ACC’s Education Enterprise: Always Striving, Always Innovating, Always Learning The ACC continues to set the standards for lifelong learning for cardiovascular professionals. In fact, for the entire cardiovascular care team. Its education enterprise – a partnership of member volunteers and staff – consistently strives to provide the highest level of evidence-based, competency-based education. The collaboration extends throughout the entire College, drawing on expertise spanning information technology, digital strategy and international affairs, among others. Apropos of a learning organization, continuous improvement through assessments of outcomes and innovation in learning modalities is firmly embraced. “We’re serving the professional development of the cardiovascular community, across the entire span of a career, starting with training,” says Janice Sibley, vice president of education at ACC. Ultimately, this in service to the ACC mission of transforming cardiovascular care and improving heart health. “We like to think that we are always learning at ACC and that we are helping our members to do the same,” she adds. The Lifelong Learning Oversight Committee (LLOC) sets the education agenda of the College. “This is members driving education that’ll be relevant to other members,” says Sibley. The LLOC, consisting of cardiovascular professionals from different practice settings, works with the education staff to formulate the curriculum for the year ahead and create a roadmap to serve the mission of the ACC in a systematic and focused manner through education programs and products. “The LLOC focuses on how best to educate cardiovascular care providers, realizing that there are a wide variety of learning styles,” says Jeffrey T. Kuvin, MD, FACC, chair of the LLOC. “We feel the key is to be innovative and focus on the learners’ needs. There is a tremendous amount of information that clinicians must synthesize and put into practice. It’s our job to help, and ACC Education is in a unique position to do just that.” From face-to-face conferences and courses like the New York Cardiovascular Symposium held this month to digital, online products like the self-assessment programs (SAPs) and the patient case series, there are learning opportunities for the cardiovascular team, including physicians, nurses and pharmacists. Activities are crafted by members who are content experts and staff who are education experts. Most activities are certified for physicians and nurses, with an increasing number certified for pharmacists. And with rare exceptions, most provide dual continuing medical education (CME) and maintenance of certification (MOC) credit. ACC.18 is a prime example – and one many will engage in soon. Through the education sessions at the annual meeting, an attendee can obtain their CME credits for the year and about a third of their five-year requirement for American Board of Internal Medicine (ABIM) MOC points. Many sessions provide continuing nursing education (CNE) and/or continuing pharmacy education (CPE) credit. International attendees can also obtain external continuing medical education (ECME) credit. Claiming the credit is automated through the same app used to navigate the meeting. Creating a program that meets the standards for obtaining these various credit types is again a story of partnership between members and staff. Under the oversight of the LLOC, the Program Committee for the Annual Scientific Session, including its conference chairs, creates a diverse program that provides clinical and non-clinical education activities to address learning needs identified by staff. At ACC.18, among the sessions are three Intensives – and new this year these include field trips. The topics are: Innovate or Perish: Emerging Technologies and the Future of Cardiovascular Practice; A General Cardiologist’s Realworld Approach to Adult Congenital Heart Disease; and Shared Decision Making for the Clinician. Key Pillars: Assessments and Standards The ACC provides an extensive education portfolio grounded in evidence and underpinned by competencies. A robust and rigorous process provides the framework through the development of competency statements and needs assessments and monitoring to meet the highest of established standards. The ACC’s Education Design Team works directly with the member-based Competency Management Committee and writing committees to develop competency statements that define the knowledge, skills and behaviors that physicians, patients, the public and accrediting bodies can reasonably expect clinical cardiovascular professionals in training to achieve and those in practice to maintain or enhance. The publication of competency documents began with the Core Cardiovascular Training Statement, now in its fourth iteration (COCATS 4),1 and has expanded into the lifelong learning space. In 2016, the ACC Lifelong Learning Competencies for the General Cardiologists was published in the Journal of the American College of Cardiology.2 The College also develops Advanced Training Statements to define selected competencies that require training beyond a standard three-year cardiovascular disease fellowship and is committed to using these as the foundation to develop analogous lifelong learning statements that address the commitment to sustaining and enriching competency over the span of one’s career. The Lifelong Learning Competencies in Clinical Cardiac Electrophysiology, published with the Heart