Continuing Medical Education Providers Research Articles

Tips and Tricks: Starting Your Own Continuing Medical Education Course

Tips and Tricks: Starting Your Own Continuing Medical Education Course

Challenges and opportunities for general practice specific CME in Europe – a narrative review of seven countries

BackgroundSeveral changes have led to general practitioners (GPs) working in a more differentiated setting today and being supported by other health professions. As practice changes, primary care specific continuing medical education (CME) may also need to adapt. By comparing different primary care specific CME approaches for GPs across Europe, we aim at identifying challenges and opportunities for future development.MethodsNarrative review assessing, analysing and comparing CME programs for general practitioners across different north-western European countries (UK, Norway, the Netherlands, Belgium (Flanders), Germany, Switzerland, and France). Templates containing detailed items across seven dimensions of country-specific CME were developed and used. These dimensions are role of primary care within the health system, legal regulations regarding CME, published aims of CME, actual content of CME, operationalisation, funding and sponsorship, and evaluation.ResultsGeneral practice specific CME in the countries under consideration are presented and comparatively analysed based on the dimensions defined in advance. This shows that each of the countries examined has different strengths and weaknesses. A clear pioneer cannot be identified. Nevertheless, numerous impulses for optimising future GP training systems can be derived from the examples presented.ConclusionsIndependent of country specific CME programs several fields of potential action were identified: the development of curriculum objectives for GPs, the promotion of innovative teaching and learning formats, the use of synergies in specialist GP training and CME, the creation of accessible yet comprehensive learning platforms, the establishment of clear rules for sponsorship, the development of new financing models, the promotion of fair competition between CME providers, and scientifically based evaluation.

What Influences Choice of Continuing Medical Education Modalities and Providers? A National Survey of U.S. Physicians, Nurse Practitioners, and Physician Assistants.

To explore what influences clinicians in selecting continuing medical education (CME) activities in the United States. In August 2018, the authors conducted an Internet-based national survey, sampling 100 respondents from each of 5 groups: family medicine physicians, internal medicine and hospitalist physicians, medicine specialist physicians, nurse practitioners, and physician assistants. In total, 1,895 clinicians were invited and 500 (26%) responded. Questions addressed the selection and anticipated use of CME delivery modalities and perceived characteristics of specific CME providers. Response formats used best-worst scaling or 5-point ordinal response options. The factors identified as most important in selecting CME activities were topic (best-worst scaling net positivity 0.54), quality of content (0.51), availability of CME credit (0.43), and clinical practice focus (0.41), while referral frequency (-0.57) ranked lowest. The activities that the respondents anticipated using most in the future were live (mean 3.8 [1 = not likely, 5 = very likely]), online (mean 3.5), point-of-care (mean 3.5), and print-based (mean 3.5) activities. For online CME, the features of greatest appeal were that learning could be done when clinicians had time (mean 4.4), at their own pace (mean 4.2), and at lower cost (mean 4.2). For live CME, the features of greatest appeal were that the subject was best taught using this modality (mean 4.0), or the activity was located in a destination spot (mean 4.0) or a regional location (mean 3.9). When rating specific CME providers, most academic institutions received relatively high ratings for research focus and clinical practice focus, whereas commercial providers had slightly higher ratings for ease of access. Responses were generally similar across clinician types and age groups. Physicians, nurse practitioners, and physician assistants are interested in using a variety of CME delivery modalities. Appealing features of online and live CME were different.

Commercial Interests in Continuing Medical Education: Where Do Electronic Health Record Vendors Fit?

The Accreditation Council for Continuing Medical Education (ACCME) will not accredit an organization that it defines as a commercial interest, that is an entity that produces, markets, resells, or distributes health care goods or services consumed by, or used on, patients. Thus, commercial interests are not eligible to be accredited organizations offering continuing medical education (CME) credit to physicians. This decision is based on the concern that commercial interests may use CME events to market their products or services to physicians, who then might inappropriately prescribe or administer those products or services to patients. Studies have shown that CME events supported by pharmaceutical companies, for example, have influenced physicians' prescribing behaviors.Currently, however, the ACCME does not recognize electronic health record (EHR) vendors, which are part of a multi-billion-dollar business, as commercial interests, and it accredits them to provide or directly influence CME events. Like pharmaceutical company-sponsored CME events, EHR vendor activities, which inherently only focus on use of the sponsoring vendor's EHR system despite its potential intrinsic limitations, can lead to physician reciprocity. Such events also may inappropriately influence EHR system purchases, upgrades, and implementation decisions. These actions can negatively influence patient safety and care. Thus, the authors of this Perspective call on the ACCME to recognize EHR vendors as commercial interests and remove them from the list of accredited CME providers.

