Life Science Compliance Update

April 14, 2016

NEJM: What Do I Need to Learn Today – The Evolution of CME

Graham McMahon, MD, MMSc, the President and CEO of the Accreditation Council for Continuing Medical Education, has written an article for the New England Journal of Medicine about the evolution of continuing medical education (CME). The article, "What Do I Need to Learn Today? – The Evolution of CME," asks for clinicians, educators, healthcare institutions, and regulators to contribute to the continuing transformation of CME.  He also suggests that CME be included as a significant asset for regulatory efforts such as MOC and the Merit-Based Incentive Payments System.

Dr. McMahon stated that such a continued transformation will serve to "expand the opportunities for educational innovation that improves physician practice and ultimately benefits patient care and the health of our country." To help the transformation, Dr. McMahon recommends that clinicians become more aware of their individual strengths and weaknesses and choose CME activities that can help them grow and become better clinicians.

In order to meet the learning needs of clinicians in today's healthcare environment, it is imperative for educators to design CME activities that focus on the learners, rather than the teachers, and incorporate opportunities for interaction and reflection. Interprofessional continuing education (IPCE) gives physicians the opportunity to build the competencies needed for team-based practice. Patients should be active in their care and should be viewed as part of the healthcare team; including patients as CME speakers can work to engage physicians' hearts as well as their minds.

Part of the problem today, as outlined in the article by Dr. McMahon, is that information is "ubiquitous," meaning that the simple exchange of information has little value, and that in order to truly learn and understand something, shared wisdom and the opportunity to engage in practice-relevant problem solving is crucial. Dr. McMahon realizes that once physicians see and understand that they are actively (and actually!) learning, they embrace future activities that allow them that same learning opportunity.

As stated by Dr. McMahon,

Education that's inadequate, inefficient, or ineffective, particularly when participation is driven by mandates, irritates physicians who are forced to revert to "box-checking" behavior that's antithetical to durable, useful learning.

It is important that going forward, regulators begin to focus on educational outcomes, not the process, and work to create other conditions that maximize flexibility and innovation in CME. The ACCME's collaboration with the American Board of Internal Medicine (ABIM) to simplify the integration of Maintenance of Certification (MOC) and CME, is an example of regulatory authorities working together to reduce the burden placed on physicians, helping to promote lifelong learning.

Dr. McMahon also points out that "If more regulatory authorities recognize the value of education in driving clinical practice and quality improvement and allow educational activities to count for multiple requirements, they can reduce the burden on physicians and promote lifelong learning. For example, participation in CME could be designated as a method for meeting the clinical practice improvement expectations of Medicare’s new Merit-Based Incentive Payment System."

Each year, the accredited CME community collectively provides nearly 150,000 activities. Accredited CME activities are required to be evidence-based and free of any commercial bias or influence. The more involved healthcare leaders, educators, and learners, become in the process, the more CME can do to promote performance, quality improvement, collegiality, and public health.

November 16, 2015

ACCME: Accreditation Rules Safeguard Continuing Medical Education from Commercial Influence

Continuing medical education courses have been under attack lately, with skeptical writers making unsubstantiated claims that CME courses have "become a key marketing tool for increasing clinician receptivity to new products." Those writers make bold claims, but are unable to back their claims up with concrete evidence.

Graham T. McMahon, a physician and the president of the Accreditation Council for Continuing Medical Education (ACCME), has been working diligently to set some of these unsupported claims straight, reminding medical professionals and others that organizations such as the ACCME exist to "set and monitor the standards that, among other goals, ensure that educational programs offered by organizations that we accredit are independent and free of commercial bias."

Dr. McMahon continues to reiterate that promotion and marketing do not have a place in accredited CME courses. Accredited education is designed to offer physicians and health care teams a space to learn, teach, discuss emerging science, and debate ethical or controversial issues without any commercial influence. Non-accredited CME does exist, however, and Dr. McMahon cannot speak to the rigorous standards that might be applied to those courses, but states that if the authors making allegations against CME courses are referring to non-accredited CME being infiltrated with marketing tactics, then they should specify that and not apply such a broad brush against all CME courses.

The authors of the most recent article, including Adriane Fugh-Bermann, a known CME critic and director of PharmedOut, suggest that providers of CME activities have allowed commercial support to include marketing messages to increase awareness and understanding of hypoactive sexual desire disorder, and implies that the ACCME Standards for Commercial Support are either inadequate or ignored by accredited organizations. The authors, however, do not provide any support or evidence of actual courses that have been given accreditation with such "marketing messages."

As we have previously written, the standards that accredited CME courses must follow cover a wide range of topics including "independence from commercial interests; resolution of any personal conflicts of interest; appropriate use of commercial support; and content and format without commercial bias." A course will not be accredited if it does not follow the standards required by the ACCME.

Dr. McMahon reviewed the ten key points the critical authors presented as being "marketing messages," and concluded that all ten points appeared to be "appropriate elements to describe the epidemiology, diagnosis, and impact of an established disorder on affected patients," not "marketing messages" as were alleged.

Dr. McMahon reminds readers that two important functions of accredited CME courses are to both "creat[e] awareness of newly identified diseases and facilitat[e] the translation of new research into practice." He continues on to state that physicians and health care teams need evidence-based disease-awareness education so they can learn how to efficiently and quickly respond to public health priorities, and know how to diagnose and treat their patients appropriately.

In addition to the strict rules the ACCME has in place regarding the management of funds and conflicts of interests for CME providers, the activities of CME providers are subject to routine audit by the ACCME. These audits are performed on a randomized basis and Dr. McMahon also highlighted the fact that only 11% of accredited CME providers receive commercial support.

