MPOG as a Platform for Education

Alex Macario MD, MBA

Professor and Vice-chair of education

Department of Anesthesiology, Perioperative and Pain Medicine

Stanford University

Secretary, American Board of Anesthesiology

• MPOG is already an education platform

• Review the five elements of education and who

the potential learners are

• MPOG may help us measure clinical experience

to allow for precision education

• ACGME quality metrics requirement

• MPOG and ABA continuing certification

Take home points:

We may think of our missions in academic

medicine as separate

Patient care

Education

Research

Patient care

Education

Research

In fact all three missions are intertwined:

the better the clinical care and the better the research the

better the education

By promoting safe and evidence-based

perioperative patient care, and by

performing research, MPOG is already a

platform for education

A framework: five elements of education

and who the potential learners are

• Administration/leadership

• Curriculum

• Teaching

• Assessment

• Advising/mentoring

The five education elements

Potential learners

• The community (lay people)

• Undergraduates

• Medical students

• Graduate Medical Education

• Residents

• Fellows

• Anesthesiologists with lifelong learning

• CME

• Board Certification

• Administration/leadership

-- (an MPOG education coordinating arm)

• Curriculum

-- MPOG CME programs

• Teaching

-- (MPOG develops innovative augmented reality modules to

improve adherence to quality metrics)

• Assessment

-- ASPIRE metrics

• Advising/mentoring

-- (MPOG consult or coaching service)

With this framework what could MPOG do?

MPOG may help us measure clinical

experience to allow for precision education

MPOG to better capture resident and fellow

clinical activity and variability

(Matt Caldwell @ Michigan is doing this)

the specialty is broad and deep so every day a

trainee has in training needs to be maximized to

be high yield

Case numbers for Resident

ACGME Minimum Required

% above

Patients < 3 months old 5

240%

Patients < 3 years old 20

316%

Patients < 12 years old 100

150%

Spinals 40

251%

Epidurals 40

422%

Peripheral Nerve Blocks 40

276%

Trauma/Burns 20

199%

Total Cardiac 20

275%

Intrathoracic Non-Cardiac 20

162%

Vascular, Major Vessels 20

174%

Vaginal Delivery 40

235%

Cesarean (including high risk) 20

269%

Pain Evaluation - acute, chronic, cancer 20

291%

Intracerebral Open 11

414%

Total Intracerebral (with endovascular) 20

200%

Using MPOG for automated data reports would

address barriers to self reporting including:

(1) once a resident reaches the minimum requirements for

case, they may be less motivated to log more,

(2) lack of accepted guidelines (so need to standardize

definitions) for logging cases (e.g., some residents record

cases when a resident relieves another resident, but not all

residents do this)

What about using MPOG to measure

experience with non-ACGME case types or

other operating room events?

Examples

• CPR in OR

• Massive transfusion (Matt Caldwell@Michigan)

• Delayed emergence

• LAST

• Many others TBD (analogous to how ASPIRE

metrics have been identified as important and

defined)

MPOG: can it facilitate precision education?

Individualize training

difficult to know ahead of time which cases

will have adverse events to assign resident

there

but can learn in other ways (participate in

debrief of case)

Imagine a dynamic portfolio or dashboard of

completed experiences and needed elements

Linked to

Competency based education

Since we don’t really know what the clinical

education for any one resident is exactly….

What about AI and MPOG

Future studies will have titles like:

• Use of machine learning models to predict which

training experiences residents have are associated

with better clinical outcomes

• AI based prediction of competence for residents once

they enter autonomous practice

computational

power

MPOG curated dataset

ACGME quality metrics requirement

ACGME Program Requirements for

Graduate Medical Education in Anesthesiology

• If practice model is to supervise residents and

CRNAs (multiple providers) how does one best

change practice to improve the metrics?

• Does showing practitioners their own quality

metrics improve future performance and clinical

outcomes?

Questions that come to mind

MPOG and ABA continuing certification:

a future with seamless integration?

Professional

Standing and

Conduct

Lifelong

Learning

Improving Health

and Health Care

Medical License

active, unrestricted

MOCA Minute

Answer 120 questions each year,

meet the performance standard

CME

125 Category 1 CME credits

every five years (including for

participation in MPOG)

Quality Improvement

Earn and attest

25 QI points every

five years

2024: American Board of Medical Specialties Standards for

Continuing Certification

IMPROVING HEALTH AND HEALTHCARE

Requirements

Standard # 18. Quality Agenda

In collaboration with stakeholder organizations, Member

Boards must facilitate the process for developing an

agenda for improving the quality of care in their

specialties.

Standard #19. Engagement in Improving Health & Health Care

Member Board continuing certification programs must commit to helping

the medical profession improve health and health care by:

• Setting goals and meeting progressive participation metrics that

demonstrate an ever-increasing commitment towards having all

diplomates engaged in activities that improve care

Standard #19. Engagement in Improving Health & Health Care

• Working with partner organizations, including medical specialty

societies, to create systems (e.g., data transfer process), for

diplomates engaged in the organizations’ quality improvement

activities to seamlessly receive credit from the Member Boards

• Modeling continuous quality improvement by evaluating methods and

sharing best practices for program implementation and diplomate

engagement.

• Recognizing the quality improvement expertise of partner

organizations and seeking collaborative opportunities for diplomate

engagement with efforts to improve care through a variety of existing

efforts

The ABA has a new Continuing Certification Committee that

is working to improve the QI piece of continuing certification

Committee Membership

4 ABA director members

6 non-director members (5 are from community practice)

1 ASA representative

Thank you!

Breakout Group Discussion Questions

1. Where will the resources and funding for education initiatives

using the MPOG platform come from?

2. Does creating a formal education arm of MPOG advance the

mission?

governance, strategic planning, multi-institution

3. What are competitor platforms to MPOG to delivering on the

promise?

ease of use, cost

Q and A: Questions to think about