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  1. 1. REPORT OF THE COUNCIL ON MEDICAL EDUCATION CME Report 1-A-06 Subject: Annual Report on AMA Medical Education Activities: 2005 Presented by: Carl A. Sirio, MD, Chair This informational report summarizes the major activities of the Council on Medical Education and American Medical Association (AMA) Medical Education Group during 2005. For more information on the Council on Medical Education, see www.ama-assn.org/go/councilmeded. I. The Council on Medical Education The Council on Medical Education was founded in 1904 with the general goal of improving medical education in the United States. The Council now has four general goals: • To propose policy on medical education to the AMA House of Delegates. • To act as primary liaison between the AMA and other organizations with responsibility for medical education and physician performance. • To collect and disseminate information about undergraduate, graduate, and continuing medical education/continuing professional development. • To ensure the quality of medical education and the physician graduate. Council activities during 2005-2006 can be classified into several areas. A. Policy Development and Implementation During 2005-2006, the Council submitted 15 reports for consideration by the House of Delegates, as well as one additional report for information. Reports typically are developed with advice and input from relevant areas of the AMA, especially the Section on Medical Schools, the Resident and Fellow Section, and the Medical Student Section. The Council on Medical Education, supported by staff from the Professional Standards Group of the AMA, has embarked on a major initiative to improve the quality of patient care by transforming medical education and training across the continuum from pre-medical preparation and medical school admissions through continuing physician professional development. The first meeting of the Initiative to Transform Medical Education (ITME) was held in December 2005, and a second meeting is being planned for September 2006 (see Council on Medical Education Report 3-A-06 for a detailed description of the ITME goals and process). 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 2
  2. 2. CME Rep. 1 - A-06 -- page 2 B. Liaison to Other Organizations A major activity of the Council is to identify and recommend qualified nominees for various national medical education-related committees. The nominations are reviewed and finalized by the AMA Board of Trustees. During 2005-2006, the Council recommended new appointments to 22 Residency Review Committees (RRCs), the reappointment of 33 existing RRC members, and the nomination of individuals to 5 medical specialty boards. In addition, the Council recommended appointments or reappointments to accrediting bodies (the Liaison Committee on Medical Education [LCME] and the Accreditation Council for Graduate Medical Education [ACGME]). The nomination process ensures that the AMA appoints well-qualified individuals who will work to enhance medical education. C. Activities in Support of Accreditation In 2005, the Council on Medical Education reviewed and commented on new and revised program requirements for adult/pediatric cardiothoracic anesthesiology, congenital cardiac surgery, family medicine, neurological surgery, nuclear medicine, ophthalmology, pain medicine, pediatric subspecialties, physical medicine and rehabilitation, surgery, transitional year, vascular surgery, and transplant hepatology. In addition, the Council on Medical Education reviewed proposed revisions to several LCME accreditation standards. D. Information Collection and Dissemination The Council on Medical Education collects information under its own auspices and in conjunction with other units in the AMA and its Medical Education Group. Data also are collected from medical schools through the LCME Annual Medical School Questionnaire. This questionnaire collects information on medical students, faculty, curriculum, and student evaluation from the nation’s 125 LCME-accredited medical schools. It is a successor to a survey done annually by the Council on Medical Education beginning in the early 1900s. The data are used for many purposes, including Council on Medical Education reports and an article on undergraduate medical education published in the Journal of the American Medical Association. During 2005-2006, information from the survey was shared with individuals and groups inside and outside the AMA, including medical school faculty and administrators, medical education researchers, and members of the federation. II. Section on Medical Schools Established in 1976 by the AMA House of Delegates to improve communication between practicing physicians and medical educators, the AMA Section on Medical Schools (SMS) provides all US-accredited medical schools and their faculty a voice in House of Delegates deliberations and offers a forum for discussing and developing policies on medical education and national health care issues. During the Annual and Interim Meetings, the Section provides educational programs on issues of importance to the academic community. The SMS and Council on Medical Education cosponsored an educational program on June 17-18, 2005, convening leaders in American medical education and health care to take an in-depth look at improving medical education and continuing a dialogue that began at the 2004 AMA Annual Meeting, when the Council celebrated its 100th anniversary. Presentations included “Reality Check: From the Real World of Health Care”; “How to Heal the 1 2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48
