Leaders in Medical Education: Leaders in Medical Education - Dr. Graham McMahon, President of the Accreditation Council for Continuing Medical Education (ACCME)

Jan 5, 2017 by Thasin Jaigirdar

Graham McMahon, MD, MMSc, is the President and Chief Executive Officer of the Accreditation Council for Continuing Medical Education (ACCME®), which leverages the power of education to drive quality in the medical profession and in healthcare. The ACCME accredits continuing medical education (CME) providers in the US and internationally, creating a framework that supports, inspires, and motivates educators to achieve their full potential. Dr. McMahon leads initiatives to accelerate learning, change, and growth, enabling clinicians and teams in practice to optimize their performance and continuously improve care for patients, families, and communities.

In addition to his role at the ACCME, Dr. McMahon serves as Adjunct Professor of Medical Education at Northwestern University Feinberg School of Medicine.

A medical educator, researcher, and endocrinologist, Dr. McMahon joined the ACCME in April 2015 from Harvard Medical School, where he served as Associate Dean for Continuing Education and Associate Professor of Medicine. He taught extensively at Harvard Medical School and at Brigham and Women’s Hospital in Boston, served as Editor for Medical Education at the New England Journal of Medicine, and as Executive Editor for the NEJM Knowledge+ program. He served as an endocrinologist in practice in the division of Endocrinology, Diabetes and Hypertension at the Brigham & Women’s Hospital.

A native of Dublin, Ireland, Dr. McMahon earned his medical degree from the Royal College of Surgeons in Ireland, where he also received a doctoral degree in medical education from the National University of Ireland. He is board certified in internal medicine—as well as endocrinology, diabetes, and metabolism. He earned a Master of Medical Science in Clinical Research from Harvard Medical School.

How did you first become interested in medicine and endocrinology in particular?
I grew up in Dublin, Ireland and my folks were interested in supporting my education from an early age, setting me up in a life of curiosity. For reasons I don’t know, when I was 7 or 8, I wanted to become a doctor and that never left me. I went to the Royal College of Surgeons in Ireland for medicine, and I started observing how teachers observed students and how we were tested as learners and began to be interested in education and a career as a physician educator.

Surprisingly, I disliked endocrinology as a medical student and thought it was too complicated. But, once I started seeing patients as a resident, I found the specialty very interesting. Endocrinologists dealt with challenging problems that also lasted for a long time; this allowed me to have long-term relationships with the patients, which was valuable and sustaining for me. I did my fellowship and my residency at Brigham and Women’s Hospital. That brought me to different roles in the New England Journal of Medicine, the Endocrine Society, and Harvard Medical School, and led me to develop a real interest in educational development. I completed a masters degree in clinical research and a doctoral degree in education, and together these helped me develop skills to think constructively about teaching, learning, and assessment and their role in optimizing patient care.

You have studied medicine in Ireland and have experience in education globally. I was wondering what differences and similarities you see globally?
The fundaments of what it takes to care for patients are shared across the world. The prevalence of different diseases and health issues are naturally different in different parts of the world, and physicians should always focus on the needs of the communities where they serve. Access to resources such as testing and treatment technologies might vary substantially; there is a great deal that we share. My experiences working with students and learners all around the world - in the USA, in Ireland, Japan, the Gulf, the Caribbean, and other parts of the world suggest that the fundamental things that unite us as learners are our curiosity and passion.

How can we help improve care in more underserved parts of the world?
Education is a critical resource for improving care. It is essential to use education that works and build longitudinal relationships with mentors. Effective education requires information sharing but also engaging information resources and formative learning approaches that are increasingly available with technology. To drive quality in clinical practice, we have to create an environment where the learning is not only effective and where learners absorb and retain information, but where education is also efficient and engaging, driving increased participation.

What is the ACCME? What are some challenges you currently face in your current role? What do you see as the future of the organization and its impact on physicians?
The ACCME sets the standards for CME, and we accredit organizations that offer CME in the United States and around the world. We work to therefore, meet the needs of physicians and teams through our understanding of how to construct effective education, independent of commercial influence. We share with our educational providers a passion for learning and a passion for driving the change that is necessary to optimize clinician performance. We collaborate with a range of organizations nationally and at the state level to create a harmonized system that supports clinician learners and responds to the changing healthcare environment.

We’re not only regulators, but also coaches. We work with accredited organizations to promote best practices and drive innovation. We’ve created a system that rewards educators who implement best practices.

The first challenge is that some physicians see the CME system as primarily a regulatory requirement - a mechanism to accrue the credit they need for state licensure or credentialing, as opposed to a system that supports longitudinal life-long learning and their professional development. If you view CME as credit-shopping, your engagement and likelihood of learning are likely to be diminished.

Secondly, some organizations still think of CME as primarily representing large group, passive lectures as opposed to a nimble and flexible and mentored form of education covering performance, quality, and patient safety issues.

For the future, we need to move the education community from being teacher-centric to being learner-centric, build personalized educational systems, and leverage technology to create longitudinal experiences that work. There are a lot of clinicians for instance, who are isolated in rural communities and do not have access to education with mentoring and in-person support. Creating programs and technologies that create a connection between these clinicians and their community is essential.

