“A small group of brave souls got together in Philadelphia a few years ago to talk about raising the CME bar,” said Jack Kues, PhD, CCMEP, president, National Commission for Certification of CME Professionals. He spoke on stage during a special event on October 21, held in conjunction with the National Task Force on CME Provider/Industry Collaboration annual conference in Baltimore. “Tonight is the culmination of a great deal of hard work,” he added, before raising a champagne toast to the 103 “pioneers” who were the first to earn the Certified CME Professional designation.

One by one, the names of the 103 CME professionals who passed the beta test in May and the first exam in June and September, were announced to hearty applause from the audience of fellow CCMEPs and supporters. Each newly credentialed professional received a plaque and a CCMEP lapel pin.

The certification program comes at a critical time, strengthening CME's credibility in the face of heightened scrutiny and criticism from government agencies, Congress, and the press, and an increased emphasis on performance and quality improvement by healthcare regulatory bodies such as the Joint Commission and the specialty boards.

“It's an important first step in validating CME as a profession,” said Lawrence Sherman, FACME, CCMEP, NC-CME's financial development chair; and president and CEO, Physicians Academy for Clinical and Management Excellence, New York, during the ceremony. “Everybody is a critic; this is how you combat the critics, by demonstrating your competence.”

From Talk to Action

A CME certification program had been discussed and debated in the industry for more than two decades. Some felt that since CME professionals' jobs are so highly specialized, a general program would not be meaningful or relevant to many in the field. Instead of going the certification route, the Alliance for CME established a maintenance of competency initiative, whereby CME professionals can assess and improve their knowledge in specific areas. It's currently working on a program to award certificates of proficiency in certain areas, such as outcomes evaluation.

But others felt that despite the inherent challenges, it was crucial to establish a CME credentialing program. “One day I was driving and I saw a van ahead of me that said: ‘Be sure that your chimney sweep is certified.’ And I laughed and I thought, chimney sweeps are certified but CME professionals are not. There's something wrong with this picture,” says Judith Ribble, PhD, FACME, CCMEP, the retired director of CME for Medscape who now serves as NC-CME's executive director, a full-time volunteer position.

Ribble first got the ball rolling in fall 2004. “A group of us had talked informally about certification and I realized that we needed to get together to see whether we could gather momentum — or if it was just an idea that would never bear fruit,” she says.

She sent invitations to a group of CME leaders, inviting them to attend a two-day retreat in February 2005 at a conference center near Philadelphia. Eleven volunteers attended, demonstrating their commitment to the idea by paying their own way.

The founding group reviewed certification programs that could serve as models, drafted a concept proposal, and adopted a mission statement. They did a SWOT (strengths, weaknesses, opportunities, threats) analysis. “And with each exercise we did, it became clearer and clearer that this was doable,” says Ribble.

“The burning question at that retreat was: Shall we move forward; is this a good idea? And after two days there was a unanimous vote of approval,” says Ribble. “So at the last session I was elected president, and I immediately invited everyone in the room to be on the board of directors.” (Ribble became executive director of NC-CME in December 2006.)

It took three years, with more than 70 volunteers from throughout the CME field working thousands of hours to bring their vision to fruition.

Finding Funding

In the spring of 2005, the board sent formal invitations to 18 organizations considered to be stakeholders in the CME enterprise, inviting them to send representatives to the NC-CME Advisory Board, which held its first meeting in June 2005 in New York City. During the next few months, the team created a Web site, drafted a three-year budget, and initiated a work plan.

To learn the fundamentals of how to incorporate as a not-for-profit organization, the team worked with the Foundation Group in Nashville, Tenn. NC-CME was formally incorporated in January 2006; they then received a 501(c)(3) designation from the IRS so that they could receive tax deductible donations.

The first group to step up was the Postgraduate Institute for Medicine, which pledged to give three years' worth of support. The North American Association of Medical Education and Communication Companies also pledged three years of support. To date, individuals and organizations have donated more than $95,000 to provide startup funding for the nonprofit, all-volunteer organization.

