On September 5, the Accreditation Council for CME, Chicago, released an update to its criteria for accreditation that reflects the shift toward maintenance of certification, which requires physicians to undertake lifelong learning based on self-assessment. It asks CME providers to assess their own programs, and to improve them accordingly to achieve improved patient safety and practice improvement for their learner participants. The three levels they will be expected to move through will be provisional accreditation (Level 1), full accreditation (Level 2), and www.accme.org.(Level 3). The new criteria go into effect for those seeking accreditation in November 2008. For a copy of the document and its supporting materials, go to
Murray Kopelow, MD,'s chief executive, says, “The idea was to bring our accredited CME providers into line with what the learners are doing. Learners need data on their quality improvement, and on what their learning projects are and what they accomplished in these projects for maintenance of licensure, as well as maintenance of certification. CME providers are going to generate information learners can use. This will empower CME providers,” he adds, and enrich their role in the greater healthcare system.
An Addition, Not a Replacement
The new criteria, he says, do not replace the ACCME's Essential Areas and their Elements, which are the current basis for the accreditation process. It's just the criteria to fulfill the Elements that are changing. “Elements 1.1 through 3.3 will stay,” says Kopelow. However, they will become more rigorous under the new criteria. For example, Element 1.1, which requires providers to have a written statement of their CME mission, now also requires providers to “include all of the [mission's] basic components with expected results articulated in terms of changes in competence, performance, or patient outcomes that will be the result of the program.” For Element 2.1, it's no longer enough just to link the planning process to identified needs and desired results: Now CME providers also must design programs and activities to “change competence, performance, or patient outcomes” to gain provisional accreditation. For full accreditation, they also must match content to the learner's “current or potential scope of professional activities.” They must “choose educational formats that are appropriate for the setting, objectives, and desired results of the activity,” as well as keep them within the context of “desirable physician attributes,” as outlined in Institute of Medicine and Accreditation Council for Graduate Medical Education competencies.
This, Kopelow says, is necessary in today's CME environment, which emphasizes results in terms of physician behavior improvement and better patient care, as outlined in “Accreditation for Learning and Change,” an article authored by ACCME deputy chief executive Kate Regnier and published in the Journal of Continuing Education in the Health Professions in September 2005.
The new criteria also roll the Standards for Commercial Support explicitly into the accreditation process, says Kopelow, by including them as Criteria 7 through 10 in the new document. “The six Standards are linked to these criteria,” he says. “We want to make the Standards an integral part of program and activity planning, not an afterthought. In number 7, for example, it says, ‘A provider develops activities independent of commercial interests.’ What do we mean by that? We mean the words contained in Standards 1, 2, and 6.”
Exemplary Accreditation Goals Raised
To move from provisional, to full, to exemplary accreditation status, CME providers are asked to jump a higher bar. Criteria 16 through 22, which must be achieved to earn accreditation with commendation, require CME providers to identify factors outside the provider's control that affect patient outcomes. They require providers to implement educational strategies to remove, overcome, or address barriers to physician change. These criteria require providers to “build bridges with other stakeholders through collaboration and cooperation,” and to participate “within an institutional or system framework for quality improvement.”
Won't this make achieving exemplary accreditation difficult for those who aren't part of an institution themselves, such as medical education companies? Kopelow says ACCME views these criteria as an opportunity, not a barrier, for MECCs. “A medical education company operates in an environment in which there are specialty societies, quality improvement organizations, and medical schools, and interactions with elements of that system is what we're talking about.”
Providers who are already in the throes of their accreditation or re-accreditation process will still be examined under the current Essential Areas and Elements, Kopelow says. Those who plan to begin the process in November 2008 will receive an outline for self-study from the ACCME, which the organization plans to post and publish as soon as it's completed. “They will have the same 15 months they always had to do their self-study,” he says, though he does add, “We do expect providers will start to change today.” According to the documents released with the new criteria, the ACCME says, “We recognize that more than half of your accreditation cycle will have been conducted under the old model so that your presentation and our evaluation will be based on a blend of new and old.”
The ACCME is prepared to answer questions that likely will arise as CME providers study the new criteria and begin to implement changes necessary to meet them, Kopelow says. “We've already met with 44 of the 47 state medical society accreditors to talk about information sharing, and we have developed materials, and trained staff and groups in the medical societies to explain this,” says Kopelow, who also plans to hold a session on the new criteria at the Alliance for CME annual meeting in January, and to answer questions at the American Medical Association's National Task Force on CME/Provider/Industry Collaboration conference in October. In addition, plans are under way to hold day-long educational sessions on the new criteria. CME providers are encouraged to e-mail their questions to ACCME at revisedmodel@accmeorg; the ACCME will provide the questions and their answers in a Q&A on its Web site.
Editor's Note: Look for the December issue of firstname.lastname@example.org with your questions and comments.for more on the new accreditation requirements. Your input is welcome: Please call Executive Editor Sue Pelletier at (978) 448-0377, or e-mail her at
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