We rely increasingly on teams, and teams are essential to the effective performance of our art. Many of the educational programs now are focused on only one particular profession (such as physicians)  and do not involve team members in a collective learning experience. If you are going to create effective education, you need to focus on the team, with diverse professions involved in planning, teaching, and participating.

Our ultimate goal is to create a seamless system that allows clinicians to engage in longitudinal, personalized education that helps them identify where they have room for growth, is relevant to their practice, and supports their professional development so that they can achieve their maximal capacity for effective performance. We are collaborating with a community of educators to facilitate achieving this transition in education.

Speaking of teams, there is a greater push towards interprofessional care in medicine. How do you help enable interprofessional care?
We worked closely with our colleagues in nursing and pharmacy to create a unified system that facilitates collaborative learning. Joint Accreditation™ for Interprofessional Continuing Education (jointaccreditation.org) offers organizations the opportunity to be simultaneously accredited to provide medicine, pharmacy, and nursing continuing education activities through a single accreditation process. We did this to promote interprofessional continuing education (IPCE) and drive quality in team learning. We need to encourage further engagement in collaborative education, removing the idea that clinicians can only learn from other clinicians in similar professions. Psychiatrists might learn best from nutritionists, for instance, about certain topics, or physicians from nurses.

What advice do you have for organizations looking to get accredited for CME?
Information on the accreditation process can be found on our website (www.accme.org). Our staff is happy to help any organization understand the expectations of accreditation. It does not have to be a challenging pathway, especially if the organization is already actively engaged in delivering high-quality education. Organizations need to demonstrate that they can conduct a needs assessment, develop material that is relevant and evidence-based, evaluate outcomes, and build connections with learners. Once an organization becomes accredited, we operate on a trust and verify system and organizations are able to provide education and issue credits. We have a regular, recurring audit and review process where accredited organizations show us that they have been compliant with requirements. We are a self-regulated system that the profession has asked us to manage; our requirements are based on the values and principles of our community. Accreditation is not an onerous task, provided the organization adheres to the regulatory structure.

What are the biggest challenges you currently see in healthcare as a whole? What about medical education?
I think the first thing is that our people are our most precious asset and resource, and we need a system that values and nurtures them. We haven’t always provided a system to offer that support. Clinicians are overworked, undervalued, and spend a lot more time on bureaucracy than interacting with patients. This creates all sort of challenges for our community of clinicians.

In many ways, education can be a fundamental solution for many of the challenges we face. Education has a strong convening power. If our clinicians are able to optimize professional development and be intellectually stimulated and awakened, they will be able to practice at higher levels. Investment in education can make a big difference — it can reduce burnout, facilitate collaborative work, and drive performance improvement. That investment in people, through education, can be very powerful for organizations.

What changes should we see in healthcare to adapt to handle the growing needs of the world’s population?My instinct is to build a collaborative culture for learning, allowing us to create empowered teams that think courageously together and see the value of their own and their colleagues’ contributions, and to create a working environment that allows them to express that ability to care for their patients.

We want to have a system that nurtures, values, and connects the healthcare community, and once we have that, miracles that can happen. In many ways, 90% of problems that patients have can be solved with 10% of the technology and knowledge we have available. If we can focus on ensuring that information and the highest quality standards are disseminated and shared, and we have simple systems for them, we can drive better quality of care for all.

What are some of the things you have learned from your mentors throughout your career?
I have had mentors in endocrinology, medicine, and in patient engagement. These role models showed me the combination of skills needed to be a competent physician. A key lesson I learned is, it's not just important what you know, but how you express what you know. You can be a terrific endocrinologist and know everything, but if you cannot engage with your patients about taking their medicine, or collaborate effectively with a professional colleague, you cannot be an effective doctor. I also learned a lot about professionalism and how to interact with teams.

It is also worth noting that if something is worth doing, it is worth doing well. You can’t do things by half in healthcare. It is unlikely to work. If you are going to engage with patients, you have to take the time to engage with them properly, understand their needs, and connect with them to leverage and implement changes necessary for them. Similarly you can't just assume that when a patient has high glucose levels that the cause is diabetes – you have to always be anticipating and searching for the unusual and the exception.

Another lesson I have learned is the fundamental principle of being evidence-based and using science to guide our practices. We cannot ignore where science guides us and the best clinical trials guide us. We have to be cautious and appropriately skeptical of the materials that commercial interests present, and ensure that our patients’ best interests are being met by our decisions.

What are some of the most memorable experiences from your career?
My patients have long sustained me – I can think of so many patients whose humor has entertained me, whose strength has inspired me, whose suffering has humbled me. I think it's those people who have made being a doctor such a continuing, remarkable privilege. Even though I've wanted to be a doctor almost all my life, I don't think I would have anticipated how much this profession would bring me joy: I still look forward to my work every day, and doing what I can to nurture a system that supports and sustains my colleagues in their professional practice.