d American Board of Medical Specialties Considers Additional Accreditation System for Continuing Medical Education - Policy and Medicine
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February 14, 2011

American Board of Medical Specialties Considers Additional Accreditation System for Continuing Medical Education

MOC CME 

The American Board of Medical Specialties (ABMS) is considering recomending to their 24 member boards to set up additional accreditation systems for continuing medical education to meet Maintenance of Certification (MOC) requirements

The new systems if adopted as proposed could require significantly more paperwork for physicians and continuing medical education CME providers or at the very least multiple sets of paperwork, creating multiple systems of compliance standards.  

All of their recommendations which we will discuss in detail can be easily accomplished using the current system of CME accreditation and the existing CME providers.

The ABMS is seeking input on their proposed changes from the CME community. 

About the ABMS

ABMS is a not-for-profit organization comprising 24 medical specialty Member Boards, and is responsible for overseeing the certification of physician specialists in the United States. The primary function of ABMS is to assist its Member Boards in developing and implementing educational and professional standards to evaluate and certify physician specialists.

Currently member boards are approving MOC/CME activities one at a time.  It is the hope of the ACCME and others that the system will revert to ACCME approved CME providers meeting a criteria vs. activity by activity.

In 2009, the ABMS Maintenance of Certification (MOC) Task Force created a Joint Working Group on MOC CME with members from both ABMS/ACCME. Initially, the group focused on key topics such as the evolving standards for MOC and the related implications for CME; the current state of CME accreditation systems; the current status of CME credit systems; and the differences among what the ABMS Member Boards accept in terms of CME (for Part II and Part IV).

 Based on these meetings and discussions, the Joint Working Group drafted a white paper and presented it to the ABMS MOC Committee last December. Upon review and approval the ABMS board decided to circulate the white paper for comment from the CME Community at large.

As a result, the ABMS MOC Committee is asking interested individuals and entities to submit comments to inform the MOC Committee as they guide the ongoing evolution of the ABMS MOC program. Comments can be sent to the attention of the ABMS MOC Support Program or via email to ABMS_MOC_Support_Program@abms.org by Tuesday, March 1, 2011.

It will ultimately be up to the ABMS to decide what recommendations to include.  As a result, states will not be the ones adopting the changes, rather each of the 24 member certifying boards will have to implement the recommendations once they are approved. After comments are collected, staff will aggregate and analyze input and make a presentation at the next MOC Committee meeting scheduled for early May 2011.

Background – Working Group 

During their discussions, the Working Group recognized that MOC CME appropriately exists as a distinct subset within the universe of accredited CME. The characteristics of CME that are of specific relevance for MOC were divided into three focus areas:

 -       Clinical (and Professional) Content

-       Educational Format and Quality

-       Requirement for Proportional Coverage of the ABMS/ACGME Competencies 

In evaluating these areas, the Working Group identified differences between Continuous Professional Development (CPD) and Continuing Medical Education (CME) as related to MOC CME. They noted that CPD may be defined as what the physician does to remain current, expand awareness, knowledge and skills, and provide quality care, while CME represents the educational and practice improvement tools and resources used in support of CPD.” As a result, they asserted that MOC CME is more appropriately considered a CPD model. 

In discussing the roles financial relationships with industry should play in regard to MOC CME, the Working Group found it important to address negative public perceptions of relationships between industry and physicians, as well as between industry and CME providers. In deciding on whether commercial support for CME is acceptable, the Working Group considered the positive role of commercial support. The white paper recognized that there might be alignment between commercial support and the public interest to the extent that commercial support may: 

  • Facilitate affordable access to CME activities for physicians (especially physicians in rural and/or underserved areas);
  • Accelerate the translation of new science and technologies into clinical practice and drive practice change (the importance of this aspect for equipment dependent specialties such as surgery and radiology was emphasized);
  • Promote multi-center or multi-provider group activities; and
  • Encourage educational innovation.

 Moreover, the white paper acknowledged that “Commercial support may become less of an issue if educational content is relevant to practice, evidence-based, practice-based, and includes core competencies.

MOC-CME White Paper Recommendations 

Based on these findings, the white paper made the following recommendations: 

  1. ABMS and the MOC Committee should assist the Member Boards in facilitating the development of approaches to CME for MOC Part II and Part IV that emphasize “informed learning” or “formative CME/CPD” for diplomates that incorporates specific characteristics (listed in the white paper)
  2. The ABMS and the MOC Committee should assist the Member Boards in developing approaches to Part II and Part IV MOC CME that emphasize coverage of all core competencies.
  3. ABMS and the MOC Committee must consider the diplomate-centered and program-centered characteristics of MOC CME in subsequent discussions regarding development and integration of MOC CME into the MOC framework and standards. 

