In 2009, the Arizona Academy of Family Physicians (AZAFP) faced a tough decision. According to (then) President-elect Jeffrey Wolfrey, M.D., of Phoenix, the chapter's annual meeting, with its focus on CME for family physicians, was in a fiscal crisis.
CME presenters Steven Brown, M.D., center, and Mark Ebell, M.D., right, take a break to discuss an evidence-based study with Harold Meyerowitz, M.D., at the Arizona AFP's 2010 Annual Clinical Education Conference.
"We'd had this (member) meeting for decades; the expenses had gotten higher, and we were losing pharmaceutical support," says Wolfrey. "I remember the board meeting where the directors voted to cancel the annual meeting. Everybody hated to see it, but we just felt like it was the fiscally responsible thing to do."
After the meeting, Wolfrey, chair of the department of family medicine at Banner Good Samaritan Medical Center in Phoenix and a clinical professor of family and community medicine at the University of Arizona College of Medicine, had second thoughts about the vote.
He and some of his chapter colleagues came up with an alternative solution that reduced expenses and delighted members. And, in 2010, the chapter introduced a new evidence-based CME format known as patient-oriented evidence that matters (POEMS) to the meeting.
- In 2009, the Arizona AFP voted to discontinue its annual CME-driven meeting because of declining pharmaceutical support and rising expenses.
- Several members had second thoughts and proposed an alternative method of CME presentation, known as the patient-oriented evidence that matters (POEMs) method, be used at the meeting.
- Since the introduction of the POEMs method, the chapter has seen record attendance and received record high marks from members on the quality of CME presented.
Registration for the annual meeting jumped from 92 attendees in 2009 to 127 in 2010, which was the highest attendance ever, according to Jamie Geng, the AZAFP's director of education. The numbers increased again to 145 in 2011 and likely will top 200 next month when the chapter holds its 2013 Annual Clinical Education Conference(azafp.org), says Geng. (See sidebar for other steps the chapter took to reduce meeting costs.)
Steven Brown, M.D., of Phoenix, program director of the Banner Good Samaritan Family Medicine Residency Program and clinical associate professor of family and community medicine at the University of Arizona College of Medicine, is the AZAFP member who approached Mark Ebell, M.D., M.S., of Athens, Ga., an early pioneer of the POEMs method of CME presentation, about creating CME for the 2010 AZAFP meeting.
Ebell, who serves as the editor-in-chief of Essential Evidence Plus(www.essentialevidenceplus.com), an online database of evidence-based clinical research, took up the challenge. His passion for POEMs is evident. "The focus (of POEMs) is on outcomes that matter and on those things that patients will notice," says Ebell.
To find the best evidence-based research, he and the other members of the Essential Evidence Plus editorial staff peruse some 100 journals a month. They follow specific criteria for selecting studies that are relevant to family physicians.
Specifically, the six-member team -- four of whom are family physicians -- look for three things in a study:
The Arizona AFP holds its annual meeting in Phoenix, shown here. In 2013, the meeting will draw at least 25 out-of-state attendees.
- Is this a question or a problem with which family physicians deal?
- Is this study reporting improved outcomes?
- Is the course of action something new that FPs are not already doing in their practices?
"Only 200 articles a year meet those criteria -- out of the 20,000 articles that we review -- so that lets us focus on what really matters to family physicians and their patients," says Ebell.
For example, for next month's AZAFP meeting, Ebell and three other CME presenters will prepare half-hour sessions on topics such as allergies, coronary artery disease, pertussis, skin cancer, dementia and liver disease.
"I think it's important that none of us have any relationship with pharmaceutical companies or speakers bureaus," says Ebell. "We're all just primary care doctors who understand family medicine. That helps us do a better job of keeping the audience engaged; we keep the lights up and talk to them as colleagues about the most important recent studies.
Those in charge of organizing the Arizona AFP (AZAFP) annual meeting knew they needed to take a hard look at expenses if they were going to preserve the CME meeting in the long term. They tackled the challenge in a number of ways.
In 2010, they increased the registration fee from $300 to $400, and, in 2011, the chapter bumped the fee up another $25.
