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July 21, 2015

JAMA: Advancing Continuing Medical Education

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In an article issued Online First in The Journal of the American Medical Association (JAMA), the Accreditation Council for Continuing Medical Education (ACCME) authored "Advancing Continuing Medical Education," by Graham McMahon, MD, MMSc, President and CEO of the ACCME. Dr. McMahon articulates the importance of accredited CME in supporting physicians' continuing professional development and the evolving healthcare environment. He explains the evolution of CME over the past 15 years, as increasingly CME has been designed to create meaningful change in healthcare professionals' skills and performance and to affect patient outcomes.

Today, educational partners base activity construction and pedagogy on assessment of needs underlining problems in practice and are required to measure outcomes. However, not all changes are visible to learners. For example, CME is often considered to encompass only lectures and knowledge but now increasingly is designed to improve skills and performance, and many activities aim to specifically affect patient outcomes. Dr. McMahon writes that of the more than 140 000 learning activities offered by accredited organizations each year, approximately 60% are designed to achieve improvements in physician performance, with 40% measured for those changes. Thirty percent are designed to improve patient outcomes; 13% measure those changes.

Stressing the need for independence of content, Dr. McMahon states that resources used to support CME, including commercial support, deserve scrutiny and stewardship so the independence of content from any external support is protected. He cites data from a 2010 report suggesting that physicians perceive low rates of commercial bias in CME and that there is no association between the extent of commercial support and the degree of perceived bias in CME activities. The importance of ensuring that CME activities are free of commercial bias is a critical priority for ACCME and is under continual review. To review accreditation, 3 sources of data—randomly selected activity files, interviews conducted by trained surveyors, and self-study reports—and a complaint process, is employed by the ACCME. However, while the entire medical community needs to take responsibility for preventing and detecting commercial bias, it is imperative that regulation does not impede the rapid dissemination of discovery and research into clinical practice.

Dr. McMahon continues his theme of shared responsibility, outlining that private/public partnerships provide a vehicle for responding to emerging health issues and accelerating research into practice. He cites the FDA's use of accredited continuing education to deliver prescriber education for opioid abuse and the agency is considering other opportunities for collaboration. Providing value is important, and Dr. McMahon calls upon the CME system to highlight "educational deserts" in which important public health issues are receiving inadequate attention.

Describing continuing education accreditors, Dr. McMahon calls them "service organizations," highlighting their mission to reflect and meet the public's needs and maintain the integrity of the system for educational providers and their learners. Accreditors have a role in promoting engagement among stakeholders, such as ACCME's proposed menu of Accreditation with Commendation Criteria. It is designed to respond to emerging issues and award commendation status to CME programs that address the integration of health data, interprofessional collaborative practice, individualized learning activities, CME research, and higher levels of outcomes measurement.

Concluding his article, Dr. McMahon states: "Effective CME programs have the capacity to help physicians and healthcare teams learn how to improve practice and patient care; how to intervene in health behaviors, social and economic factors, and the public's physical environment; and how to improve the health of the nation." Ultimately, this will meaningfully improve health, but it demands the cooperation of educators, health system leaders, and engaged learners.

We are perhaps in the "Golden Age" of CME with the emphasis on education focused on improved patient outcomes and tremendous innovation in the delivery of educational content. It is encouraging that the ACCME along with other stakeholders are speaking up about the tremendous activities that CME providers are producing. It is essential that the contribution that CME makes towards improving healthcare here and around the world is publicized, and it is promising that JAMA and other journals are beginning to take notice.

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