I recently completed an eight-hour mandatory training — one of many trainings that doctors are required to complete each year — and it got me thinking: What is the value of mandatory training? And can it be improved to reduce the time burden while increasing the benefits for physicians (and our patients)?
Don’t get me wrong. I support mandatory training’s underlying mission. It helps keep doctors current on important topics ranging from compliance and cybersecurity to diversity and inclusion. But there are a lot of mandatory trainings and it isn’t always clear who is requiring the training and why it would be useful.
The seemingly arbitrary nature of mandatory training may in part explain why, year after year, both anecdotally and in large surveys, physicians have expressed to me how much they dislike mandatory training. Indeed, in the most recent survey of the more than 2,200 physicians who are part of Harvard Medical Faculty Physicians (HMFP), 65% of respondesnt reported to us that fixing mandatory physician training was the top priority item, substantially outpacing other priorities. This finding is despite the fact that over the years we have consistently modified, shortened, and consolidated training.
Why specifically do physicians rank improving mandatory training so highly? To begin with, trainings are typically not personalized in terms of either topics or level of expertise. Physicians do not get to pick training topics: we are told what we have to be trained in, and because topics can be broad, they can feel irrelevant, or so basic that physicians cannot see how they are applicable or appropriate. Being forced to be trained in areas that we do not feel are relevant or necessary to our practice is something that many of us find condescending. Moreover, physicians often report that trainings are neither particularly useful, nor are they taught at the right level. Instead, most trainings seem to simply check a regulatory box as opposed to teaching something meaningful.
A second reason that doctors dislike mandatory training is that it is often not well organized or streamlined and can be repetitive. With many trainings, each session has a large number of content experts, and consequently tends to contain an encyclopedic amount of material. As busy physicians, we need the executive version, which contains the essentials, and trainings should be edited with that in mind.
And of course, mandatory training is yet one more thing to do: There is nothing more frustrating than receiving an email on Sunday at 10 a.m. telling you that you have to complete yet another eight-hour training that doesn’t seem valuable or relevant to your practice, especially given ongoing challenges with physician burnout.
Finally, it’s problematic that there is a lack of coordination between the many different organizations that require mandatory training. Each entity thinks that it has regulatory scope, be it the Joint Commission, the specializing board certification, Federal requirements, CMS requirements or institutional compliance departments, which all operate as if their content must be validated as essential for physicians.
What Can Be Done?
To improve the physician experience and actually train us in areas that are important, we need to do several things. We need to coordinate the training, consistently provide CME credit for all completed trainings, make the training itself more efficient and effective, and connect the value of the training to the physician experience.
If they do not already, each institution should have a training point person who is responsible for coordinating and streamlining training, making sure that it is not repetitive or irrelevant. This person could also ensure that CME credit is provided for any appropriate physician training. At our organization, we coordinate with the Massachusetts Medical Society and upon completing training, physicians can click a single button to instantly receive CME credit (a gratifying instantaneous reward for going through a mandatory training).
The organizations providing the training should also be encouraged to make the trainings themselves better. Training modules should be reviewed to ensure that they are concise, and every training where it’s feasible or allowable should come with a pre-test that allows those already trained or proficient to test out. Finally, decreasing the number of interactive clicks would make trainings less annoying. In an effort to make training interactive, programs often go overboard, making the training stilted and more onerous than necessary.
Lastly, the easiest way to decrease physician irritation over mandatory training would be to have mandatory training emails synced to send on the first Monday of a month during business hours, rather than on the first day of the month, which might coincide with the one Sunday morning when a doctor has time away from work.
Optimistically, I find that sometimes there is hidden value in mandatory training that cannot be anticipated. For example, I vividly remember a physician coming in for his annual review with a bandage around his hand. He had had a small kitchen fire, and he humorously – but authentically – credited his mandatory fire safety training with teaching him how to handle it. This is one example of how mandatory training can impact outcomes and make a difference. With an effort to coordinate, streamline, and add value to physician training, we can continue to give physicians tools they may not know they need, while helping them tolerate it a little bit better.
How would you improve mandatory physician training?
Alexa B. Kimball, MD, MPH is President and CEO of Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center.
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