The Accreditation Council for CME's new accreditation criteria were top of mind for many of the 1,820 attendees at the Alliance for Continuing Medical Education 2007 Annual Conference, held January 17 to 20 in Phoenix. Speaking at several sessions,Chief Executive Murray Kopelow, MD, explained the ration-ale behind the new guidelines and fielded questions about how to implement them.
“CME must contribute to patient safety and practice improvement,” said Kopelow. “We must ensure that CME is based on valid content, and the content needs to be independent. Physicians are being asked to continuously improve patient care based on constant self-assessment and lifelong learning. You're being asked to do the same.”
A number of forces drove the changes, he explained, such as new maintenance-of-certification requirements, which mandate that physicians participate in lifelong learning. He also drew parallels between the new criteria and the Accreditation Council for Graduate Education's core competencies, which include practice-based learning and improvement. Further, he pointed to a general consensus that CME is ineffective and to the concerns about pharmaceutical industry funding and commercial bias, which sparked the U.S. Senate Finance Committee probe into CME.
The new criteria, which go into effect in November 2008, require providers to focus on education that improves physician competence, performance, or patient outcomes to reach Level 1 (provisional) or Level 2 (full) accreditation. To meet Level 3 () requirements, they also have to integrate CME into practice improvement, address barriers to physician change, and participate in quality improvement — all of which asks providers to take on components of the healthcare system that traditionally have been outside the purview of CME. (For a full listing of the 22 criteria, along with supporting documents and FAQs, go to accme.org.) While recognizing that it will be a decade before the whole CME enterprise is fully in compliance with the new accreditation system, the ACCME expects providers to begin filling in their gaps in knowledge, competence, and performance now.
Kopelow pointed to Criteria 11 and 12, which ask providers to analyze changes they've made as a result of their overall CME program and see to what extent they've met their mission.
“Your net success is the extent to which you've met [learners'] needs,” he said. For the criteria needed to achieve accreditation with commendation, particularly Criterion 17, which requires providers to use noneducational strategies, “use information from peer review, participant reminders, and patient satisfaction questionnaires,” he added. “It doesn't necessarily have to be the CME department that does this.” Hospitals can work with quality-improvement departments, he suggested. “If [the quality-improvement office] doesn't invite you to their meeting, hold a meeting of your own about how to integrate CME into quality improvement and quality assurance.” Collaboration is a two-way street, he said. “Ask the quality-improvement department what you can do for them. They will like that.”
QI Collaboration Strategies
At the Hospitals and Health Systems Provider Section Meeting, participants shared their experiences collaborating with quality-improvement departments and other areas of the wider healthcare system. While no one said it was an easy transition, there were some success stories. One participant said, “We invited a QI person to be on the committee. He hasn't completely bought into it yet, but we have time.”
Another person said that it's important to help physicians realize that getting involved in CME is to their benefit, particularly in terms of pay-for-performance and licensure requirements. Another respondent said, “I did a roadshow about how [physicians] can benefit from all this, and we got more of them interested in getting involved. I also go to all the physician orientations for new doctors, and we've had some say the first committee they want to be on is CME. It helps to say, ‘Hey, you can get credit for that.’”
“Motivation is a big part of this,” said Kopelow. “The value of CME is going to go up exponentially as [physicians] start to work with maintenance of competence, licensure, and performance improvement. You have to be ready because the CME office is the first place they'll go to for more information.”
To address concerns expressed about outcomes measurement, which is a requirement under the new criteria, Kopelow said, “There's a difference between evaluation and research. We're not asking you to do research with a high level of statistical validity. The academics will have to follow up on our self-report evaluations to check their validity, but that's not what we're asking you to do.”