Specifically, under recommendation 3, the white paper states that “A general framework for MOC CME must be developed that assures the public trust by progressively eliminating or reducing, to the extent possible, influence exerted by commercial entities.” 

To achieve this framework, the white paper recommends that the MOC Committee include feedback from the ABMS Ethics and Professionalism Committee, other related standing committees, and public input, to allow full consideration of perceptions of specific bodies and the public to assure optimal degrees of separation between educational and commercial interests. 

  1. The MOC Committee should continue discussions with the ACCME and others regarding the development of a “standard currency” for MOC CME that would ensure interchangeability of programming between Member Boards, and other stakeholders, and would also identify the special nature of CME programming that meets the identified characteristics of MOC CME. 

Conclusion 

For those of you left confused, from reading the white paper it was not clear how the ABMS was tactically going to achieve their goals.

Almost everything in their recommendations can be easily accomplished within the current ACCME accreditation system.   There are already systems in place to ensure freedom from undue commercial influence and the quality of education from providers.  The ABMS needs to ask themselves what business are they in the business of certification of physicians or accrediting courses. Wouldn’t it be much more efficient if the medical boards were to work with the ACCME to establish criteria for MOC?

The current system of MOC where individual activities are approved by individual boards is not sustainable.  There are over 100,000 CME activities conducted each year and it would take an army of reviewers to consider each activity individual by potentially multiple boards for credit.   Many boards currently offer courses to meet MOC requirements and the revenue from these activities is significant.

The impact these regulations could have on CME are significant. The new recommendations could lead to "tiers" of CME, different credit systems, exclusion of commercial support from MOC CME, and a number of other consequences. 

There is considerable momentum to have maintenance of certification be adopted by state medical boards and become maintenance of licensure (MOL).  Ohio and Minnesota have adopted MOL systems and Wisconsin in the lame duck session of their legislature passed legislation enabling MOL to be adopted by their state board. 

So how could this affect the CME Community? 

  • Physicians could be forced to choose between getting CME from annual meetings and learning new science to attending events that are MOC only events.

 

  • Hospitals and health systems potentially may be required to have more than one CME accreditation for their physicians, and will have to keep track of significantly greater amounts of paperwork and learning criteria on lower budgets.

 

  • University medical centers these new regulations can also limit the academic freedom seen at many institutions adding yet another level of “required” CME requirements and accreditation system.  Much of the CME on new developments including gene therapy and findings in improved cancer care will not qualify for MOC CME.

 

  •  Medical Societies will be especially hard hit as this move if adopted will force attendees to make a choice between learning new science at an annual meeting or fulfilling MOC requirements. 

 

  • Patients especially those with rare diseases will be affected in that their physicians will be forced to learn things to meet governmental requirements at the detriment to learning about medical breakthroughs that will potentially save their lives.

 

  • All stakeholders will be required to develop more restrictive CME content with significantly greater paperwork requirements and do it with almost $1 Billion less resources to pay for them.

A simple solution to meeting Maintenance of Certification requirements should be for individual boards to require specific hours in a certain area that meet certain criteria.  

An example of this would be for the Oncology board to require 2-3 hours of CME in on a specific tumor type, ie. breast or lung tumors, in the same way electrophysiology boards could require a certain number of hours on radio frequency catheter ablation and drug therapy for AFIB….. 

This would enable the CME community to develop CME activities that meet certain criteria without the additional burden of a unique CME credit system. 

Those physicians trained in medical specialties need CME regularly to be kept up to date on the newest breakthroughs and advances in medicine and medical technology, including new techniques, updates, and clinical data. Physician specialists also need to be able to productively interact with physicians and members of industry to create new ideas and to get answers to important questions about ways to improve patient care and outcomes. 

If ABMS will ultimately decide on recommendations that are best for patients, regardless of the mechanism of support, than the answer should be clear: patients need and want commercial support of CME because it will lead to improved care and patient outcomes. There are other ways to ensure objectivity and ACCME and numerous CME providers have already implemented policies to do so. Accordingly, we should not be removing access to programs, education, training, and information that doctors find valuable.

Send In Comments: 

ABMS_MOC_Support_Program@abms.org

by Tuesday, March 1, 2011

ABMS White Paper on MOC CME

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I probably agree in considering Additional Accreditation System for continuing medical education...It would be full benefit for many students...

