Simplification of the CME Process, Part I

By Erin Schwarz

Editor’s Note: Mitsuo Tomita, MD, is a retired family practice physician from the San Diego area with an extensive record of support for nonprofit organizations, including serving for over 10 years as a surveyor for the Institute for Medical Quality (IMQ), a division of the California Medical Association (CMA), California’s state CME accreditor.

The following is the first of three parts in a series regarding simplification in the CME process. Tomita has been saddened to see providers in California give up their accreditation because they perceive that the administrative burden of CME is too great. He believes that many providers make the administrative job overly complicated.

In this article, Tomita provides some strategies that, based on his experience, might be useful for providers to review. Tomita provides personal recommendation for things such as using objectives or goal statements for Criterion 3, or which set of physician competencies to reference, etc., which would not be technically “incorrect” but do not represent the “only” or “required” way to meet the ACCME’s expectations.

The ACCME website has additional examples in the Compliance Library. As the ACCME notes, “these are examples only, not prescribed practices; nor do they represent a list of options from which providers must choose. Each example in and of itself may not necessarily describe all practices that are required to meet compliance, but rather evidence of practices that contributed to compliance or noncompliance findings.”

By writing this article, Tomita hopes to dispel some of the misunderstandings and myths that accompany the administrative process for CME so that providers may focus on planning education that is meaningful and useful for physicians.

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of the Alliance.

Simplification of the CME Process, Part I

By Mitsuo Tomita, MD

I have been an IMQ CME Surveyor for over a decade and would like to share my suggestions to make the CME paperwork and process simpler.

These are my personal suggestions, not those of the IMQ/CMA.

Criterion 1

Mission Statement. A CME program’s “mission statement” needs to simply indicate that the purpose of your overall CME program is to change “competence” (i.e., ability, and/or physician performance and/or patient care outcomes). It is difficult to demonstrate changes in patient care outcomes, and it is not necessary to include that in your “mission statement,” but it is something we hope is accomplished by having a robust CME program.

Examples: “The purpose of our CME program is to provide CME activities designed to change our physician’s abilities or practice in an effort to improve patient care.”

“The expected results of our CME program are for our physicians to apply new knowledge and skills to improve patient care.

Criterion 2

For each CME activity, there needs to be an explanation as to why it is being done (i.e., based on the “professional performance gaps” (PPGs) of your learners). The PPG or PPGs can be from many sources, such as recommendations from hospital committees or departments, recent articles in the news or professional journals, suggestions from members, etc. The relevance of the topic can be confirmed by such means as soliciting verification from local department chiefs, members of your staff or by your planning committee, which consists of physician peers representing the learners. The CME planners are to “deduce” if there is an underlying deficit in knowledge, competence (ability) or performance that may be the basis for the PPG. One can simply deduce that it is a lack of knowledge.

Example #1:

“The Infectious Disease Committee recommended we have an educational activity on [insert topic] since there have been recent reports which may pose a public health problem.”

Example #2:

Hepatitis C is a common cause of liver-related deaths and transplants. The chief of internal medicine confirmed that our physicians need to know about hepatitis C diagnosis and treatment in order to prevent liver-related mortality.

Example #3:

Dr. X, who serves on the county disaster preparedness committee, recommended an educational activity on disaster planning because our staff should be knowledgeable and prepared for a disaster. He recommends Dr. Z as faculty since he is the director of [insert here] (no need for CVs of faculty).

Example #4

There are constant advances in infectious diseases. To keep our staff knowledgeable and able to recognize and manage various infectious diseases, our chief of infectious diseases will plan specific topics for our annual conference.

Example #5

Our head of human resources recommends an educational activity on sexual harassment in the workplace since it is important for our physicians to be aware of what may be construed as sexual harassment.

Example #6

Grand Rounds: The selection of cases to present at the start of grand rounds are based on the department chief’s selection with lecture and faculty selection based on expertise and current medical literature and designed to keep attendees current on advances in medical knowledge and its application in practice.

Example #7

Tumor Board: Current cancer cases that are challenges to our physicians will be presented to discuss and determine best course of management utilizing the shared knowledge and experience of various physicians.

Example #8:

Case Conference: Review of recent or current specialty cases that presented challenges in diagnosis or management provides the opportunity to determine the best course of care.

Example #9:

M&M Conference: The review of recent cases provides the opportunity to improve care in order to prevent deaths and complications.

Example #10:

Journal Club: By analysis and discussion of recently published relevant journal articles, provide the opportunity to consider application of new knowledge to improve practice.

Example #11:

Committee CME: The purpose of the monthly Bioethics Committee meetings are to review and discuss recent cases in order for the committee members to gain knowledge that can be applied to future cases.

Criterion 3

For each CME activity, you need to state one or more goals described in terms of what you hope learners will be able to do or possibly actual changes in practice (or changes in patient care if that is part of your mission statement). This may complete the sentence: “Upon completion of this activity, attendees should be able to (advise, assess, determine, diagnose, distinguish between, evaluate, explain, formulate, identify, interpret, manage, monitor, perform, recognize, recommend, refer, screen for, select, treat, utilize, etc.) … Or the objective may be stated like: “The goal of this activity is to reduce nosocomial infections,” and evaluation could be by monitoring nosocomial infection rates.

Criterion 5

C5 asks you to note the format chosen for the activity and why it was appropriate. The word “format” is used in two ways in CME. Here it refers to the method utilized for a CME activity that is usually based on the available space and facilities, time, cost, equipment, intended audience, faculty and desired results. For example, to learn skills, a hands-on workshop may be necessary instead of a lecture. “Format” is also referenced in the AMA’s learning format” that must be included in the AMA Credit Designation Statement.

Example #1

Grand Rounds: Case presentation and lecture with questions and answers and discussion allows most efficient use of time and space for dissemination of practical information.

Example #2:

Tumor Board, M&M, Case Conferences: Formal case presentations and discussion allows for thoughtful in-put based on the experience and knowledge of multiple physician specialists, providing practical and relevant shared learnings.

Example #3:

Journal Club: Prior reading of selected articles helps prepare attendees for thoughtful discussion with colleagues and consideration of application of learnings into practice.

Criterion 6

I suggest just using the six ABMS/ACGME Core Competencies since the original intent was to link CME to ABMS Maintenance of Certification. There is no need to use the IOM’s physician attributes.

  1. Patient Care and Procedural Skills – that are compassionate, appropriate and effective for the treatment of health problems and the promotion of health.
  2. Medical Knowledge – about established and evolving biomedical, clinical and cognate (e.g., epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.
  3. Practice-based Learning and Improvement – that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care.
  4. Interpersonal and Communication Skills – that result in effective information exchange and teaming with patients, their families and other health professionals.
  5. Professionalism – as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population.
  6. Systems-based Practice – as manifested by actions that demonstrate an awareness of the responsiveness to the larger context and system for health care and the ability to effectively call on system resources to provide care that is of optimal value.
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