International CME: European Accreditation Council of Continuing Medical Education Conference Highlights New Accreditation Requirements

 

The Journal of European Continuing Medical Education recently published a recap of this year’s “Union Européenne des Médecins Spécialistes” (UEMS) Conference on continuing medical education (CME) in Europe. We have provided highlights from the conference report, written by Julie Simper, below.

As a background, the UEMS established the European Accreditation Council for Continuing Medical Education (EACCME) in 2000 to ensure international mutual recognition of quality assessments of CME activities throughout Europe. As we have seen in the United States, CME has evolved in many ways since 2000. The Journal notes that “[p]articipation in CME and formal registration of CME activities has become common and in many countries obligatory.” Furthermore, not only has the actual delivery method of education shifted in many cases to online platforms, but we have seen a strong movement to ensure independent and bias-free speaker programs, and to increase transparency regarding the role of commercial interests.

With these trends in mind, the UEMS-EACCME in October 2011 implemented criteria for the accreditation of e-learning materials. The next year, they adopted a substantially revised set of criteria for the accreditation of live educational events (LEEs). This revised policy went into effect for all applications made after January 1, 2013. In February of 2014, the UEMS-EACCME convened in Brussels, Belgium to discuss the current CME landscape.

The UEMS Conference highlighted three aspects of CME in Europe in particular:

• The role of accreditation in continuing medical education and professional development, with a focus on EACCME accreditation as a means of assuring the quality of CME-CPD in Europe.
• The UEMS-EACCME’s accreditation process.
• Implementation of the new criteria for the accreditation of LEEs.

Implementation of the new criteria for the accreditation of LEEs

Dr. Borman, UEMS Secretary General began by categorizing the accreditation changes as an “evolutionary revolution” characterized by increasing emphasis on the quality of CME-CPD, attention to outcomes, focus on the learner, and need for greater transparency and accountability throughout. Dr. Borman also reiterated a key theme of the conference which was the move toward greater cooperation amongst stakeholders, while still recognizing the importance of maintaining clearly demarcated boundaries between the groups.

According to the Journal report, “[o]f great interest to the audience were the statistics from the past year of EACCME applications. Data showed a 22% decrease in the number of new applications submitted in 2013 (1451) compared to 2012 (1871). Dr Borman indicated that this was an anticipated decrease and that by the end of February 2014, the number of applications compared to the same time last year was already up 31%. This increase 1 year later seems to indicate that providers are now getting used to the new criteria and application procedure.”

Dr. Borman also walked through the accreditation process with some notes for CME companies:

• It is strongly recommended to apply at least 14 weeks prior to the LEE start date; all information and payment must be received by the EACCME no later than the official 12 week deadline.
• An application amendment process exists whereby at any time during the review period the EACCME may ask for additional information from the provider, who then has 1 week to submit the requested material.
• Declare the total number of expected participants, both physician and non-physician; this number may not be reduced after application and providers are required to report actual attendance after the event.
• Signed conflict of interest forms must be submitted with the application for members of both the scientific and organizing committees; providers must demonstrate how actual conflicts have been resolved.
• All sponsorship and advertising components must be clearly separated from the scientific and educational elements of the event (for example, no company names, logos, or product information in the program, separation of the exhibitor listing, etc.).
• All industry funding must be declared and documented for transparency purposes.
• Events provided by the pharmaceutical and medical equipment industry will not be considered for accreditation.
• Until accreditation is received, the UEMS logo may not be used and the only approved wording in promotional materials is “An application has been made to the UEMS-EACCME for CME accreditation of this event.”

How has the new criteria affected providers?

Several providers who submitted applications to the EACCME in 2013 were invited to comment on their experiences implementing the new criteria. Speakers represented a wide range of provider types and brought expertise in organizing both live and online international CME-CPD. The Journal of European CME noted that many of the providers expressed similar views and experiences:

Professionalization of the provider role, including a commitment to providing high quality CME-CPD that contributes to improved patient care and a desire to fully satisfy the revised criteria and comply with all related guidelines. Providers also noted the importance of the provider to “translate” the criteria from concepts to practice.

The new criteria has required providers to expend additional resources to ensure compliance. Providers have had to create or modify procedures and policies, which has led to an increase in planning and accreditation fees.

