for component 4, the practice assessment and quality improvement portion of MOC.

The American Academy of Dermatology (AAD) sells PICME program modules for three common dermatology practice areas: acne, atopic dermatitis, and melanoma. A fourth module on biopsies is planned. The AAD has called these modules its Clinical Performance Assessment Tools (CPAT), "but the name may change to better reflect the PICME aspect," said Dr. Stratman. He also noted that PICME tools will soon become available from other sources, too.

"We expect to see more and more PICME activities," he said in an interview. "The academy is a leader in the initial response to the MOC requirements, but I hope that many other organizations and institutions will develop PICME modules, too," said Dr. Stratman, who is chairman of the AAD’s Council on Education. He noted that the institution where he works, the Marshfield Clinic, will soon make PICME modules available.

"It’s far better for physicians to select PICME activities that are locally relevant rather than look at national products, because they know where in their practice they need the most help. It will start at the bigger institutions, but it will then spread to private practice offices. I think the American Board of Dermatology is interested in having many different groups apply that are not linked to the Academy."

Dr. Stratman also said that PICME programs are feasible for small practices; they will not require a lot of technology support that only big societies or institutions can afford. Creating a PICME module "is not as hard as integrating an electronic medical record into a practice. It does not involve hard-to-manage data."

Another emerging CME style is point of care. When physicians face a patient-care related question that requires a literature search they can earn 0.5 CME credits by simply documenting the search and the result it produced. "It takes about 5 minutes [to write the documentation] to earn the half credit of CME," he said. "There is a good likelihood that soon we will all be required to have point-of-care CME as a percent of annual CME."

Dr. Stratman said that he had no disclosures.

NEW YORK – Since its introduction in 2007, performance-improvement CME has become a key part of dermatology’s maintenance of certification, but many dermatologists still need to set up their personal program.

"Don’t wait to start on point-of-care and performance-improvement [PI] CME projects," Dr. Erik J. Stratman said at the meeting. "If you’re not yet in the first phase of a PICME program, you better do it. It may take a while to accumulate enough patients to run an analysis," said Dr. Stratman, a dermatologist and medical director of the division of education at the Marshfield Clinic of the University of Wisconsin–Madison.

Dr. Stratman also advised dermatologists to "take control" of their maintenance of certification (MOC) timeline, and to be patient as new forms of CME programs roll out in the near future. "In 2009, there were at least four major overhauls to the MOC requirements. "The MOC dermatology program continues to change with time," he said.

PICME arrived on the CME scene as part of a trend toward programs that do a better job of closing practice gaps, the difference between optimal practice and what physicians actually do. Closing practice gaps involves four steps, he said: changing physician knowledge, changing their competence, changing physician performance, and changing patient outcomes. Measuring changes in performance and changes in patient outcomes requires a patient-oriented program like PICME. "When there is a gap in performance there is an opportunity to improve, and that is the future of CME," he said. Physicians "need to become more practice-gap savvy and more alert when they read the literature, by asking themselves whether it contains something that changes practice."

A PICME program has three phases. First is measurement of what is done in the practice at baseline, second is devising a plan to improve performance, and third is later measuring how well the CME program worked to improve practice. A PICME can satisfy 20 CME credits for component 4, the practice assessment and quality improvement portion of MOC.

The American Academy of Dermatology (AAD) sells PICME program modules for three common dermatology practice areas: acne, atopic dermatitis, and melanoma. A fourth module on biopsies is planned. The AAD has called these modules its Clinical Performance Assessment Tools (CPAT), "but the name may change to better reflect the PICME aspect," said Dr. Stratman. He also noted that PICME tools will soon become available from other sources, too.

"We expect to see more and more PICME activities," he said in an interview. "The academy is a leader in the initial response to the MOC requirements, but I hope that many other organizations and institutions will develop PICME modules, too," said Dr. Stratman, who is chairman of the AAD’s Council on Education. He noted that the institution where he works, the Marshfield Clinic, will soon make PICME modules available.

