CorrectCare

Continuing Education for Docs
How the Oregon DOC Provides High-Quality CME on a Shoestring Budget

by Michael T. Puerini, MD, CCHP

Professional education is expensive, especially for physicians. But ignorance is far more costly.

In our quest to build and maintain a cohesive, committed and highly competent team of physicians and midlevel providers, the Oregon Department of Corrections uses a tried-and-true solution to an integral part of the equation: Regularly scheduled meetings for the providers who deliver medical care to the 13,000 inmates in the ODOC system. We operate an in-house CME program, and we do it on a shoestring budget.

Twice a year, some two dozen medical providers from 14 prisons across Oregon convene for two days of quality time. They spend time socializing with one another, sharing war stories and successes. And they receive continuing medical education in a collegial setting, earning free CME credits.

A Wealth of Benefits
Our approach to continuing education for providers takes a lot of hard work and planning, as well as collaboration with many organizations and individuals beyond our walls. But it’s worth it because it has a lot of advantages for the system, for the providers and, ultimately, for our patients. Below are some of the key benefits we’ve seen.

Cohesiveness Among Providers. Our medical providers are scattered across the state, but there is a commonality to our work and the challenges we all face. Our patients move from facility to facility and providers share patients. In reality, our medical system is rather like a large group practice. So when we get together, we don’t just listen to lectures. We also socialize, sharing meals and stimulating conversation. This strengthens our relationships and our sense of community. Then if a problem arises, the providers are more comfortable turning to their colleagues for assistance or advice.

Systemwide Consistency and Best Practices. When all of our providers receive the same education, everybody follows the same playbook. In choosing topics and speakers, our objective is to help create consistency in medical knowledge and care across the system. That’s not to say we dictate each provider’s decisions, but we do promote evidence-based practices while discouraging questionable or capricious acts.

Corrections-Community Interface. We send a lot of patients to specialty providers in the community, but that doesn’t mean these providers understand or appreciate correctional health care. I often recruit these specialists to present at our meetings. It’s good for everybody when we can put a name with a face, and they begin to view us as skilled professionals rather than possibly seeing us as “those docs who have to work in prisons for a living.”

Education and CME Credit. Providers want and need professional education, but for those who work in far-flung prison settings, it’s not always easy to obtain CME credit that relates directly to the medical issues common to the population and unique environment in which we provide care. In this program, ODOC receives approval by the American Academy of Family Physicians to offer prescribed CME credit in medical, legal and risk management topics that are germane to our work.

Networking With Other Institutions. We invite medical providers from other correctional facilities (including members of the Society of Correctional Physicians) to join us at our educational meetings. The work of organizing the meeting has already been done, so as long as it adds no cost, it is worthwhile to share the experience with others. Everyone benefits when we share information and resources with each other, and this also helps us develop networks and create goodwill.

Topics That Matter
So how do we plan the content? Lots of ways. After each meeting we evaluate the program through a survey of attendees, and the results help us to understand our providers’ interests and needs. But we also use less formal methods to identify topics that are timely, relevant and needed. I often start with ODOC’s medical director. He often has a specific learning objective in mind that needs some attention, or that addresses common questions he receives, particularly when our providers are engaging in inconsistent treatment practices. Frequently this education can lead to significant cost savings.

For example, hepatitis C is fairly common in our prisons, so we have brought in experts in HCV management. We were getting requests from cardiologists to do expensive new procedures, so we asked a cardiology expert to teach the pros and cons of those procedures. Maybe we’re just due for an update on TB management because the national recommendations have changed. Or significant advances in medical practice may lead to a timely topic.

Once the list of desired topics is set, I develop a list of possible speakers. The ideal speaker is one who knows something about corrections, can address specific questions that relate to corrections and understands our practice ideas and goals. If the speaker is going to say everyone with a sore back needs a special mattress, for example, that’s a problem.

Doctor, Mendicant
Then comes the begging. We have never paid a speaker honorarium, but we don’t want just a warm body at the podium. We want the best at no cost. After doing this for 15 years, our experience at the Oregon Department of Corrections is that it’s not easy, but it is doable.

