APA Anticipates Future With New CME Opportunities

An electronic tool for helping clinicians continually sharpen their clinical acumen, known as eFOCUS, is APA's newest initiative in the brave new world of “lifelong learning.”

APA members have begun to receive periodically a clinical vignette and a multiple choice question via e-mail about how to manage the case described in the vignette. There are no wrong answers—this is not a test!—but rather, all of the options represent valid clinical approaches to a complex case.

As members respond to the question, a table and pie chart illustrating the proportion of members who chose each option automatically appear on their screen.

Later, after members have electronically returned their responses, eFOCUS sends an e-mail containing an “expert commentary” on the case by a prominent clinician-researcher in the clinical area being addressed by the case.

“EFOCUS allows a clinician to think about how he or she would assess and care for a patient as described by the vignette and compare and contrast it with expert opinion and with the approach of other colleagues,” said Mark Rapaport, M.D., who is co-editor of APA's CME journal Focus (along with Deborah Hales, M.D., director of APA's Division of Education).

The new program, an extension of the journal, is edited by Thomas Kramer, M.D., and Carl Chan, M.D.

There have been two editions thus far, with the first edition sent to members last year. Hales says that in time she hopes to have eFOCUS sent to members four times a year.

The first eFOCUS vignette described a patient referred by a primary care physician for depression. The patient is prescribed fluoxetine for depression, but on follow-up a month later the patient reveals a history of obsessive-compulsive symptoms.

Clinicians were then offered a range of options including increasing the dosage of the antidepressant, switching drugs, and adding or switching in combination with other agents and/or with cognitive-behavioral therapy (CBT).

As members chose an answer, the table and pie chart appeared showing how psychiatrists around the country were responding. Ultimately, 44 percent of respondents opted to increase the dose of fluoxetine and initiate CBT, 26 percent said they would switch to another SSRI and initiate CBT, and 16 percent said they would start or refer for CBT. Smaller percentages of respondents said they would increase the dose of fluoxetine or switch to a different SSRI without initiating CBT.

John Greist, M.D., a clinical professor of psychiatry at the University of Wisconsin School of Medicine and Public Health, who has written widely about OCD, offered commentary on the vignette.

Rapaport and Hales emphasized that eFOCUS is one part of an evolving effort by APA to prepare members for what Hales called a “sea change” in the way physicians in all specialties will be expected to demonstrate competency. The model of a one-time or periodic recertification examination and accumulation of continuing medical education credits through attendance at symposia and lectures is on its way out.

In its place is the new buzzphrase “lifelong learning,” by which physicians are expected to measure their clinical performance continually against standards of care.

“We want members to understand that APA has taken a very proactive approach to continuing medical education,” Rapaport told Psychiatric News. “We have created a systematic approach to lifelong learning for APA members to help them stay current and constant with what the American Board of Medical Specialties considers the critical issues in clinical practice. So far we have a paper journal, the electronic journal, eFOCUS, and 'Focus Live' at the annual meeting.”

Hales described a perfect storm of factors—including the movement toward electronic medical records and concerns about medical errors and the“ quality” movement—that are moving American physicians toward a new way of maintaining certification through demonstration of lifelong learning.

For instance, she noted that in 2013 the American Board of Psychiatry and Neurology (ABPN) will require clinicians to complete a performance-in-practice clinical module—essentially a chart review of five or more patients with comparison of the clinician's performance against recommended standards of care.

To help prepare members for this change, a sample performance-in-practice module on major depressive disorder was included in the winter 2008 Focus. Members receive five hours of CME credit for completing the module and returning their feedback to APA.

Hales said the feedback on the voluntary module will help APA when performance in practice becomes a requirement for all specialties. A second voluntary sample module on PTSD will appear in the spring Focus.

The performance-in-practice requirement is still being developed by the American Board of Medical Specialties and the ABPN, but Hales emphasized that these and similar changes in CME are certainly coming.

“Eventually the way you will show competency is not only by getting CME credits but by showing that your clinical practice follows evidence-based guidelines, facilitated by electronic medical records,” Hales said.“ Performance in practice will be part four of maintenance of certification and will be a requirement for all specialties.”

Further information about eFOCUS, the journalFocus, and other continuing education products is available by contacting Miriam Epstein, CME program manager of eFOCUS, by phone at (703) 907-8661 or by e-mail at [email protected].▪