Continuing Medical Education: Better Education Through Accreditation

by Pamela Beaton

In June, 2010, the American College of Phlebology established Continuing Education (CME) accreditation through the Accreditation Council for Continuing Medical Education (ACCME) in order to better educate and prepare current and upcoming physicians in the field of phlebology. VEIN Magazine spoke with Pam Beaton, the ACP’s resident CME expert, to discuss accreditation, industry’s role in providing content and what it all means to physicians who practice the specialty.

VM: Why is CME important in the field of phlebology?

PB: CME consists of educational activities that serve to increase the professional competence and relationships a physician uses to provide services. The content of CME is the body of knowledge and skills generally recognized and accepted by the profession.

Sixty-two boards require continuing medical education for maintenance of licensure (MOL). Forty-three states accept AMA PRA Category 1 Credit as equivalent for license renewal. CME is required not only for MOL, but also to maintain hospital privileges, comply with Board Maintenance of Certification (ABPh or other ABMS specialties), and required for ICA VL accreditation, to name a few. CME can also assist in developing consistent guidelines for treating venous disease.

VM: How did the ACP become an accredited CME provider and who will regulate the CME programs and content?

PB: The ACP is emerging as a leader in the medical community dedicated to the diagnosis and treatment of venous disease with the goal of providing improved patient care by establishing the highest medical education standards in the industry. The ACP Board of Directors, as part of the ACP’s strategic plan, is to be its members’ indispensible resource for education, knowledge exchange, and practice development. By obtaining ACCME accreditation we believe the ACP is demonstrating its commitment to be the leading professional organization dedicated to providing the highest quality phlebology education available.

The ACP’s CME accreditation couldn’t have been possible without the generous support of the ACP Foundation. In 2009 independent CME accreditation was researched and a pre-application was accepted by the ACCME, where the ACP was deemed eligible to continue with the accreditation process. The next step was to complete a self-study (application), submit evidence of performance-in-practice (activity files), and go through a face-to-face interview with the ACCME.

As an initial applicant, the ACP was only responsible for specific sections of the self-study (some criteria were optional), and only had to submit two best examples of performance-in-practice, selected by the ACP. Now that the ACP is an accredited provider, we are responsible for compliance with all ACCME criteria, standards and policies. When the ACP applies for re-accreditation, we will have to complete all sections of the self-study, as well as submit activity files selected by the ACCME.

As for who regulates the CME, the ACCME establishes the policies pertaining to the development, planning and execution of CME programs. They accredit societies, associations and companies to designate credit.

PB: Per the ACCME: “Accredited CME is an essential component of continuing physician professional development in the eyes of the U.S. organizations of medicine. ACCME accreditation is a mark of quality continuing medical education activities that are planned, implemented and evaluated by ACCME accredited providers in accordance with ACCME’s Essential Areas and Elements and Accreditation Policies."

"ACCME accreditation assures the medical community and the public that such activities provide physicians with information that can assist them in maintaining or improving their practice of medicine, to help them bridge the gap between today’s care and what care should be. In addition, accredited CME activities are free of commercial bias and based on valid content.”

The Physician’s Recognition Award (AMA PRA Category 1 Credit), is issued by the American Medical Association (AMA). The ACP can designate CME activities for this credit. It is the physician’s responsibility to only claim credit for the portions of the activity that they attended. The AMA has rules in addition to those guidelines required by the ACCME regarding what types of programs may be approved for credit and policies for faculty members. For more information, the AMA Physician’s Recognition Award booklet can be downloaded from their website.

In addition, the Food and Drug Administration (FDA) has policies regarding the independence of educational materials and programming from industry influence, as well as policies pertaining to off-label use of products. Off-label use may be discussed in CME programs, as long as faculty discloses that it is off-label use.

As an accredited provider, the ACP is responsible for compliance with all ACCME criteria, standards and policies.

VM: With all this new regulation, how may the industry partner with the ACP to provide CME?

PB: The ACCME’s 2004 Standards for Commercial Support (SCS) have made some clarifications over the years and the SCS are now a part of the 2006 Accreditation Criteria (Criteria 7-10). A CME activity should never include “advertising, trade names, or product-group message” of a commercial interest.