When recruiting doctors to speak, it’s essential that it be a doctor who makes the phone calls. And the right beggar makes all the difference: The person must be outgoing and persuasive. A physician-to-physician contact usually works to get the speakers we want without costing us a dime.

When possible, I try to choose physicians I know, those I call regularly anyway for patient referrals. That’s easier than cold calls to doctors I’ve never met, but I do that too. I have found that it pays to be audacious. Some physicians will work with us and some won’t, but I always expect a colleague to be collegial and I have seldom been disappointed.

One recent success: An internationally renowned specialist in osteoporosis and vitamin D metabolism agreed to speak at our meeting. He traveled 60 miles on his own time without expecting or charging an honorarium. If I had listened to those who said “impossible,” it wouldn’t have happened and we would have missed out on a fantastic lecture.

At times an outside speaker may not be right for a topic, so that’s when I’ll look to our internal resources. After all, many of our own staff physicians are experts in their own right. For example, one of our physicians has an MPH degree and an interest in tuberculosis. She gave a series of wonderful talks on TB that were perfectly suited to our daily practice of primary care medicine.

One thing we seldom do is accept corporate sponsorship for a lecture. If we already have a speaker and topic arranged and a pharmaceutical corporation will sponsor it, so much the better. But that’s a rarity. In general we don’t want corporations involved in our educational activities. Why? ODOC is trying to deliver health care as cost-effectively as possible, while industry seems to want to discover new and creative ways for us to spend the state’s money. Thankfully, we are able to avoid any conflict of interest and maintain full autonomy at low cost.

Working Out the Details
It’s quite an accomplishment to secure speaking commitments from a group of busy physicians, but it can be almost as challenging to solve the scheduling puzzle—that is, to find out who’s available when and to resolve conflicts in timing. Usually I work with the physicians’ schedulers and assistants on this, so it helps to get in good with the office staff. I keep a computer file of contact information for everybody I’ve spoken with.

Once the conference schedule is firm, I send each of the speakers’ reps a letter confirming the date and time, directions to the meeting site and pertinent phone numbers. A reminder when the meeting date is closer helps, as well. Advance planning helps avoid crises, and to date, we’ve never had a last-minute cancellation or no-show for a scheduled speaker.

Another important task is to secure the CME credits for the program. We chose the AAFP as the source of the credits we provide because the cost is nominal compared to some other CME accreditation groups and the application process is fairly simple. An AAFP member must complete the CME review application (available at www.aafp.org).

The application asks for details about the educational activity, including the agenda, faculty and learning objectives. We must indicate how we determined the content of the program (the method of needs assessment) and, after the meeting ends, we must conduct a program evaluation.

Win-Win
The providers are paid for work days while they are at the meeting, and their travel expenses are paid, as well. We used to have half-day meetings every two months, but now that we have semiannual meetings held over two days, planning is much easier for everyone and travel expenses are lower.

The meetings are held at the ODOC Central Health Services office in Salem. We try to schedule them on weekdays when we also hold training sessions for pharmacy, mental health, nursing and other health care professionals at the various facilities. That works well because when the medical providers are at their meeting, things slow down at their facilities. This affords those other professionals a chance to receive necessary training, as well.

Who takes care of the patients while the providers are away? It’s like any other weekend or holiday. Providers are available by phone on call, and the nursing staff covers us. It works out.

Of course, none of this could happen without support and resources from the top. Our experience has proven that excellence in educational programming is cost effective. For a relatively small outlay of money for travel and food, ODOC can offer its providers two-days of high-quality education that earns them up to 12 CME credits.

They providers are happy, the administrators are happy and the inmates get better, more consistent care. What about the meeting planner? If all goes well, during the conference I usually can sit back and enjoy it, learn something from our invited speakers. Before long, though, I’m back on the phone, planning the next meeting.

— About the author: Michael T. Puerini, MD, CCHP, is the chief medical officer at Oregon State Correctional Institution, Salem. He serves on the Society of Correctional Physicians’ board of directors as the West Coast director. He can be reached at mike.t.puerini@doc.state.or.us.

[This article first appeared in the Winter 2008 issue of CorrectCare.]