Nancy Davis, PhD, director, division of CME with the American Academy of Family Physicians, presented some of what AAFP has been doing to move CME forward at the SACME meeting Nov. 6 in Boston.
Like the AMA, AAFP has been concentrating on evidence-based CME, point of care/just in time learning, and physician performance measurement. Note that AAFP accredits activities, not providers.
EBM and CME
Evidence-based CME is important because it assures CME is developed and presented with the best available scientific evidence; physician expertise; and consideration of the individual patients, said Davis. AAFP s EB CME criteria are that key practice recommendations come from AAFP-approved EBM sources, and that faculty has to disclose to learners the strength of the evidence in AAFP-accredited activities. Effective January 5, 2005, EB CME activities get twice the credit of non-EB CME, she said.
Point of care learning
POC learning for AAFP-accredited activities must include clinical decision support tools, and learning must occur at the point of care. Docs have to identify the clinical question; search the evidence for the answer, and implement (or not) with the patient and they have to document that all this occurs to get credit.
Learners can get 0.5 prescribed credits per inquiry, limited to 15 credits/year maximum because, she said, "all CME should not come from one source."
PI in practice
Performance improvement under AAFP is very similar to the AMA criteria for PI. It comes in three stages: learning from EB measures and current practice performance assessment; learning from the application of interventions to improve performance to patient care; and learning from evaluation and re-measure. Each stage is worth five credits; docs get 20 for completing all three stages.
Remaining challenges
But all is not rosy in the world of innovative CME, she added. It s still a challenge to determine how to measure value, if not in hours. Also, how does this fit into mandated CME will state licensing boards be interested in the point-of-care metrics? How will this be funded, and will physicians used to seats-in-seats credit metrics accept a new way of doing things?
In answer to a question about how to verify the docs are doing what they say they re doing, Davis said that is why a Web-based system that can capture all the data when they log in is the way to go. Charles Willis of the AMA added, "There s always going to be some capacity to game the system," whether it s traditional CME or POC learning.
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