A commercial interest is “any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on, patients. Commercial support is defined as financial, or in-kind, contributions given by a commercial interest, which is used to pay all or part of the costs of an educational activity. 'In-kind’ refers to the loan or donation of equipment, supplies, and/ or services from a commercial entity.”

Commercial interests, while valuable in supporting continuing medical education activities and the transmission of new information may not control the content or be involved in the educational portion of the CME activity. Commercial interests have never been allowed to pay for any or part of physicians’ involvement in a CME activity, either as faculty or a planner.

PB: As an accredited CME provider, the ACP is obligated to collect disclosure information from all those who control content, identify and resolve any conflicts of interest, and disclose to the audience (learners) of the presence or absence of relevant financial relationships. Disclosure is not intended to exclude someone from participation in the CME activity, but rather to ensure transparency to the learners so that they may make their own decisions about the content being delivered.

The ACP is not required to ask for a dollar amount, only the nature of the relationship (speakers’ bureau, consultant, investigator, etc). The ACP then has to resolve any identified conflicts (if a faculty member has a relevant financial relationship and controls content, it automatically creates a conflict of interest which has to be resolved).

The ACP does not need to ask a faculty member to sever their financial relationship; resolution can be accomplished by content review to ensure presentations are free from commercial bias. Disclosure and resolution of conflicts of interest are the most common areas out of compliance, based on ACCME data.

VM: So, how does accreditation change the types of activities the ACP will now offer?

PB: As an accredited provider, we have the opportunity to develop numerous activities to address the gaps and needs of our learners. Some of them are:

  • Annual Congress
  • One-day courses/symposia, such as the Advanced Sclerotherapy Course and Advanced Ultrasound Skills Course
  • Webinars (both live and archived)
  • Self-Assessment Modules (for ABPh MOC), and
  • Journal CME

The best part is that now the ACP is not limited to the courses listed above.

CME planning must involve the identification of a physician practice gap, which is the difference between current practice and best practice of the learners. As an example, if there is new research on a topic relating to the treatment of venous disease, that’s the start of CME planning.

The next step would go beyond “presuming” that learners need to know about that new research; we cannot assume that they are all up-to-date with the literature. In order to determine a professional practice gap, the ACP would then have to find out what the learners don’t understand (knowledge gap), aren’t able to apply to their practice (competence gap), or aren’t able to do (performance gap).

PB: If the research shows that the learners are not utilizing the new research, there is now a demonstrated need for education. If the ACP surveys the membership to gauge their level of understanding and implementation of the new research, there is now an expressed need. CME providers have to consider the current or potential scope of practice of the learners, the format and setting of the activity (symposia, webinar, hands-on workshop, etc.), and desirable physician attributes based on ACGME, IOM and ABMS competencies.

As an accredited CME provider, it is no longer acceptable for the ACP to have physicians simply attend an educational session. Physicians must now be actively engaged them in the educational process and the ACP now has to plan activities with consideration of what will happen when the learners go back to their practice. What are the trends?

What worked? What didn’t? All this information goes back into planning future CME activities--discovering those professional practice gaps. Those evaluations may seem time consuming, but they make all the difference in the world to a good CME program.

Although the ACCME criteria require the identification of professional practice gaps, the assessment of needs remains the same. Accredited CME providers have always had to use planning process(es) that linked identified educational needs with a desired result.

PB: The only thing that has changed is now those needs must underlie a professional practice gap of the learners. Education is no longer done for the sake of what learners want to know, there is more focus (and compliance evaluation) of what learners need to know.

The ACP has to evaluate the learners that attend educational activities. This hasn’t changed, however evaluation now has to go beyond rating an activity to actual involvement of the learner in their evaluation of the activity. Yes/No questions and Likert scales are still valid mechanisms of evaluation, but they are not enough to maintain compliance (and identify professional practice gaps). Learners have always had to evaluate an activity, now it’s required that the ACP asks for more detail.

While these CME requirements may seem restrictive, the goal isn’t to diminish industry and physician involvement or make CME planning difficult, but rather to raise the bar on clinical practice and improve patient care.

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