"It’s far better for physicians to select PICME activities that are locally relevant rather than look at national products, because they know where in their practice they need the most help. It will start at the bigger institutions, but it will then spread to private practice offices. I think the American Board of Dermatology is interested in having many different groups apply that are not linked to the Academy."

Dr. Stratman also said that PICME programs are feasible for small practices; they will not require a lot of technology support that only big societies or institutions can afford. Creating a PICME module "is not as hard as integrating an electronic medical record into a practice. It does not involve hard-to-manage data."

Another emerging CME style is point of care. When physicians face a patient-care related question that requires a literature search they can earn 0.5 CME credits by simply documenting the search and the result it produced. "It takes about 5 minutes [to write the documentation] to earn the half credit of CME," he said. "There is a good likelihood that soon we will all be required to have point-of-care CME as a percent of annual CME."

Dr. Stratman said that he had no disclosures.

NEW YORK – Since its introduction in 2007, performance-improvement CME has become a key part of dermatology’s maintenance of certification, but many dermatologists still need to set up their personal program.

"Don’t wait to start on point-of-care and performance-improvement [PI] CME projects," Dr. Erik J. Stratman said at the meeting. "If you’re not yet in the first phase of a PICME program, you better do it. It may take a while to accumulate enough patients to run an analysis," said Dr. Stratman, a dermatologist and medical director of the division of education at the Marshfield Clinic of the University of Wisconsin–Madison.

Dr. Stratman also advised dermatologists to "take control" of their maintenance of certification (MOC) timeline, and to be patient as new forms of CME programs roll out in the near future. "In 2009, there were at least four major overhauls to the MOC requirements. "The MOC dermatology program continues to change with time," he said.

PICME arrived on the CME scene as part of a trend toward programs that do a better job of closing practice gaps, the difference between optimal practice and what physicians actually do. Closing practice gaps involves four steps, he said: changing physician knowledge, changing their competence, changing physician performance, and changing patient outcomes. Measuring changes in performance and changes in patient outcomes requires a patient-oriented program like PICME. "When there is a gap in performance there is an opportunity to improve, and that is the future of CME," he said. Physicians "need to become more practice-gap savvy and more alert when they read the literature, by asking themselves whether it contains something that changes practice."

A PICME program has three phases. First is measurement of what is done in the practice at baseline, second is devising a plan to improve performance, and third is later measuring how well the CME program worked to improve practice. A PICME can satisfy 20 CME credits for component 4, the practice assessment and quality improvement portion of MOC.

The American Academy of Dermatology (AAD) sells PICME program modules for three common dermatology practice areas: acne, atopic dermatitis, and melanoma. A fourth module on biopsies is planned. The AAD has called these modules its Clinical Performance Assessment Tools (CPAT), "but the name may change to better reflect the PICME aspect," said Dr. Stratman. He also noted that PICME tools will soon become available from other sources, too.

"We expect to see more and more PICME activities," he said in an interview. "The academy is a leader in the initial response to the MOC requirements, but I hope that many other organizations and institutions will develop PICME modules, too," said Dr. Stratman, who is chairman of the AAD’s Council on Education. He noted that the institution where he works, the Marshfield Clinic, will soon make PICME modules available.

"It’s far better for physicians to select PICME activities that are locally relevant rather than look at national products, because they know where in their practice they need the most help. It will start at the bigger institutions, but it will then spread to private practice offices. I think the American Board of Dermatology is interested in having many different groups apply that are not linked to the Academy."

Dr. Stratman also said that PICME programs are feasible for small practices; they will not require a lot of technology support that only big societies or institutions can afford. Creating a PICME module "is not as hard as integrating an electronic medical record into a practice. It does not involve hard-to-manage data."

Another emerging CME style is point of care. When physicians face a patient-care related question that requires a literature search they can earn 0.5 CME credits by simply documenting the search and the result it produced. "It takes about 5 minutes [to write the documentation] to earn the half credit of CME," he said. "There is a good likelihood that soon we will all be required to have point-of-care CME as a percent of annual CME."

Dr. Stratman said that he had no disclosures.