Response: Re: Marketing Messages in Continuing Medical Education (CME) Modules on Binge-Eating Disorder (BED)

To the Editor: No one disputes that drug companies provide educational grants for continuing medical education (CME); as the largest CME provider in the country, Medscape receives substantial funds from industry. In this case, all 3 Medscape activities[1][1][⇓][2]–[3][3] were funded by Shire.

Creating Effective and Efficient Pediatric-Specific CME Content: More than Just Checking a Box.

States dictate the type of continuing medical education (CME) required for licensing; however, CME providers are not mandated to create content relevant to all specialties. This often forces pediatricians to engage in educational activities that are irrelevant to their practice. This is contrary to what constitutes effective CME. The goal was to develop pediatric content using adult learning theory that aligns with effective CME principles while simultaneously satisfying state licensure requirements. A targeted needs assessment of pediatric providers revealed that pediatric-specific CME activities satisfying the state's requirement for pain management and end-of-life issues were lacking. Webinars adhering to adult learning principles were created in consultation with content experts. Five hundred ninety-seven learners across 30 states successfully completed the webinars and received CME credit. To satisfy ongoing state licensing requirements, 44% of learners had completed similar activities in the past, but 72% of those learners participated in activities focused on adult medicine due to the lack of available pediatric modules. Until states and regulators allow for more flexibility in satisfying licensing requirements, it will be incumbent on those who create CME to develop educational activities that satisfy state requirements while aligning with the principles of effective CME. With strategic planning, this is possible and will hopefully empower physicians to engage in CME without resorting to "checking a box."

Impractical CME programs: Influential parameters in Iran.

Background: Traditional approaches in Continuing Medical Education (CME) appear to be ineffective in any improvement of the patients’ care, reducing the medical errors, and/or altering physicians' behaviors. However, they are still executed by the CME providers, and are popular among the majority of the physicians. In this study, we aimed to explore the parameters involved in the degree of effectiveness of CME program in Iran. Methods: In this study, 31 participants, consisting of general practitioners, CME experts and providers were recruited to participate in in-depth interviews and field observations concerning experiences with CME. Application was made of the qualitative paradigm along with the qualitative content analysis, using grounded theory data analysis methodology (constant comparative analysis). Results: Based on the participants’ experiences, the insufficient consistency between the training program contents and the demands of GPs, in addition to the non-beneficiary programs for the physicians and the non-comprehensive educational designs, created a negative attitude to the continuing education among physicians. This could be defined by an unrealistic continuing education program, which is the main theme here. Conclusion: Impracticable continuing education has created a negative attitude toward the CME programs among physicians so much that they consider these programs less important, resulting in attending the said programs without any specific aim: they dodge absenteeism just to get the credit points. Evidently, promoting CME programs to improve the performance of the physicians requires factual needs assessment over and above adaptation of the contents to the physicians’ performance.

A Qualitative Evaluation of an Online Expert-Facilitated Course on Tobacco Dependence Treatment.

Qualitative evaluations of courses prove difficult due to low response rates. Online courses may permit the analysis of qualitative feedback provided by health care providers (HCPs) during and after the course is completed. This study describes the use of qualitative methods for an online continuing medical education (CME) course through the analysis of HCP feedback for the purpose of quality improvement. We used formative and summative feedback from HCPs about their self-reported experiences of completing an online expert-facilitated course on tobacco dependence treatment (the Training Enhancement in Applied Cessation Counselling and Health [TEACH] Project). Phenomenological, inductive, and deductive approaches were applied to develop themes. QSR NVivo 11 was used to analyze the themes derived from free-text comments and responses to open-ended questions. A total of 277 out of 287 participants (96.5%) completed the course evaluations and provided 690 comments focused on how to improve the program. Five themes emerged from the formative evaluations: overall quality, content, delivery method, support, and time. The majority of comments (22.6%) in the formative evaluation expressed satisfaction with overall course quality. Suggestions for improvement were mostly for course content and delivery method (20.4% and 17.8%, respectively). Five themes emerged from the summative evaluation: feedback related to learning objectives, interprofessional collaboration, future topics of relevance, overall modifications, and overall satisfaction. Comments on course content, website function, timing, and support were the identified areas for improvement. This study provides a model to evaluate the effectiveness of online educational interventions. Significantly, this constructive approach to evaluation allows CME providers to take rapid corrective action.

Dissemination of Evidence From Systematic Reviews Through Academic CME Providers: A Feasibility Study.

