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February 14, 2011

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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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