Spreading the Word

Ribble, Kues, and others spread the word about NC-CME by speaking and exhibiting at the annual conferences of the Alliance for CME, the National Task Force on CME Provider/Industry Collaboration, the National Medical Association, and at other meetings. More than 100 CME professionals attended an open forum during the January 2006 Alliance for CME conference. Their names and contact information formed the basis of an NC-CME database of potential volunteers.

Several organizations, including the Society for Academic CME and NAAMECC, posted notices on their Web sites and listservs. Eventually NC-CME had a database of more than 1,000 individuals interested in certification.

“We were encouraged because those who came to the workshops were asking: ‘When is this going to be available? What are the qualifying requirements going to be? What's going to be on the test? How do I prepare to take it? What is going to be a passing score?’ They were asking the kind of questions that somebody who intends to take the exam would ask,” says Kues, who became NC-CME president in December 2006 and is also assistant senior vice president for continuous professional development at the University of Cincinnati Academic Health Center in Ohio.

The Three E's

To determine the components of the credentialing process, NC-CME's founders researched the best practices of other professional organizations, joining the National Organization for Competency Assurance and adopting the National Commission for Certifying Agencies' Standards for Accreditation of Certification Programs. They found out that the three principal elements that determine a valid certification program, according to NOCA, are education, experience, and an exam. NC-CME followed that model, deciding that CCMEP applicants would submit a form summarizing their education and continuing education, work experience, and leadership qualifications. Each element is assigned a point value and applicants with the requisite point total are admitted to the exam. Regardless of their experience level, everyone must pass the exam before achieving the CCMEP.

“Although the board discussed it initially, people were very vocal in opposition to ‘grandfathering’ the credential,” says Karen Overstreet, EdD, RPh, FACME, CCMEP, who chaired the test-development committee and is now president-elect of NC-CME. Overstreet is also president of Indicia Medical Education LLC, North Wales, Pa. “Given the rapid pace of change in the field and the importance of having current knowledge of CME guidances and regulations, everyone with the credential needs to have demonstrated that [expertise].”

Developing the Exam

One of the objections to CME certification that had been raised over the years was that CME professionals' roles were too diverse, their jobs spread across too wide a spectrum, to be accommodated under one credentialing umbrella. The team approached this challenge in the same way that undergraduate medical education addresses the diverse roles that physicians perform — by identifying core competencies that all members of the profession can be expected to know, according to Kues.

The first step in creating the exam was to conduct a job analysis with the aid of test development company Schroeder Measurement Technologies. NC-CME convened a group of CME experts in 2008 to develop the outline for the job analysis, starting with the competencies developed by the Alliance for CME as the foundation. “The group listed every possible task and type of knowledge that a CME professional needs to have. We then had them rank the importance of those tasks to their jobs. There were a few tasks that didn't rank very highly and so we deleted those,” says Overstreeet.

Building on that groundwork, the psychometricians at SMT helped the NC-CME team design a job analysis survey. “The goal of the survey was to get input from all types of constituents regarding the relative importance of various tasks and knowledge to their jobs. It's an objective process that has been done many times by SMT,” Overstreet says.

The online survey was sent to the more than 1,000 individuals whose names NC-CME had collected in its database. “They represented every region of the United States, every type of provider,” says Overstreet. Nearly 300 responses were analyzed to determine the final content outline for the exam. Next, a team held a three-day workshop to write and edit test items for the initial exam. Then, the beta testers met prior to two national conferences to sit in a proctored room to take a paper-and-pencil exam. Like those who came to the initial retreat, these 47 volunteers participated at their own expense.

NC-CME gathered feedback from the beta testers via an evaluation form. “And some of them took it upon themselves to send detailed comments to Judy or speak with her,” says Overstreet. “So we found out if they thought a particular question was ambiguous, or if they thought there could be two correct answers, or whether some parts of the exam were more difficult than others. The beta testers provided valuable feedback that helped us assess the relevance and accuracy of the items.”

