The Council of Medical Specialty Societies has issued a report calling for fundamental change in the CME system so that CME will better prepare physicians to fulfill the new maintenance of certification (MOC) requirements mandated by the American Board of Medical Specialties.
Under the new system, physicians must demonstrate their commitment to lifelong learning, engage in a periodic self-assessment process, and show their competence in areas such as patient care and communication skills, as well as medical knowledge. The ABMS adopted the MOC program in 2000; currently all 24 specialty boards are required to develop their own set of requirements based on the guidelines.
There has been much debate and controversy about what role CME would play in helping physicians maintain their certification. Both the ABMS and the CMSS have raised numerous concerns about the effectiveness of CME in meeting these new standards. In fact, some specialty boards are not planning to use specialty society CME in their MOC requirements at all. Last year, the CMSS set up a task force to examine the strengths and weaknesses of the current CME system. This report is a result of that analysis.
“Repositioning for the Future of Continuing Medical Education,” includes 16 recommendations, calling on the CME system to (among other things):
incorporate the ABMS definitions of physician competencies into CME;
encourage physician self-assessment to identify previously unrecognized learning needs;
design education activities that foster interactive, rather than passive, learning;
base CME content on evidence-based medicine, where possible;
eliminate bias in CME content;
and develop methods to document how CME improves physician practice behaviors and patient outcomes.
Stressing that there are many positive aspects of the current CME system, as well as things that need improvement, Bruce Spivey, MD, CMSS president, says the report is a work in progress, and that the process of change will be evolutionary, rather than revolutionary. Next, the CMSS task force will seek input from other stakeholders in the CME system; then it will develop an action plan for prioritizing and implementing the recommendations.
“The report affirms that lifelong learning and physician self-assessment are in the arena of the specialty society, and that the boards' primary task is certification,” says Bruce Bellande, PhD, executive director, Alliance for CME. “The CME community will play a pivotal part in helping the regulatory bodies achieve their goals.”
But to do so, CME will have to become highly individualized, says Bellande. “CME professionals need to become education facilitators, rather than educational meeting planners.” One of the challenges, he adds, is that individualized education is far more costly than traditional education. “Where will the funds come from?” he asks.
Too Much to Expect?
Cost is only one of the hot buttons. Some of the recommendations are controversial, and will be extremely difficult to implement, acknowledges Spivey. For instance, it is not feasible right now for specialty societies or boards to measure individual physician practice performance, he says. Is it realistic to expect specialty society CME to change physician behavior and patient outcomes?
“You can educate somebody, but you can't make them moral. You can't rewire their brains [changing] their intellectual capacity to employ what they know,” says Spivey. Nevertheless, he says that specialty societies will increasingly be asked to assist their members demonstrate their proficiency in the various competencies.
Evidence-based CME is another much-debated topic. Some providers feel that requiring evidence based content precludes CME from addressing cutting-edge science. “You cannot restrict CME to evidence-based content,” Spivey agrees, adding that providers could flag content that is evidence-based.