"We also got more economical in terms of the site," says AZAFP Past President Jeffrey Wolfrey, M.D. In 2010, the chapter selected a less expensive hotel venue, which saved some money. But the big change came in 2011. "That year, we made a substantial cut; we didn't use a resort hotel anymore. We used the Phoenix Zoo because it has some educational space," says Wolfrey. The chapter was able to use a private caterer and saved a whopping $30,000 on food and beverage service.
Looking forward, Jamie Geng, the AZAFP's director of education, concedes that success does have its drawbacks. She is concerned that in 2014, the chapter's annual meeting likely will outgrow the inexpensive and popular Phoenix Zoo venue.
That means Geng already is brainstorming to find a replacement site.
"I call it 'teaching without a net,' and it's a lot of fun," Ebell adds. "You have to be very current with the literature, because they (physicians) will hold your feet to the fire and, in 10 minutes, will be calling me on something. This is all about family physicians teaching family physicians using the best patient-oriented evidence."
Brown, who will serve on the team of CME presenters at the upcoming meeting, as he has every year since 2010, says he has developed a real passion for the effort. "I love bringing the literature that really matters to the family doctor who might not have time to comb through the literature. I love see seeing heads nod when you sort of bust a conventional myth."
According to Brown, presenters toss out their reliance on overhead slides and lengthy discourse on background information about a disorder so they can focus instead on "foreground information."
"We ask, 'What do I need today to make a decision about my patient?'" says Brown.
A report in the September 2012 Journal of Continuing Education in the Health Professions focused on the AZAFP's revamped CME meeting. The authors note that participants in the 2011 meeting rated, among other things, whether the meeting achieved promised educational objectives. Attendees weighed in with an average score of 4.8 on a 5-point scale, the highest ever recorded for the meeting.
Tracy Middleton, D.O., of Peoria, Ariz., strongly supports the new meeting format. "I talk it up to all the students, residents and faculty. It is unlike any other CME experience. By the time you're finished with these couple of days, you feel like you're on top of the most recent literature for everything," says Middleton, who is family medicine chair at Midwestern University's Arizona College of Osteopathic Medicine.
Ditto for Carter Mayberry, M.D., of Benson, Ariz., who partners with his brother in a two-physician family medicine practice. He says he found the POEMS approach to CME to be the best use of his time and money. The 30-minute CME segments are "very compact and compressed," he notes, adding that he was pleased that speakers highlighted new recommendations found in evidence-based literature. "The information is practical, relevant and has changed my practice of medicine in several areas."
For example, Mayberry says he no longer routinely checks patients' vitamin D levels because research shows that monitoring the vitamin to keep patients above certain levels does not correlate with beneficial outcomes. "It saves a patient a poke, and maybe saves some cost," says Mayberry.
In addition, based on what he has learned at the Arizona meeting, Mayberry is more judicious about ordering bone density testing for his patients, and he no longer relies on what he calls "cookbook checking for everyone over a certain age."
Instead, he relies on a patient's FRAX (fracture risk assessment) score and a T-score to make a determination as to when the test is necessary. FRAX is a patient assessment formula, and the T-score is a method of comparing a postmenopausal Caucasian woman's bones with those of a 30-year-old Caucasian woman.
Chapter EVP: Laura Dearing
Number of chapter members: 1,571
Year chapter was chartered: 1949
Location of chapter headquarters: Phoenix
2013 annual meeting date/location: Feb. 22-24, Phoenix Zoo, Neely Education Center, Phoenix
"Again, I'm trying to avoid unnecessary testing," says Mayberry.
Everyone involved with the change in the AZAFP CME format was surprised by the level of member support.
"I was worried that physicians wouldn't be ready for this -- that it was too much of a transformation," says Brown. "But the response from family physicians has been amazing.
"I think (POEMs) really turns the concept of education on its head and moves it away from expert-based subspecialty care to family doctors telling us what is really going to matter for our patients. It shows family physicians that there is a different way to learn and to practice."
Wolfrey notes that the CME presented at the chapter meeting is the same unbiased evidence-based approach used in residency education. "We're able to introduce that to the rank-and-file practicing physician in the same way we train medical students and residents," he says.
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