SMT worked with NC-CME to evaluate the scores on each item on the beta test as well as the feedback from the testers. A group of CME experts participated in a lengthy item-by-item review process, and the NC-CME team deleted questions from the exam that were not effective. Altogether, five examination teams plus SMT test developers and psychometricians were involved in creating, reviewing, and validating the exam.

They finally had the first test ready to go — a three-hour, pass-fail exam including fewer than 200 multiple-choice items. “In certification exams, the primary goal is a pass-fail discrimination. Every candidate who achieves the minimum score is deemed to be competent,” says Kues.

The First Graduates

A total of 79 CME professionals took the beta test in May and the first official exam in June, and 70 passed. Of the 37 who took the exam in September, 33 passed. The beta tests were done with pencil-and-paper; beginning with the June exam, the tests were taken on computers at proctored testing centers, with instantaneous electronic scoring, enabling proctors to print the results and give them to the candidates on-site.

Kues notes that a number of the newly certified CME professionals are among those leaders who initially expressed skepticism about certification. Some had questioned the value of what might be perceived as a general certification to those with highly specialized jobs or with terminal degrees and many years of experience.

“When NC-CME had the first discussion about who the target audience is, we never assumed that the people with terminal degrees would take this exam because we agreed with them that if, for example, you have a doctoral degree in adult education and you've been in CME for 15 years, we don't think that the certification credential is going to add much,” says Kues. “But apparently we were wrong. And I think that it goes to show that there truly is a need for certification, and even the people at the top of our profession recognize that they need to verify that they can do this job.”

Moving Forward

NC-CME will construct a new version of the exam for the June 2009 testing period to reflect developments in the profession, such as new regulations or guidelines. “While many questions are likely to be repeated, each new exam will be unique,” says Ribble. Meanwhile, test items in the current exam are scrambled to prevent candidates from sharing answers. Certification is valid for three years, a standard for certifying organizations.

Candidates who fail the exam may reapply to take it as often as desired, provided they continue to meet the eligibility requirements and submit a new application and fee for each attempt.

Once NC-CME has given the exam for one year or 500 candidates have been tested, the organization may apply for certification by the National Commission of Certifying Agencies, which would give the program increased credibility. “We are working toward that goal and will apply for NCCA certification as soon as we are eligible,” says Ribble.

Another aim of the NC-CME is to become financially self-sufficient. “As with any nonprofit organization, fundraising continues to be a challenge,” says Overstreet. “Of course, once we get a critical mass of candidates being certified and recertified on a rotating basis, that will cover the expenses of the organization.”

NC-CME is also working on building collaborations with other organizations. In July, the Alliance for CME issued a statement noting that the Alliance has met with NC-CME, supports its program, and is providing an Alliance liaison. “We appreciate and want the liaison. What we are working out now is the exact role that the liaison would play, whether as a board member, or an observer, or some other role,” says Kues. “We will be approaching other key organizations to provide liaisons as well.”

It was evident at the CCMEP celebration in October that NC-CME leaders, charter donors, and graduates are thrilled about their accomplishment, and appreciate the support they received from organizations and hundreds of people that made it possible. “Certification can be the glue that holds the CME community together and gives it coherence,” says Ribble. “I really feel that this is a concept whose time has come and that it is needed and welcomed by all aspects of the CME community. It has been the dream of a lifetime to actually see this happen.”

Dave Kovaleski contributed to this article.

Sidebar: Taking the Plunge

To apply to take the Certified CME Professional exam, you first fill out a form detailing your education and continuing education, CME experience, and leadership activities. If you qualify, you then may register and sit for the exam.

The CCMEP exam covers five areas of competency, with a percentage of questions assigned to each:

  • Adult learning principles — 15 percent
  • Educational interventions — 30 percent
  • Relationships with stakeholders — 10 percent
  • Leadership/administration and management — 25 percent
  • Knowledge of CME environment — 20 percent

The next NC-CME exam will be available from December 1-31 at 200 testing centers throughout the United States and Canada. In 2009, exams will be available March 13-30, June 13-30, September 13-30, and December 1-31.

