Because quality of care and patient safety are the central themes in continuing medical education today, the Accreditation Council for Continuing Medical Education’s Criterion 21, which requires that a CME provider participate in an institutional or system framework, is the linchpin to achieving Accreditation with Commendation.

Specifically, the criterion states: “The provider is focused on integrating and contributing to healthcare quality improvement. The provider has evidence that CME has become part of institutional, or system, quality improvement efforts.”

Your commitment to being part of a quality framework should begin with the language in your organization’s mission statement and be manifest in every activity that you plan, implement, and evaluate. Here’s how.

Defining a Quality Framework

To be successful in demonstrating compliance with Criterion 21, you must describe both your internal and external quality framework.

Internally, the framework should demonstrate integral intra-organizational mechanisms that systematically identify areas of poor quality performance in targeted areas of education. While the type of internal mechanisms your organization uses will depend on the type of CME provider your organization is, to comply with this criterion you must engage in these processes to ensure your approach to improvement in quality of care is consistent.

The underlying concept is that a Level 3 CME organization—one that qualifies for Accreditation with Commendation—takes the time to clarify the emerging quality issues in selected content areas. It then uses those gaps in professional practice to create CME activities that result in demonstrable improvement in quality metrics. In other words, the CME provider can objectively demonstrate that it has contributed to an improvement in specific quality findings through its CME program.

The external framework should demonstrate that the content of CME incorporates established best practices, current guidelines, and/or appropriate standards of care. While the external mechanisms are important to demonstrating compliance with Criterion 21, they are secondary to the internal mechanisms.

 

Here are some examples of mechanisms that contribute to a potential framework for different types of CME providers:

Medical School
Internal mechanisms:
• Create a subcommittee dedicated to the quality of CME.

• Base CME activities on clinical department-based quality findings.

• Use QI department findings as basis for behavior change.

• Use regularly scheduled series (RSS) to systematically address quality findings.

External mechanisms:
• Use applicable clinical guideline(s) to establish the educational outcome goal.

• Design educational outcomes measurements that will determine the impact of CME interventions on quality improvement relevant to clinical guideline goals.

• Have key CME course directors and faculty participate in guideline writing or other quality-driven committees with other bona fide standard-setting organizations.

National Specialty Society/Association
Internal mechanisms:
• CME program has a strong relationship with board-established quality committee.

• Organization’s leadership sees the CME program as a mechanism to change behaviors and trigger the implementation of appropriate guidelines.

External mechanisms:
• Publish clinical guidelines and use the CME program to execute changes in member guideline-related behaviors.

• Have key CME course directors and faculty participate in guideline writing or other quality-driven committees that are both internal and external to the association.

Hospital/Healthcare System
Internal mechanisms:
• The CME program is integrally involved with the institution’s QI committee and vice versa.

• Many of the activities of the CME program are planned to address internal problems in practice related to quality and patient safety findings.

External mechanisms:
• Use applicable and timely clinical guideline(s) to establish the educational outcomes goal.

• Use educational outcomes measurements to determine the impact of CME interventions on quality improvement that is tied to clinical guideline goals.

• Have key CME course directors and faculty participate in guideline writing or other quality-driven committees with other bona fide standard-setting organizations.

Medical Education Company:
Internal mechanisms:
• The CME advisory board assesses areas for quality improvement in core areas of content, which are updated periodically in strategic planning sessions.

• Establish a chief quality officer—either on staff or as part of an active CME advisory board—who intervenes in the planning of every CME activity to ensure that identified quality issues are addressed, improved, or resolved.

External mechanisms:
• Use applicable and timely clinical guideline(s) to establish the educational outcomes goal.

• Use educational outcomes measurements to determine the impact of CME interventions on quality improvement that is tied to clinical guideline goals.

• Have key CME course directors and faculty participate in guideline writing or other quality-driven committees with other bona fide standard-setting organizations.