  3. 3. CME Rep. 1 - A-06 -- page 3 Medical Education System”; “A Call to Action – Transforming Medical Education”; and “Effective Strategies for Improvement in Clinical Care Systems.” The SMS held its 2005 Interim Meeting in November in Washington, DC, in conjunction with the Association of American Medical Colleges (AAMC) Annual Meeting. Attendees were briefed on the progress of AMA and AAMC initiatives to reform medical education and discussed proposed changes to continuing medical education, and the Section’s Governing Council met with the AAMC Council of Deans Administrative Board to discuss issues of mutual concern. The SMS is celebrating its 30th anniversary in 2006. The educational program theme is behavioral impairment in physicians. Participants will discuss how disruptive behavior and impaired physicians can contribute to medical errors and jeopardize patient safety. Also to be discussed will be the impact on the learning environment, licensure and legal implications, and the effect on individuals and their families. Increasing AMA membership among academic physicians is a top priority for the SMS Governing Council, which will continue to work with staff from AMA Membership. The Governing Council is discussing a possible revision to the SMS bylaws at the March meeting of the Council on Constitution and Bylaws. The Governing Council is requesting an additional membership category by which any AMA member with a faculty appointment at an LCME-accredited medical school would be eligible for SMS membership. At the 2006 Annual Meeting, the Section will again participate in the HOD Candidate Forum— consisting of representatives from the Section as well as the Medical Student Section and Resident and Fellow Section—to interview candidates for the AMA Board of Trustees and the Council on Medical Education. This process helps ensure that issues of importance to the academic community are seen as a priority by the candidates. III. Medical Education Group Activities A. Office of the Vice President 1. Appointments to Other Organizations Responsibilities of the Office of the Vice President include communicating and sending Council or staff representatives to physician credentialing organizations, such as the American Board of Medical Specialties (ABMS) and Federation of State Medical Boards (FSMB), where medical education issues are discussed. The Council serves as the critical link between these organizations and the AMA and obtains feedback from the representatives to assist in AMA policy development and implementation. Representation to physician assistant accrediting and certifying bodies and health professions accrediting organizations, such as the Commission on Accreditation of Allied Health Education Programs (CAAHEP), are overseen by the Office, with feedback provided to the Council. Good working relationships with these entities are essential to the continued production of several medical education books and CD-ROM products that serve as references for the Council. The Office is monitoring the work of the Federation of State Medical Boards and state licensing boards as they develop a common licensure application and physician portability, as specified in Resolution 324 (A-04), Simplifying the State Medical Licensure Process. FSMB staff report that three states have incorporated the common form into its licensure application process and that several other states have expressed interest. 1 2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49
  4. 4. CME Rep. 1 - A-06 -- page 4 2. AMA Membership Activities The Office serves as the liaison to other membership-related groups within the AMA as well as other units within Professional Standards. 3. Medical School Representation/Outreach Program The Medical School Representation/Outreach Program was reinstated as part of the overall Board of Trustees’ Representation Program. It involves participation by members of the Board of Trustees and is coordinated with other areas of the organization, such as Membership, Communications, and the student and resident sections. The program was implemented on two levels (mini visit and full-day visit) with full-day visits in 2005 to Texas A&M University, Rosalind Franklin University (Chicago Medical School), University of Illinois at Chicago, and Creighton University, allowing trustees the opportunity to meet with students, faculty, administrators, etc. B. Undergraduate Medical Education Policy and Standards 1. Accrediting Activities Ongoing Council involvement in undergraduate medical education includes sponsoring the Liaison Committee on Medical Education (LCME). The LCME, established in 1942 by the AMA and the Association of American Medical Colleges (AAMC), approves educational programs leading to the MD degree in the United States and Canada, the latter in cooperation with the Committee on Accreditation of Canadian Medical Schools. The LCME also serves as the deliberative body through which standards and procedures for accrediting educational programs are established. During 2005-2006, the LCME conducted 17 full accreditation surveys, three of them for Canadian programs. The LCME conducted one post-probation visit for a medical school in Canada and six focused limited visits. The LCME Secretariat staff from the AMA and AAMC conducted 13 consultation visits with medical schools, of which three were Canadian. During the year, one program in Canada was removed from probationary status. 2. Hurricane Katrina The AMA, working through the LCME, facilitated the relocation of Tulane School of Medicine from New Orleans to Houston, TX and the relocation of Louisiana State University School of Medicine at New Orleans to Baton Rouge, LA. This process required repeated consultations and the waiving of one LCME standard. The LCME through its staff has maintained careful review of activities at both institutions to ensure that the medical education of enrolled students has not been compromised and the return of the programs to New Orleans is supported by appropriate resources. 