The fee is $400 plus a $50 processing fee.

The Candidates Handbook, registry of CCMEPs, an explanation of exam scoring, and other information is available at www.NC-CME.org.

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Sidebar: What the Grads say

BRUCE BELLANDE, PhD, FACME, CCMEP, president, CME Enterprise, Carmel, Ind.; former executive director, Alliance for CME.

Years in CME: 25

Benefits: “As an employer, I would consider hiring someone coming to CME with certification to have a real leg up versus someone without it.”

Value to CME profession: Physicians and healthcare professionals are being held more accountable for their actions, so it's only appropriate that the CME professionals who are educating them are held accountable, Bellande says. “We've got to be a different type of professional than we were even five years ago.”

Taking the test: “It was a good opportunity to self-assess after many years in CME.”

Limitations: The exam could delve deeper in areas such as quality and performance improvement, Bellande says. With so many subspecialties within CME, the credential might not make sense for individuals focused in one particular area, such as compliance or outcomes.

PAMELA MASON, CCMEP, director of medical education grants at AstraZeneca, Wilmington, Del.; member, board of directors, National Commission for Certification of CME Professionals.

Years in CME: 20-plus years in the pharma industry, mostly in medical education.

Taking the test: “I thought it was important for me to take the exam early so that I wasn't just talking about it. [The exam] was fair, it was thorough. There were items that touched all stakeholders, and that's important because each stakeholder needs to know about the other.”

LINDA CANN, MSEd, CCMEP, managing director, professional education, conventions, and international affairs, American Diabetes Association, Alexandria, Va.

Years in CME: 17

Taking the test: “It's been a very long time since I've sat down and taken a three-hour exam with a No. 2 pencil.”

Benefits: “It is a guarantee to a future employer that one does understand CME, and that's a bonus if you are job hunting. It tells internal stakeholders that I know what I'm doing, so it's less likely that ADA would go down a path or develop relationships that might not be appropriate for our organization.”

Value to CME profession: “This makes us feel a little bit better about where we are and where we are going. [The certification process] validated my knowledge and experience.”

MELISSA NEWCOMB, CCMEP, MBA, assistant director for certification, continuing professional education at the University of Rochester, New York

Years in CME: 7

Exam prep: Studying was difficult because there's no book or study guide that captures all the information in one place, Newcomb says. Even if there were, the field is changing so rapidly, the information would be outdated by the time the book was printed. Keeping abreast of the latest developments via articles, meetings, and networking, along with practical experience in the field are the keys to prepping for the exam.

Value to CME profession: “It's hard to pinpoint what it is we do. When people ask, I say we're a little bit medicine, a little bit education, and a little bit business. It's exciting to me that the field has made a commitment to us by offering this exam and saying, instead of being a little bit of all those things, we're going to make our own category. I now have a definition for what I do. I am a CME professional. There might be some folks newer to the field who are enticed to stay because it's not just a job — they can make this their career.”

KATHY ANN SMITH, CCMEP, CMP, coordinator of CME, Fox Chase Cancer Center, Philadelphia

Years in CME: 28

Taking the test: “CME is a new field, almost, with all the changes that have taken place. We've seen the roles change. CME professionals need a different skill set than we've needed in the past, so I took it as a self assessment.”

Exam prep: Smith opted to take the exam without doing any sort of extensive review, to see where she stood. “Given all the changes, it makes you wonder if you're getting it all.”

Benefits: “I would hope that it would bring a certain level of confidence in not just my abilities, but in the abilities of our CME office.”

Limitations: Smith doesn't think the CCMEP should become a requirement for employment in the field, given the fact that there are so many different roles within CME. “I'm not sure that certain people who specialize in one area or another are going to feel like they need to have it.”