Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited. Letters to the Editor Academic Medicine, Vol. 90, No. 8 / August 2015 1002 have been well designed, although with six years and 50,000 patients’ worth of experience, we are getting better) will result in persuasive data that not only promote rapid improvement in care but also generate excitement among front- line clinicians eager to learn more. This excitement is a fundamental requirement if we are to change our health care system for the better. Disclosures: None reported. Michael Farias, MD, MS, MBA Pediatric cardiology fellow, Department of Cardiology, Boston Children’s Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts. Kevin G. Friedman, MD Staff cardiologist, Department of Cardiology, Boston Children’s Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts. James E. Lock, MD Cardiologist-in-chief and professor of pediatrics, Department of Cardiology, Boston Children’s Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts. Jane W. Newburger, MD, MPH Associate cardiologist-in-chief and professor of pediatrics, Department of Cardiology, Boston Children’s Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts. Rahul H. Rathod, MD Staff cardiologist, Department of Cardiology, Boston Children’s Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Rahul.Rathod@childrens.harvard.edu. References 1 Sox HC, Stewart WF. Algorithms, clinical practice guidelines, and standardized clinical assessment and management plans: Evidence-based patient management standards in evolution. Acad Med. 2015;90:129–132. 2 Farias M, Friedman KG, Lock JE, Newburger JW, Rathod RH. Gathering and learning from relevant clinical data: A new framework. Acad Med. 2015;90:143–148. care across several dozen network institutions. Their commentary focuses on the similarities between clinical practice guidelines (CPGs) and SCAMPs, contending that the major difference is that SCAMPs encourage deviations from the plan, and thus use insights from variation to improve care. In one sense, Sox and Stewart are exactly right: SCAMPs are, at the outset, no different than CPGs in that they rely on established literature and “expert” opinion to create a standardized care algorithm. The major advance of SCAMPs is not, in fact, the encouragement of deviations as a tool for learning. Rather, it is the focused prospective collection of relevant clinical data, using targeted data statements that attempt to predict how the SCAMP will affect an episode of care. This collection of a limited data set, based on known uncertainties in an episode of care, is fundamentally Bayesian in nature. Since the data collection (including, but by no means limited to, deviation data) is tightly focused, the data can be collected and analyzed in a time frame unprecedented in medical care. Until the first data are analyzed, a SCAMP is a CPG. After the clinicians receive their first analysis, everything changes: The CPG becomes a SCAMP. Clinicians learn from the deviations as well as the targeted information collected and can improve the SCAMP using persuasive data (not, as is the case for CPGs, expert opinion or “conclusive” data). This process continues and even accelerates, and clinicians are invariably surprised by prior clinical beliefs that are shown to be flawed based on real data from their own patients. SCAMPs are becoming increasingly popular among thoughtful academic clinical leaders who practice medicine on a day-to-day basis. The innovation responsible for this acceptance goes beyond the assessment of deviations—it is the use of targeted data statements to direct data collection and analysis, predict what happens in real-life medicine, and permit a continuous- improvement process. The focus of the commentary by Sox and Stewart indicates that we have not done very well in communicating why SCAMPS work where other efforts have failed. SCAMPs provide a framework that facilitates the collection and analysis of targeted relevant clinical data. A well-designed SCAMP (note that not all SCAMPS uncovering sensitive information that had no clinical or educational merit, then we would be guilty of snooping—which is clearly unethical, regardless of the source of data or our level of training. When completing clinical rotations we sign over patients for whom the diagnosis has not yet been made and/ or the response to treatment established. From our own experience, and in discussion with our colleagues, it is common practice to ruminate on cases, ask colleagues for updates, and review progress via paper and electronic charts. Rather than snooping, the primary driver of information-seeking behavior is our need for cognition. 3,4 And, while we appreciate that individuals may behave differently when online versus in person, 5 we should still be capable of meeting our learning needs without compromising the privacy needs of patients. Disclosures: None reported. Kevin McLaughlin, MB ChB (Hons), PhD Assistant dean of undergraduate medical education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; kmclaugh@ucalgary.ca. Sylvain Coderre, MD, MSc Associate dean of undergraduate medical education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. References 1 Brisson GE, Johnson Neely K, Tyler PD, Barnard C. Privacy versus confidentiality: More on the use of the electronic health record for learning. Acad Med. 2015;90:1001. 2 Canadian Medical Association. CMA Code of Ethics. Updated 2004. http://policybase. cma.ca/dbtw-wpd/PolicyPDF/PD04-06.pdf. Accessed May 4, 2015. 3 Wilson TD. Human information behavior. Informing Sci. 2000;3:49–55. 4 Verplanken B, Hazenberg PT, Palenéwen GR. Need for cognition and external information search effort. J Res Pers. 1992;26:128–136. 5 Suler J. The online disinhibition effect. Cyberpsychol Behav. 2004;7:321–326. Differentiating Standardized Clinical Assessment and Management Plans From Clinical Practice Guidelines To the Editor: We would like to thank Sox and Stewart 1 for their extensive commentary on our Standardized Clinical Assessment and Management Plan (SCAMP) initiative, 2 an effort that now extends to more than 60 SCAMPs touching nearly all aspects of medical The Role of Professional Medical Education Societies in Fostering Professional Identity To the Editor: I read with keen interest the article by Sabel and colleagues 1 describing the barriers to professional identity construction as a medical educator among physicians in the United Kingdom. The experience of anesthesiology in the United States may serve to illustrate one facet of fostering professional identity as a medical educator.