3. Fifth Pathway The Fifth Pathway program was developed by the AMA as a mechanism for entry into approved programs of graduate medical education for students from foreign medical schools who fulfilled specific criteria. The pathway became available as of July 1, 1971. Since that time, the criteria for entry into the program have been maintained by the Council on Medical Education and were most recently updated on June 17, 2005. At the present time, only two medical schools in the US sponsor Fifth Pathway programs and both have fewer than 100 students enrolled per year. The AMA Physician Profile System is being modified to more accurately reflect physician participation in this program, and an electronic database has been created to facilitate the identification of participants. 1 2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49
  5. 5. CME Rep. 1 - A-06 -- page 5 4. Career Information for Premedical and Medical Students In response to the Council’s interest in promoting careers in medicine, medical education staff maintain the “Becoming an MD” Web site (www.ama-assn.org/go/becominganmd), one of the more popular sites within Medical Education and on the AMA Web site. The main page is visited more than 12,000 times per month and serves as a resource in responding to more than 5,000 requests from high school and college students seeking information about the medical profession. C. Graduate Medical Education 1. Liaison Activities The Council and division staff maintained active liaisons with the following organizations: AcademyHealth, Accreditation Council for Graduate Medical Education (including several Residency Review Committees, eg, Internal Medicine, Pediatrics, and Psychiatry), American Academy of Family Practice (including its Commission on Education), Association of American Medical Colleges (including its Group on Residency Affairs), Association for Hospital Medical Education, Council on Graduate Medical Education, Council of Medical Specialty Societies (including their Organization of Program Directors Associations), Health Professions Network, Joint Commission on Accreditation of Healthcare Organizations (including their task force on Health Care Professional Education), and 25 allied health professions accrediting organizations. 2. Direct Communications GME Program Directors E-letter—This monthly e-mail newsletter, with 14,000 subscribers, provides a forum for sharing and soliciting information on GME (and promoting the AMA’s GME products/services). Key topics in recent issues include coverage of pharmaceutical industry access to residents and program directors. Medical Education Bulletin—The Bulletin, with a readership of over 12,000, is published twice a year, providing a review of the actions of the HOD of interest to medical educators and serving as a source of information about undergraduate and graduate medical education. The Winter issue included highlights from the Interim Meeting. Bimonthly welcome letter to new program directors—A letter signed personally by the division director goes to all newly appointed program directors (more than 1,000 last year), informing them of the many medical education activities, services, and products provided by the AMA. Health Professions Career and Education E-letter—This monthly e-mail newsletter, with 6,000 readers, helps reinforce and strengthen AMA relationships with allied health professions accrediting agencies/professional organizations and serves to promote AMA products and initiatives. 3. Research and Publication The Department of Data Acquisition Services works closely with the AMA’s Department of Census and Self Reported Data and the AAMC to administer the National GME Census. The Census collects information on all ACGME-accredited and combined GME programs, and on all 130,000 active and graduating residents and fellows. GME program information from the Census goes onto FREIDA Online® (see Product section, below), and resident information becomes part of the AMA’s Physician Masterfile. 1 2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46
  6. 6. CME Rep. 1 - A-06 -- page 6 Program and resident information is also used in research studies conducted at the AMA and by health services researchers nationwide. Department staff licensed program and resident data for several research projects, after screening for data security and confidentiality 4. Products/Services FREIDA Online® —This Internet database provides access for medical students and residents to information on nearly 8,400 ACGME-accredited and ABMS board-approved GME programs. Total searches by medical students and residents range from 28,000 to 82,000 per week. A new member benefit allows users to print their own program director mailing address labels. Graduate Medical Education Directory—Now in its 91st edition, the 2006-2007 “Green Book” continues to be a key reference work for the GME community. This edition includes extensive data tables for specialties/subspecialties, to help students determine which field is right for them. Guidebook for GME Program Directors—Available online, this document provides pertinent and valuable information to residency directors/coordinators on all facets of AMA involvement in GME, as well as contact information for the ACGME, ABMS specialty boards, FSMB, and more. State Medical Licensure Requirements and Statistics—Published annually, this book provides updated information on licensing board requirements for the 54 allopathic and 13 osteopathic boards of medical examiners in the US and territories. Health Professions Career and Education Directory—The 2006-2007 edition of this annual book includes 6,666 educational programs and 2,521 educational institutions in 67 health professions. D. Continuing Physician Professional Development (CPPD) The Division of CPPD provides support for the Council in relation to continuing medical education (CME) policies and trends. In addition, the Council on Medical Education has delegated responsibility for the administration of the AMA’s accredited CME program to the division. 