Furthermore, there have been practical implementation challenges. The accreditation deadline of minimum 12 weeks has been “extremely challenging, if not impossible for some planning timelines,” the report notes. Delays in accreditation decisions are hindering timely organizational planning. Providers also noted that where and how to acknowledge company support is unclear in many circumstances—the report spoke to the paradox of balancing “transparency” with “advertising.” The disclosure and management of potential conflicts of interest has also been challenging for larger events with hundreds of faculty.

The providers state that variation and subjectivity amongst UEMS-EACCME reviewers on how the criteria are to be actually implemented has been a challenge. They also noted that there remains significant need for additional support, guidance, and more timely responses.

How has the new criteria affected funders?

Panelists from industry explained how they were interested in supporting well-designed educational initiatives that address identified gaps in physician competence, performance, or patient outcomes. The speakers described how many of the elements of a grant request mirror the various accreditation criteria, especially the focus on achieving measurable and improved outcomes. Maureen Doyle-Scharff of Pfizer said she believed that the educational standards set by the pharmaceutical industry’s grant systems exceeded those of the accrediting bodies. The companies also touched on challenges around the international implementation of transparency initiatives internationally.

Global Trends in Continuing Medical Education

Dr. Len Harvey, UEMS Honorary President described his recently updated UEMS survey which aims to provide a profile of CME-CPD in 29 European Union/EEA Member States, Armenia, Israel, Turkey, Canada, and the USA. The survey began in December 2013 and final results are expected for the end of 2014. Dr. Harvey presented initial data outlining the following trends and statistics in CME-CPD.

Dr. Harvey noted that CME-CPD is becoming increasingly mandatory. Now, 21 countries now have obligatory systems (either professional or legal), while 13 still have voluntary structures (but even in these, CME is actively supported). CME credits are also key to fulfilling national requirements and European CME credits help physicians collect their CME-CPD credits—28 countries have cycles averaging 3–7 years with an average minimum requirement of 40 credits annually. There is an increasing variety of activities approved for credit as well. The report notes that recognized formats in the surveyed countries vary with live education remaining the most prominent, with personal learning, internet study, lecturing and publishing activities gaining ground.  

There has also be a gradual implementation of sanctions promoting engagement. Sixteen countries have no sanctions for failure to engage in CME-CPD activities; 18 have sanctions that include reminders, financial measures, disciplinary measures, or loss of license.

Dr. Harvey found that CME-CPD is most often financed by the individual physician and/or employer—in 29 countries it is financed directly by the individual doctors.

U.S. Perspective

UEMS and American Medical Association Collaboration

Dr. Alejandro Aparicio, Director, Division of Continuing Physician Professional Development at the American Medical Association (AMA) described how after several years exploring the idea of a transatlantic collaboration in CME, the UEMS-EACCME and the AMA began a pilot program in June 2000 of “mutual recognition” of credit points awarded for participation in live educational events. “Based on the success of the pilot,” the Journal states, “in June 2006 the agreement status was changed from pilot to an on-going arrangement, reviewed and renewed every 4 years.” The Journal notes that “[t]he landmark agreement was amended in 2010 to also include recognition of credits awarded for participation in e-learning activities.”

Accreditation Council for Continuing Medical Education

Dr. Murray Kopelow, president and CEO of the ACCME, spoke to his organization’s accreditation system and how it differs from the other nationally established CME accreditors like the American Academy of Family Physicians (AAFP) and the American Osteopathic Association (AOA). The ACCME accreditation requirements, for one, are provider-based, wherein the AMA allows organizations accredited by the ACCME to designate individual activities for AMA PRA Category 1 Credit. “Through the ACCME’s network of directly accredited providers and recognized state medical societies, approximately 130,000 CME activities were produced by providers accredited in the ACCME system in 2012,” the conference report notes.

Dr. Kopelow stated that accredited CME is accountable to the public for presenting clinical content that supports safe and effective patient care. He outlined the fundamentals of the ACCME system: content driven by professional needs, not funding (20% of ACCME accredited CME activities are commercially supported– ACCME’s 2013 Annual Report); resolution and disclosure of relationships with industry; and CME that is truthful, evidence-based, and “by the profession, for the profession.”

For our coverage of ACCME’s Conflict of Interest procedures, click here.

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Dr. Borman concluded the conference by reiterating the need for self-regulation of European CME-CPD and the commitment to the participants’ shared goal of improving patient care by providing high-quality, accredited educational initiatives.

For the full conference report click here. Thanks to the Journal of European CME for their thorough outline.