The curriculum template: creating continuing medical education curricula for physicians in practice in managed care settings.

Abstract

As medical educators in a community hospital setting, we were eager to find CME programs designed to help physicians make the transition to managed care practice. We expected that they would need strategies for addressing the common patient care problems encountered in clinical settings. For example, within a 15-minute visit, how does one elicit an essential database on a 49-year-old obese diabetic patient who presents with new-onset chest pain? The CME programs we found were disappointing. Although physicians could now attend seminars on how to select billing system software, negotiate a “withhold,” or write a practice guideline,7,8,9 we found no programs that focused on the actual process of providing care to patients. It was as if caregiving per se—such as listening to patients and diagnosing illness—would continue unchanged under managed care. Was it anticipated that the new managed care policies and the changes they generated could be easily integrated into the daily practice of medicine? On a practical level, we wondered about physicians' ability to reliably meet increasing productivity standards while maintaining quality of care and professional satisfaction. It remained, therefore, to create CME efforts that could meet these challenges. Summary points There is a lack of continuing medical education to address the daily work of practicing medicine in the managed care setting Physician competence for managed care practice requires definition via curricula Eighteen California clinicians and educators from managed care organizations and academic medical centers engaged in a process to create a template for developing curricula The template focused on physicians “in relationship” with managed care organizations, their patients, and their colleagues, as well as in tandem with their professional and private selves The template offered an interdisciplinary, small group venue that allowed protected time for case-based discussion Medical educators and managed care leaders can reconstruct managed care organizations to put relationship-based practice firmly in place