Although systematic reviews represent a source of best evidence to support clinical decision-making, reviews are underutilized by clinicians. Barriers include lack of awareness, familiarity, and access. Efforts to promote utilization have focused on reaching practicing clinicians, leaving unexplored the roles of continuing medical education (CME) directors and faculty in promoting systematic review use. This study explored the feasibility of working with CME directors and faculty for that purpose. A convenience sample of five academic CME directors and faculty agreed to participate in a feasibility study exploring use in CME courses of systematic reviews from the Agency for Healthcare Research and Quality (AHRQ-SRs). AHRQ-SR topics addressed the comparative effectiveness of health care options. Participants received access to AHRQ-SR reports, associated summary products, and instructional resources. The feasibility study used mixed methods to assess 1) implementation of courses incorporating SR evidence, 2) identification of facilitators and barriers to integration, and 3) acceptability to CME directors, faculty, and learners. Faculty implemented 14 CME courses of varying formats serving 1700 learners in urban, suburban, and rural settings. Facilitators included credibility, conciseness of messages, and availability of supporting materials; potential barriers included faculty unfamiliarity with SRs, challenges in maintaining review currency, and review scope. SR evidence and summary products proved acceptable to CME directors, course faculty, and learners by multiple measures. This study demonstrates the feasibility of approaches to use AHRQ-SRs in CME courses/programming. Further research is needed to demonstrate generalizability to other types of CME providers and other systemic reviews.

Use of Massive Online Open Courses as a Potential Resource to Provide Continuing Medical Education in Pakistan.

The Pakistan Medical and Dental Council (PM&DC) has made Continuing Medical Education (CME) mandatory for doctors, from 2015 onwards. Aminimum of 15 credit hours of CME per year for general practitioners and 30 credit hours for specialist doctors have been made mandatory for renewal of the PMDC registration. While doctors can attend conferences to earn this CME credit, the opportunities are minimum and limited to major cities across Pakistan. Webbased CME is an attractive alternative to attending conferences. It can make up for 25% of the yearly PMDC requirement. So far, only two web-based CME providers have been launched in Pakistan, which is a shortage. Could Massive Online Open Courses (MOOCs) be used to fill this shortage? The MOOCs are online courses that are easily accessible to all learners irrespective of geographical boundary and resources, and can be used as a tool to provide CME to physicians. The problem as to how credit from PM&DC can be obtained, will need to be explored further.

Using the CTC tool in establishing Mid-Levels of Expanded Outcomes Framework - A CME Provider Perspective

Existing gaps in the quality of healthcare have led to calls for change by Continuing Medical Education (CME) providers around the world to plan and implement continuing medical education activities based on improving physician competence and performance. This article offers the use of the commitment to practice change (CTC) tool at mid-levels of the expanded outcomes framework using post-only design, for inquiring and promoting physicians’ commitment to practice change, and for assessing the impact of the educational activity.

CME credit systems in three developing countries: China, India and Indonesia

Introduction. Two of the largest countries in the world, still developing nations, China and Indonesia, have now created national credit systems for continuing medical education (CME). A third, India, has tried but succeeded only on a state-by-state basis. This study tracks the development of CME/continuing professional development (CPD) credit systems in these three major Asian countries, analyses the related administrative backgrounds and points to strengths and weaknesses of each system in terms of serving the goals of CME/CPD in impacting medical care systems. Methods. The authors researched national- and state-level government records to identify legal and regulatory data affecting CME in China, India and Indonesia. Information on current and future activities was gained from media reports. Results. In all three countries, CME/CPD systems evaluate physician continuing competence by counting credits or credit hours. Central health authorities in China and Indonesia have established national systems applying to all health professionals. In Indonesia, CME/CPD is mandatory for re-licensure; in China, it is necessary for career advancement and re-registration. An effort to develop mandatory CME requirements in India, for physicians only, failed because the central agency underwent a major overhaul. Nevertheless, 9 of 28 states in India have developed systems, all tied to re-registration. Discussion. A comparison of systems in the three countries shows that little attention has been paid to physician performance improvement or improved patient health outcomes. Needs assessments and outcomes measures are not regularly carried out. We did not find any evidence of programmes to train administrators or faculty in CME/CPD principles, with the possible exception of Indonesia. Suggestions are offered to CME system leaders and providers to help their counterparts in developing nations.