Dr. McMahon ended his written response by reminding everyone that accredited CME is part of the solution to the health needs of our country, "there is considerable evidence to show that accredited CME has a positive impact on physicians' ability to deliver high-quality care, and is one of the key resources that enables physicians and teams to deliver safe, ethical, effective, cost-efficient, and compassionate care that is based on best practice and evidence – and not on promotion."

Confirming Dr. McMahon's position is a synthesis of systematic reviews, done earlier in 2015 and focused on the impact of CME on physician performance and patient health outcomes. That synthesis identified eight systematic reviews of CME effectiveness published beginning in 2003. Five of the eight reviews directly addressed the question of "Is CME Effective?" by using primary studies that employed randomized controlled trials or experimental design methods, and concluded that CME courses and requirements do improve both physician performance and patient health outcomes.

August 14, 2015

ABIM and ACCME Announce Collaboration in Support of Physician Lifelong Learning

  Accme logoAccme logo

On August 12, the American Board of Internal Medicine (ABIM) and the Accreditation Council for Continuing Medical Education (ACCME) announced a collaboration to support physicians who are engaged in lifelong learning by enabling them to use those activities to satisfy requirements for ABIM’s Maintenance of Certification (MOC) program.

“This collaboration will expand the options available to physicians to receive MOC credit and will enable continuing medical education (CME) providers to offer more lifelong learning options with MOC credit to internists and subspecialists,” according to a new press release from ACCME and ABIM.  This also means a more streamlined process for accredited CME providers—ABIM will no longer require them to submit applications for activity approval and peer review to ABIM. Instead, accredited CME providers will be able to use one unified shared system to record information about CME and ABIM MOC activities. Importantly, this system will help lower the burden on CME providers who wish to register activities for MOC credit. 

View ABIM's medical knowledge assessment recognition program here

“All accredited CME providers in the ACCME system already use the ACCME Program and Activity Reporting System (PARS) to enter data about each of their CME activities,” ACCME states. “With this collaboration, CME providers will also be able to use PARS to register activities for ABIM MOC. As part of this registration process, providers can attest to compliance with ABIM-specific requirements for the Medical Knowledge Assessment Recognition Program and submit learner data.”

ABIM and ACCME will begin testing the technology later this month, and they expect to have the process open for accredited CME providers that meet standards set by ABIM by the end of 2015. The ACCME will maintain a list of activities that have met ABIM requirements and are registered for MOC credit. ACCME states that this list will be publicly available on their website, “providing a one-stop resource for ABIM diplomates seeking to earn ABIM MOC credits by participating in accredited CME.” Data verifying that diplomates have completed the activity will be communicated through PARS to ABIM.

This collaboration offers additional choices for CME providers and internists without adding any new ACCME requirements. “While ABIM already offers more than 300 medical knowledge options to physicians engaged in MOC, our diplomates have asked for a more streamlined process to enable them to more seamlessly combine their ongoing educational activities with MOC requirements,” said Richard J. Baron MD, President and CEO of ABIM. “By collaborating with ACCME, ABIM will open the door to even more options for physicians engaged in MOC and will allow them to get MOC credit for high-quality CME activities they are already doing.”

Under the new system, diplomates will have the option to pursue CME activities that have been registered for MOC credit, while ACCME providers have the option—but are not required—to offer accredited CME that meets ABIM MOC requirements and to submit activity and learner data through PARS to ABIM, states the announcement. 

Graham McMahon, MD, MMSc, President and CEO of the ACCME stated:

“The ACCME has long supported the goals of MOC and the alignment of accredited CME and MOC. We share a common mission to facilitate the continuing professional development of physicians. We celebrate this collaboration because it will make a real and meaningful difference to physicians and educators who are working every day to improve healthcare in their communities. This collaboration will generate many more opportunities for accredited CME providers to serve as a strategic resource by delivering relevant, effective, independent, practice-based education that counts for MOC. I look forward to working together with ABIM, our community of accredited CME providers, and our community of diplomates to leverage the power of education to drive quality in our medical profession and improve care for the patients we serve."

MOC Update

In another big change, ABIM is reversing its policy requiring physicians who have passed their initial Certification exam in 2014 or later to have enrolled in the MOC process in order to be listed as board certified. Effective immediately, physicians who are meeting all other programmatic requirements will not lose certification simply for failure to enroll in MOC.

The American College of Cardiology wrote that earlier this year, ACC leadership was made aware that ABIM had sent emails to early career cardiologists who had passed the Cardiovascular Disease Certification Exam in 2014. The email informed them of the need to enroll in MOC by March 31, 2015, in order to be publicly reported as certified in Cardiovascular Disease, and also that their certification would remain valid only as long as they were participating in MOC. “Concerned about the implications of this new process, ACC leadership engaged ABIM leaders immediately, encouraging them to level the playing field for all diplomats,” the College wrote. “The current policy reversal that affects all recent ABIM diplomats, not only cardiologists, is a direct result of ACC intervention.”

"By tying together board certification and enrollment in Maintenance of Certification, the American Board of Internal Medicine appeared to devalue the secure examination passed by recently certified physicians, by setting different standards for them compared to those certified in previous years. The ABIM should be commended for recognizing the negative impact of this policy on current and future employment opportunities, particularly for those in the early stages of their careers, and taking the steps necessary to reverse it," said ACC President Kim Allan Williams, Sr., MD, FACC.

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