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  1. 1. Objectives • Manage conflict of interest based upon the principles established by the AMA and the ACCME • Define continuing medical education as it pertains to physician practice and/or patient outcome • Restate approved activity categories and associated mechanisms for receiving AMA PRA Category 1 creditsTM • Recognize the four components of the maintenance of certification process
  2. 2. Leadership in Lifelong Learning Todd Dorman, MD, FCCM Associate Dean & Director, CME Vice Chair for Critical Care Associate Professor Departments of Anesthesiology/CCM, Medicine, Surgery, and the School of Nursing Johns Hopkins Medical Institutions tdorman@jhmi.edu
  3. 3. No Relevant Financial Relationships with Commercial Interests www.hopkinscme.net
  4. 4. Disclosure • For a conflict of interest to exist – Received money or in kind gift/award • Cash, honoraria, speakers bureau, stock, gift, supplies – Commercial entity • Not-for-profit and government are presently excluded – Impacts planning or talk
  5. 5. Disclosure Rules • Must be made to learner in advance of learning • Must be managed if conflict exists • Must be assessed on evaluation • If identified during evaluation, must be address
  6. 6. Managing Disclosure Process • Must be managed in advance of the education • Turn in those disclosure statements when received • Turn in talk/slides as early as possible • Some CME groups are requiring both disclosures & content before activity is approved • We are discussing with institutional COI committee AND we are building a web site to facilitate • If one refuses to disclose, then one can not speak!
  7. 7. Disclosure • Disclosure MUST include – Name of the person disclosing – Commercial entity in the relationship – Nature of the conflict Todd Dorman VISICU, Inc Stockholder VHA Consultant
  8. 8. Pressure for CME Changes • “…The challenge is to revolutionize our expectations of health care…” Donald Berwick, MD • FSMB • Public Perception • EBM • $$$$ – Healthcare expenses – Funder expenses • Gold Book
  9. 9. The Future CME will be part of the fabric of our daily lives
  10. 10. Topics • Continuing Medical Education – American Medical Association • AMA – Accreditation Council for CME • ACCME – State • Maryland Board of Physicians • Maintenance of Certification – Based on your specialty (ABMS)
  11. 11. AMA Definition CME consists of educational activities which serve to maintain, develop, of increase the knowledge, skills, and professional performance and relationships that a physician uses to provide services for patients, the public or the profession. The content of CME is the body of knowledge and skills generally recognized and accepted by the profession as within the basic medical sciences, the discipline of clinical medicine, and the provision of health care to the public. AMA HOD policy # 300.988
  12. 12. Tip • You must check to see if what you are attending is accredited • Make no assumptions • www.hopkinscme.net – RSC material
  13. 13. CME Content • Accurate, objective and current • Commercially-unbiased, independent, objective • Needs should drive objectives and content • Evidence-based clinical topics • Non-clinical topics if appropriate for physicians AND benefit patient care or public health
  14. 14. Tip • Add references to every slide possible • If providing clinical recommendations, add a level of best evidence
  15. 15. Desired results Identified needs Objectives Instructional design (methods)
  16. 16. AMA Council on Ethical & Judicial Affairs • Gifts to physicians from industry – CEJA 8.061 • Ethical issues in CME – CEJA 9.011
  17. 17. Gifts: CEJA 8.061 • Defines a legitimate CME activity….. – the gathering is primarily dedicated, in both time and effort, to promoting objective scientific and educational activities and discourse and – the main incentive for bringing attendees together is to further their knowledge on the topics being presented • so not skiing, donor relationships, or to visit family
  18. 18. 8.061 (cont) • Subsidies to activities are permissible • Subsidies should be accepted by the accredited provider (this is OCME & there must be a Letter of Agreement (LOA)) • Payments to defray the costs of a conference should not be accepted directly from the company by the physicians attending the conference
  19. 19. 8.061 (cont) • Subsidies for hospitality should not be accepted outside of modest meals or social events held as a part of a conference or meeting • Faculty at conferences or meetings can receive reasonable honoraria and be reimbursement for reasonable travel, lodging, and meal expenses – JHUSOM honoraria payment rules will apply – Not from commercial entity
  20. 20. 8.061 (cont) • No gifts should be accepted if there are strings attached. Quid Pro Quo is a No No • Control over the selection of content, faculty, educational methods, and materials should belong to the organizers of the activity
  21. 21. Ethics: CEJA 9.011 • Physician guidelines for attending CME activities – Select those activities which are of high quality and appropriate for the physician’s educational needs. – Choose only those activities that (a) are offered by accredited providers (b) are relevant to the physician’s needs; (c) are responsibly conducted by qualified faculty – The educational value of the CME activity must be the primary consideration in the physician’s decision to attend or participate. Amenities unrelated to the educational purpose of the activity should be secondary to the educational content of the conference – Physicians should claim credit commensurate with only the actual time spent attending a CME activity
  22. 22. 9.011 (cont) • Guidelines for faculty at CME activities – Physicians serving as presenters, moderators, or faculty at a CME activity should ensure that • Research & therapeutic recommendations are based on scientifically accurate, up-to-date information and are presented in a balanced, objective manner • The content is not modified or influenced by representatives of industry or other financial contributors, and they do not employ materials whose content is shaped by industry – When invited to present at non-CME activities that are primarily promotional, faculty should avoid participation