Rhythm Society – in late November – is the most recent example.3 These competencies are at the foundation of the ACC education curriculum and are a critical driver in the development of needs assessment Documentation and are a mechanism to support personalized or focus Education . The Goal : the tranformation of cardiology into a set of competency - based experiances . and developed the judgment necessary at the early stage of a career, a commitment to lifelong learning enhances the value of longitudinal experiences to enhance and maintain competency within the scope of practice. The staff team conducts education needs assessments to identify gaps in knowledge, skills and attitudes that may be met through the curriculum and that cut across the six domains promulgated by the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties and endorsed by the ABIM. These domains are: Medical Knowledge, Patient Care, Systems-Based Practice, Practice- Based Learning and Improvement, Interpersonal and Communication Skills, and Professionalism. In concert with ACC members, Education’s instructional designers then define learning objectives to be met through an education activity. The instructional design professionals work closely with faculty to determine the best format for the content that will support a learner in closing the gap(s) identified in the needs assessment by providing practical, relevant, implementable information and strategies as part of the activity. For the upcoming Cardiovascular Summit, being held from Feb. 22-24, 2018, the course has been designed to include plenary sessions, interactive workshops and deep dive mini-intensive sessions across the themes of business of medicine, workforce well-being, leadership as well as operational excellence and quality improvement. Working in unison with the other education Certification Team, ensures education activity meets accrediting bodies. vigilantly monitors the requirements of all these bodies worldwide. “The ACC is an accredited provider with commendation,” says James B. McClurken, MD, FACC, a member of the LLOC. This is the highest recognition by the Accreditation Council for Continuing Medical Education of a CME provider, for exceeding a robust list of standards and guidelines. The College is also accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.James B. McClurken, MD, FACC, a member of the LLOC. This is the highest recognition by the Accreditation Council for Continuing Medical Education of a CME provider, for exceeding a robust list of standards and guidelines. The College is also accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. “The goal is to lead the pack in cardiovascular continuing education design, efficacy and freedom from bias,” adds McClurken. “This is accomplished by teamwork with a wide spectrum of engaged ACC member experts and dedicated expert staff.” Among the standards addressed are those for commercial support of education activities, including conflict of interest. The team oversees a robust process for conflict of interest disclosure and resolution for all members and staff involved with education activities to ensure the tight regulations that prevent any commercial influence of any education content. Accreditation standards require vigorous evaluation of every education activity, which is performed by the Education Design Team. ACC’s outcomes assessments look at factors such as whether there was a change in knowledge, competence and performance and ultimately impacted patient outcomes. The outcomes assessment is essential for a successful education activity by measuring and maintaining quality. It also provides information about what’s needed, so the right education can be delivered to the right learner at the right time. “Through the partnership between our member volunteers and our education staff, we ensure every activity is relevant and grounded in evidence for its learning need and for its educational impact,” says Sibley. Among the standards addressed are those for commercial support of education activities, including conflict of interest. The team oversees a robust process for conflict of interest disclosure and resolution for all members and staff involved with education activities to ensure the tight regulations that prevent any commercial influence of any education content. Accreditation standards require vigorous evaluation of every education activity, which is performed by the Education Design Team. ACC’s outcomes assessments look at factors such as whether there was a change in knowledge, competence and performance and ultimately impacted patient outcomes. The outcomes assessment is essential for a successful education activity by measuring and maintaining quality. It also provides information about what’s needed, so the right education can be delivered to the right learner at the right time. “Through the partnership between our member volunteers and our education staff, we ensure every activity is relevant and grounded in evidence for its learning need and for its educational impact,” says Sibley. Always Innovating Customizing the learning experience for personalized is one driver of innovation. Coupled with adult learning principles, this means a focus on providing education that responds to clinical problems and challenges and allows the learner to walk away with solutions. In practical terms, one translation of this is bite-size education, which comes through digital products that