1. AMA Physician’s Recognition Award (PRA) and AMA PRA Category 1Credit™ Revisions In November 2005, the Council approved major revisions to the AMA PRA policy booklet. The new booklet, designed to address both physicians and CME providers who grant AMA credit to physicians, provides greater clarity in terms of the many types of activities for which physicians may claim credit, as well as the expectations of CME providers to meet PRA requirements when awarding AMA credits. Among the new rules set forth in the revised PRA is the requirement for CME providers to assert trademark when using the term AMA PRA Category 1Credit™. The booklet is available on the AMA website at www.ama-assn.org/go/cme. 2. Internet Point of Care CME In March 2005, the Council approved rules governing how AMA PRA Category 1 Credit can be awarded for interactive, physician-directed use of clinical databases at the point of care (PoC). This concluded a 5-year study that included a pilot program and collaboration with the ACCME on a provider guidance for implementing this new model of learning. These rules have been incorporated into the revised AMA PRA booklet. CPPD has reached out through numerous state 1 2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48
  7. 7. CME Rep. 1 - A-06 -- page 7 societies and other national bodies to help disseminate and encourage adoption of this new form of certified CME. 1 2 1 2 3
  8. 8. CME Rep. 1 - A-06 -- page 8 3. 16th Annual Collaboration Task Force Conference In October 2005, CPPD hosted the 16th Annual Conference of the National Task Force on CME Provider/Industry Collaboration: “Practical Strategies for the Survival in the Guideline-rich CME Environment of 2005.” The event had its largest audience ever, with more than 600 participants representing all areas of the CME enterprise. The 17th Annual Conference is scheduled for the Baltimore Marriott Waterfront Hotel Oct. 16-18, 2006. 4. Regional Meetings The Division of CPPD held two regional conferences on CME, “New Directions in Physician Learning,” on Oct. 23, 2005, in Baltimore, MD, and on Nov. 10, 2005, in New York, NY. These conferences provided a unique focus on the AMA PRA credit system and highlighted the new modes of physician learning that have been approved by the Council. The AMA planned and marketed these events in collaboration with state and regional organizations. 5. Conjoint Committee on CME CPPD has participated in the meetings of the Conjoint Committee on CME, a group hosted by the Council of Medical Specialty Societies. The Committee’s goal is to galvanize action among stakeholder groups toward the evolution of CME. It seeks to accomplish this through consensus recommendations from thirteen of the principal stakeholders in CME (ACCME, ACGME, ACME, AAFP, ABMS, AHA, AMA, AOA, AHME, CMSS, FSMB, NBME, and the Society of Academic Continuing Medical Education [SACME]). New learning modalities approved by the Council, including Performance Improvement and Internet Point of Care, have been embraced by the Conjoint Committee and are reflected in its recommendations. Along with CPPD staff representatives, James L. Borland, Jr., MD (previously), and Susan Rudd Bailey, MD (currently) have represented the Council on the Conjoint Committee. 6. Alliance for CME Awards The CPPD Division, jointly with the AAFP, was awarded the 2006 Frances Maitland - PACME Award for “outstanding vision and leadership in developing innovative processes to recognize physician participation in ‘just in time,’ ‘point of care’ and other nontraditional learning opportunities” by the Alliance for Continuing Medical Education, a national organization representing over 2,000 CME professionals. In addition, the Alliance awarded Barbara Schneidman, MD, MPH, Vice President of the Medical Education Group, the 2006 Frances Maitland Memorial Lecture Award. 7. Communications and Collaborations CPPD has implemented a number of communications to connect with the CME community. The CPPD Web site includes the new AMA PRA booklet, applications for the AMA PRA, and an AMA PRA tutorial, as well as links to AMA CME activities for physicians. CPPD also delivered updates through presentations at both national and state conferences and meetings. Three issues of the CPPD Report reached more than 5,000 subscribers in both print and online versions. CPPD also contributed columns in the Society for Academic CME’s Intercom and the Alliance for CME’s Almanac. The Division Director and the Director of PRA Standards and Policies also published a scholarly article in the Journal of Continuing Education in the Health Professions describing the evolution of the AMA PRA credit system and highlighting the most recently approved formats of learning. CPPD also actively participated in multiple collaborative efforts with such organizations as the Physician Consortium for Performance Improvement, the Coalition for Physician Enhancement, MedBiquitous, and state medical societies recognized to accredit intrastate CME providers. 1 2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48