I would like to respond to your posting from February 14, 2011. I served on the ABMS/ACCME MOC CME Working Group and I am the current President of the Alliance for Continuing Medical Education. However, my comments are purely my own and they do not represent the opinon of the Alliance, the ABMS, the ABMS MOC Committee, the ACCME, the Working Group, or the University of Wisconsin. Importantly, the Alliance Advocacy Committee will be crafting a response to the call for comments in the near future. That response must go to the Alliance Board of Directors before it is publically released.

There appears to be some disconnect between MOC (Part II and Part IV) and certified CME. Specifically, at this point in time there are projects and activities that are certified for CME credit but they have not been approved for MOC (Part II or Part IV). Similarly, there are projects and activities that are approved for MOC (Part II or Part IV) that are not currently certified for CME credit. However, this does not mean that a seperate accreditation system is being created or is desirable. In addition, each of the 24 member boards of the ABMS has the autonomy to make its own decisions about what they will approve for MOC and some of these issues are unrelated to CME at this point (e.g., oral examination or case loads in some specialties). I believe that CME/CPD will continue to play a vital role in the MOC process but stakeholders must be confident that appropriate standards are met and are in the best interest of the public. For example, it is critically important that the content within certified CME/CPD reflect the best available scientific and medical evidence and it is just as important that the educational formats and evaluation methods reflect the best available educational evidence regarding knowledge translation and implementation science. In other words, there is an evidence-base regarding effective educational modalities that I believe is not currently being used in many settings. Verification of individual CME activities, let alone what happens to an individual clinician as she/he moves through a learning activity, is not a part of the current ACCME accreditation system and that has raised questions about quality control. Together, we must continue to advance CME/CPD so that learning translates into safe, effective, patient-centric, team-based care that improves health outcomes. From what I understand, ABMS is interested in exploring a process to work through the various issues and solutions, and clarity regarding many unresolved issues will become evident over time. For now, the White Paper does not represent policy or standards but is a place to start thinking about the issues related to CME/CPD and its role in MOC.

I encourage individuals and organizations to respond to the White Paper and its associated Call for Comments.

George C. Mejicano, MD, MS, FACP, FACME
Professor and Associate Dean
School of Medicine and Public Health
University of Wisconsin - Madison

After reading your February 14 blog, I’m compelled to respond. Although I served on the ABMS/ACCME MOC CME Working Group, the opinions expressed here are my own. I am not representing the Working Group, the ABMS or the ACCME.

The recommendations for MOC CME do not call for a new accreditation system; they do not call for “significantly more paperwork for physicians and CME providers”; they do not call for the elimination of commercial support of CME; there is no intent to diminish the attendance at association annual meetings; and there are no disadvantages for academic medical centers, hospitals, medical societies and patients.

The goal of MOC is to ensure on-going physician competence. That is a goal of CME as well. This is an opportunity for CME to be a part of a larger process to ensure improved patient care and outcomes. It’s a call for CME to be evidence-based, relevant to practice, focused on actual practice gaps, free of commercial bias, performance-based and to provide evidence of practice improvement. This is a time for CME to demonstrate its value. The current systems need to ensure high quality, effective CME that can ensure the public that the health care they receive is safe and of the highest quality.

If CME providers wish to respond to the initial recommendations for MOC CME I hope they will respond to the actual document and not inaccurate interpretations.

Nancy Davis
Executive Director
National Institute for Quality Improvement and Education

Commercial support of CME has been a target for several years. No doubt there have been occassional cases of undue influence and biased presentations in the past. The response to the scrutiny of commercial support of CME, however, has been a significant tightening of safeguards to ensure a higher level of independence and credibility than ever before. New procedures and rules regarding full disclosure of authors and presenters, restrictions on communication within companies between marketing and professional education, extensive firewalls required in companies involved in developing or collaborating on CME, and regulations on information that can be shared between commercial supporters and sponsors of CME, to name a few, have dramatically changed the CME landscape.

It is time to recognize the strong industry response that has been put in place to ensure the highest level of credibility for CME. Certified medical education is judged to be free of bias over 99% of the time. Programs are consistently based on evidence-based medicine and accepted latest guidelines. Restricting commercial support of CME or layering on yet more regulations will not improve the quality of education and patient health. It will have the opposite effect. It will limit the number of educational initiatives that will be available to physicians to further their medical skills. This in turn will harm the patients who might otherwise benefit from a better informed medical community.

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