provide education in a format the learner can consume wherever they are and within their available time, while also obtaining solutions and credits. In addition to face-to-face activities, a rich variety of learner-centered education is provided through ACC.org and the JACC family of journals The Live and Digital Educational Content Development Team works with member content experts to produce ACC’s e-learning education activities. Among the structured digital products are the SAPs. Innovative features in ACCSAP 9 include the intuitive user dashboard, which is designed to help clinicians quickly identify knowledge gaps and offer personalized content. The new design of ACCSAP 9 allows users to choose how they want to learn, whether through reading, watching or listening. Content is also supplemented with hundreds of case-based questions generating customized quizzes and simulated board exams. Also new with this version is the ACCSAP 9 mobile app that’s designed to facilitate on-the-go learning via phone or tablet, with or without an internet connection. Users can also earn up to 155 CME and MOC points to help meet the requirements for both. The College’s new ECG Drill & Practice tool is also designed to help clinicians prepare for initial Board certification in cardiovascular disease or simply hone their ECG interpretation skills. The product provides an opportunity for users to learn about identification of ECG abnormalities, practice what they just learned using flash card technology and challenge their ECG interpretation skills. The ECG Drill & Practice incorporates the self-assessment ECG test, featuring format and answer options similar with those of the ABIM’s certifying examination in cardiovascular disease. The international regional conferences are another and growing example of innovation. Held in Latin America, the Middle East and just this month in the Asia Pacific region, these conferences are designed in collaboration with the local ACC chapters to address challenges and issues specific to the region, along with taking the best of ACC education to those who may not have the opportunity to travel to ACC’s Annual Scientific Session. The Annual Scientific Session is an innovation incubator for much of the rest of ACC’s education portfolio. “It’s not just a matter of providing the latest and greatest evidence-based information, but doing it in a manner that engages the learner in the content and allows for in-person networking,” says Kuvin. New learning formats that are ever-more interactive and responsive to the attendee have been piloted over recent years and are expanding. Experiential learning through the ENGAGE Theater, games and meet-theexpert sessions and learning spaces for personalized skills development have been highly successful with positive attendee feedback. Debuting at ACC.18 are the Heart to Heart (H2H) sessions – look for the H2H stage in the center of the Lounge and Learn Pavilion for interactive, conversational sessions on topics such as Prior Authorization, MACRA and another on how help patients with the challenges of smoking and diet. Programs that are successfully piloted within the meeting have become an established component of the education portfolio. Simulation-based education first piloted at an annual meeting is growing deeper roots within the education portfolio. The LLOC has established a Work Group to shepherd this expansion (see story in the October issue of Cardiology). “We’re a learning organization,” says Sibley. In addition to providing education, “we’re adapting and adjusting to changes in the environment of practicing medicine.” This entails monitoring regulatory changes at the state and national level and monitoring changes and updates in science through staff and members. Real-time data and insights that come from the NCDR inform the design of education programs and products, as well as the development of tools from the Science and Quality arm of the College like the STS/ACC TAVR In-Hospital Mortality Risk app and CathPCI Bleeding Risk Calculator app. In addition, Sibley notes the ACC sets the standards for science through its clinical practice guidelines. Another driving force for innovation is the goal to ease the burden of members to be current with science and clinical information, as well as the regulatory information and other factors that affect the ever-changing practice environment. Technology and the burgeoning volumes of data are a new partner in the patient-provider relationship and ACC is working to help members best incorporate this within their practice and patient interactions. Looking ahead at 2018, a dynamic education curriculum is in place. Continued emphasis will be placed on personalizing education for members and on offering learning experiences in a variety of formats. “We’re excited about our varied approach to education for the upcoming year,” says Kuvin. “Whether you engage in a live program, e-learning or other type of educational experience, rest assured, ACC Education Will Provide the best opportunities for learning to ensure cardiovascular providers are on top of their Game." To learn more, go to ACC.org/Education REFERENCES Halperin JL, Williams ES, Fuster V, et al. J Am Coll Cardiol 2015;65:1721-3. Williams ES, Halperin JL, et al. J Am Coll Cardiol 2015;67:2656-95. Tracy CM, Crossley GH, Bunch TJ, et al. J Am Coll Cardiol 2017; November 27:[Epub ahead of print].
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