  23. 23. 9.011 (cont) • Sponsor guidelines for CME activities – Physicians involved in the sponsorship of CME activities should ensure that • The program is balanced, with faculty members presenting a broad range of scientifically supportable viewpoints related to the topic at hand • Representatives of industry or other financial contributors do not exert control over the choice of moderators, presenters, or other faculty, or modify the content of faculty presentations – The program, content, duration, and ancillary activities should be consistent with the ideals of the AMA CME program
  24. 24. ACCME • Providers can be accredited by 2 pathways – State – ACCME • Creates rules and standards that programs must follow • If accredited then provider awards AMA PRA Category 1 creditsTM • Accreditation has 3 parts – Activity files – Self study – Face to face
  25. 25. Tip • Involve the CME office before you begin any planning of any activity
  26. 26. Credit Certificates • Attestation forms most common for live activities • Must be handled at completion of activity • Most providers are defining this as no more than 30 days after an activity ( we use 45 days) • No credit can be given without these forms • Credit will not be awarded if the form is submitted after the final due date
  27. 27. Tip • Do not wait till the documentation is needed & then try to get it • Manage credit certificates like they are money –Submit attestation form on site –If no certificate in 28 days contact provider to ensure attestation form on file • Keep your records for 6 years
  28. 28. Types of Accredited Activities • Live • Enduring • Journal-based • New procedures • Test item writing • Manuscript review • Performance Improvement • Internet Point of Care • Other
  29. 29. Live activities • Attendance required • 60 minutes = 1 credit • 0.25 credit increments permitted • Faculty (changed as of July 2006) – 2 credit hours/lecture provided – No double dipping – Claimed for original performances only • In next few years, “proof” of “Getting it” will be required
  30. 30. Enduring materials • Used over time – Web, CD-based, DVD-based • Include referenced materials • Self assessment – Pre/post test – Case examples • 60 minutes = 1 credit
  31. 31. Journal-based • In a journal • Must self assess • One article = 1 credit – Focus group can document higher ratio • Rules about advertisement in and around the article
  32. 32. New Procedure • Usually surgical, device, or privileges • Must assess competency at end – Attendance, course completion, proctor ready, competent • The rarest of all forms, but likely to become common – Cardiac CT & Cardiac MR
  33. 33. Test-item Writing • High stakes exam – NBME, ABMS, medical specialty exam • Must include training for writers • Include literature review and documentation • Must personally participate in group peer review • One writing activity = maximum of 10 credits • Handled through that Board
  34. 34. Manuscript review/editing • Under journal editor • Multiple reviewers per manuscript • Evidence of training of reviewer • Require literature review and documentation • Evidence of oversight process with feedback • Each manuscript = maximum of 3 credits • Handled through that journal
  35. 35. Performance Improvement • Oversight of selected topics • Training of learner • Validation of depth of participation – Stage A = practice assessment – Stage B = Implementation of intervention – Stage C = Re-evaluation/reflection • 5 credits per stage • Enter at any stage – Must document preliminary work • If all three done then 20 credits permitted • We are building a relationship with JHH QI
  36. 36. Internet Point of Care • Self –directed learning • Few academic centers supporting at present • Document content integrity • Training of learners • Track topics and process • Document feedback mechanisms and impact of practice • 0.5 credits per completion of cycle with typical cycle last 30-45 minutes( not time based though)
  37. 37. Self Claim Credits: Apply to AMA • Publishing manuscripts with Medline listing – Lead author can get 10 credits per manuscript • Poster presentations with published abstract for a conference that offers AMA PRA Category 1 CreditTM – Lead author can get 5 credits per poster • Medically-related advanced degrees – 25 credits per degree if course not CME accredited • Completion of MOC – 25 credits • Other including GME
  38. 38. Maryland Board of Physicians (BoP) • 50 Category 1 credits for the 2 years prior to licensure – This applies to standard CME events – Will need to be updated given the new PRA guide
  39. 39. BoP CME Equivalents Is a service performed under the auspices of a peer review or physician rehabilitation committee of the Faculty or a Faculty- approved committee of one of its component societies or a specialty society and involves evaluation of medical care or fitness to provide medical care, and the service is performed without compensation and is credited up to a maximum of 10 credit hours for a 2-year period (proportionality) • 5 hours of service = 1 credit • 1 credit per medical record reviewed
  40. 40. BoP CME Equivalents Is a service performed as a preceptor to medical students in LCME-accredited medical schools and to postgraduate trainees in accredited training programs and involves case presentations and regular and ongoing evaluations, and the service is performed without compensation and is credited with CME Category I credit for 5 preceptor hours, up to a maximum of 10 credit hours for a 2-year period.
  41. 41. Maintenance of Certification • An ABMS mandate – 24 Boards • 4 components – Evidence of professional standing • Mostly licensure & credentialing – Evidence of self assessment & lifelong learning • CME plus self assessment (core competencies) – Evidence of cognitive expertise • Mostly recertification exam – Evidence of performance in practice • Still being adjudicated
  42. 42. www.aad.org/professionals/educationcme PICMED
  43. 43. Reminder • State pathways for CME do not count toward MOC • Your board may require more CME credits than your state does for licensure
  44. 44. Summary • CME has moved from vacation to education • CME has moved from just a regulatory requirement to part of the fabric of our daily lives • Disclosure is required but not sufficient • One must manage their CME – Know whether the activity is accredited & follow-up on certificates – Lifelong learning through self-directed and directed-self learning • The state has additional CME that may help some meet regulation
  45. 45. www.hopkinscme.net