CME Accreditation

Abstract

To The Editor: Medical progress—as with all advances—moves forward by communication of ideas, comments, suggestions and constructive criticism. James Breeling's contributions to continuing medical education are well-known and his observations in the December, 1987 Chest are valuable in bringing the attention of your readers to the present state of continuing medical education quality assurance. While true at one time, some of his statements no longer reflect the operation of the Accreditation Council for Continuing Medical Education (ACCME) review and approval process. This illustrates the dynamic activity of the ACCME in response to concerns of representatives of the organizations named in the editorial, plus other members of the Council representing the general public and federal establishment. Changes have been made in the review and accreditation process since the founding of the ACCME in 1980, which incorporated the Liaison Committee on Continuing Medical Education material relating to national and state sponsors. Bylaws were approved by the parent organizations in 1980, as were “Essentials” in 1981 and 1982, along with “Guidelines” developed by the Continuing Medical Education Advisory Committee of the American Medical Association's Council on Medical Education. Initial applications for accreditation are evaluated by on-site visit teams, at the time of a CME offering. While Mr. Breeling is correct in his observation that some members of the Accreditation and Review Committee (ARC) may have exhibited various biases (sites, management style, categories, etc) in the past, continued refinement of the selection and indoctrination process promises to eliminate most (if not all) questions unrelated to the “Essentials”. This will not preclude close questioning to assure the review committee that the applicant is in compliance with all seven essentials. Within the past year, ACCME has instituted procedures to insure that all reviewers are informed, that questions and recommendations are based on the “Essentials”, and that representatives of the reviewed organizations leave the reverse site visit feeling helped rather than harassed. Further, the ACCME's certificate of accreditation no longer mentions credits, and a monitoring process of the ARC is now in place to assure that Council deliberations and decisions are based on a just, fair and equitable review process with Council oversight at each step in the accreditation pathway. As Mr. Breeling points out, all of the materials submitted by an organization seeking accreditation or reaccreditation are available at each Council meeting; you may be assured that these materials are used and closely examined by the Council whenever necessary. The recommendations of the ARC are contained in the agenda book sent to every Council member to study before each meeting; these are presented individually by the Chairman of the ARC for discussion and vote, with abstention by members of the Council who may have a real or perceived conflict of interest in a particular case. The Monitoring Committee, established in 1987, reports to the Council on its findings of the activities of the ARC, with questions and comments from Council members before acceptance of that report. Other measures which have been instituted in the recent past include: 1) adoption of a standard four-year term of accreditation, with up to two additional years for exceptional excellence. 2) procedures for reconsideration and appeal of adverse accreditation decisions; 3) procedures for handling complaints regarding accredited programs; 4) guidelines for commercial support of CME; and 5) guidelines for producers of enduring educational materials, including sponsors whose sole products are such materials. As changes in the field of CME occur, they will be addressed by the ACCME and its parent bodies, as necessary. In a few short years of its existence, having just completed the first full cycle of review of all applicants, ACCME has demonstrated its ability to function as a responsible organization, which is dedicated to abiding by its Bylaws, with particular attention to Article II—Purposes and Functions: “review periodically its role in continuing medical education to insure it remains responsive to public and professional needs.” It's apparent that the process is working, not only through the ACCME and its committee structure, but through editorials by Mr. Breeling and this opportunity to respond to his comments.