COSM14: Case-Based Learning May Improve Medical Education

“They both want quality at the lowest possible cost to achieve the best possible outcome,” he said. “MOC should add value in several ways. It can provide the methodology for practice improvement, encourage participation in lifelong learning, and provide a framework to meet the regulatory requirements of the Centers for Medicare and Medicaid Services through the Physician Quality Reporting System (PQRS) in conjunction with participation in MOC.”

The MOC program is voluntary for diplomats with a lifetime certificate, but Dr. Weber said that it might become a requirement of maintaining licensure, and that some hospitals now require participation in the program for hospital privileges.

The program consists of four parts:

1. Professional standing (being board-certified; having an unrestricted medical license; and having hospital privileges);
2. A self-assessment component;
3. A practical-based cognitive exam; and
4. A collection of components in Part IV that includes a performance improvement module, a patient survey, a professional survey, and non-punitive feedback to the diplomat regarding his or her practice.

Simulation as Educational Tool

An educational approach that’s growing in use is simulation. But simulation is about more than just creating a system that tries to replicate a real-life situation, said Gregory Wiet, MD, professor of otolaryngology and biomedical informatics and director of pediatric otolaryngology research at The Ohio State University in Columbus. A good simulation system is one that accomplishes what you want it to do, he said. “It’s not about the simulation,” he said. “It’s about the objective.”

Systems should be validated, but the validation depends on how the results are going to be interpreted. Using a simulator to teach someone the anatomy of the ear doesn’t require a high level of validity evidence. But if someone’s certification is based on how they performed in a technical-skills simulator, then a lot more validity evidence is going to be needed, he said.

Simulation courses or boot camps are being offered at the University of Pennsylvania, Georgetown University, and the University of Michigan, among others.

Reviews of published articles on simulators have found that a large number have not been held to a high level of validation. One study from 2012 found that only half were validated (Otolaryngol Head Neck Surg. 2012;147:999-1011). And Dr. Wiet added that validation, when done, is largely just subjective opinions on how good the assessors thought the simulation was, which is far from the ideal of validating the simulation outcomes (Int J Surg. 2014;12:87-94).

Keeping Up

Panel moderator Kathleen Yaremchuk, MD, professor of otolaryngology-head and neck surgery at Henry Ford Health System in Detroit, said the session showed that educators need to keep pace. “There is so much change in the amount and way people get their information today that we have to be open to new ways of looking at 1) education for our residents and our students, and 2) how we ourselves process information and use it,” she said.