Interdisciplinary CME: is the need evident? Results of the evaluation of CME articles in the Journal of the German Medical Association

Background. Medicine has become more and more specialised over the last decades, which in turn has increased the need for interdisciplinary information exchange. The aim of this study is to describe the extent of the need for interdisciplinary knowledge transfer in a contemporary medical specialist population. Methods. We analysed reading by medical specialty of 53 accredited continuing medical education (CME) articles published in Deutsches Ärzteblatt (“Journal of the German Medical Association”), which is available to all German physicians. Results. In all, 86,340 physicians participated 1,007,923 times by reading one or more of the 53 articles. In fewer than 50% of all cases, 89.5% of all participants read content belonging to their specialty (rated by self-assessment). The highest percentage of interdisciplinary use of print CME was found in the group of physicians working neither in ambulatory care nor in hospitals, that is, those physicians working in the public health area, with public authorities, etc. Linear regression analysis in the biggest group of specialists (internal medicine) showed a tendency for more interdisciplinary use in the group of younger participants, female physicians, and those working in ambulatory care. Conclusion. This study demonstrates a somewhat unexpectedly high interdisciplinary use of medical information from freely available CME articles. The extent of interdisciplinary use of information most probably reflects an individual need of similar magnitude. These findings should stimulate CME providers more often to plan interdisciplinary CME independent of the mode of presentation.

Keeping pace with New Frontiers in Pathology.

Keeping pace with New Frontiers in Pathology.

Setting CME standards in Europe: guiding principles for medical education

Objective:The requirement for formal Continuing Medical Education (CME) is growing in Europe with a concomitant focus on quality and independence of medical educational programmes, together with a need for measurable effects on patient outcomes. However, during this rapid evolution, it has become clear that there are misunderstandings and confusion amongst CME providers in relation to standard and regulations. To address this challenging situation, the Good CME Practice Group undertook an initiative to establish a set of standard core principles with a view to adoption by European CME providers and other key organisations involved in provision of CME programmes.Methods:The Good CME Practice Group developed four core principles relating to (a) appropriate education, (b) effective education, (c) fair balance and (d) transparency. In order to seek advice and input from peer groups and others involved in CME including accrediting bodies and medical societies, 93 representatives from these bodies were asked to complete a questionnaire and provide comments on the core principles. Participants for the consultation process were generated by a systematic search for European organisations with sections committed to medical education across all therapy areas and all key accrediting bodies. Following the consultation phases, the core principles were reviewed in light of responses and feedback and amended as appropriate.Results:The response rate amongst invited participants was 42% and similar across all groups with the exception of European medical societies. However, despite this limitation, there were significant levels of endorsement of the principles by all stakeholders with 90–95% recommending adoption of principles relating to appropriate education, fair balance and transparency. The principle relating to the measure of effective education was also highly endorsed with 89% of respondents recommending uptake. In response, however, to some questions relating to feasibility of implementation, the principle was revised accordingly. Overall, the stakeholders have recommended uptake of all core principles.Conclusions:The overall goal of the Good CME Practice Group is to guide how European CME providers contribute to improving public health outcomes by championing best practice in CME, maintaining and improving standards, mentoring and educating and working in collaboration with critical stakeholders. The significant endorsement of the four core principles has confirmed that this is a timely and well-received initiative that is aligned with the objectives of key organisations involved in provision of CME-accredited programmes. The Good CME Practice Group will continue to have dialogues with CME accreditation authorities, regulatory bodies and other key stakeholders in order to facilitate collaboration in improving standards across Europe.

Criteria for awarding CME credits to health physicians.

Credits have traditionally served as an incentive for physicians to participate in the continuing medical education (CME), which is the means for life-long learning. The public at large has granted special rights to the profession of medicine giving them their most precious commodity; their lives. The providers of CME have a responsibility to maintain and update physicians' knowledge and competency. 1 United States and Canada have been using continuing medical education credit to measure physician's participation in education for more than 50 years. It has been proven that engaging in lifelong learning would lead to a change in physician’s practice and improved patient care and outcomes.2 In this perspective, we have specifically defined the criteria for awarding CME credits to encourage practicing physicians in Pakistan and particularly within our University setting; as no system has yet been developed to measure and certify physician's participation in educational events. However, this could be replicated to award credits to other continuing professional development (CPD) activities. American Medical Association Physician's Recognition Award (AMA PRA), was emerged in 1968, in which live educational activities i.e. Category I was designated by accredited providers, whereas the rest five categories included various types of self-directed activities. In 1985, the AMA (PRA) was defined into categories 1 and 2 that made physicians fixed to attain 150 credit hours every 3 years with a minimum of 60 credit hours participation in Category I, i.e. live CME activities. The AMA and the Accreditation Council for Continuing Medical Education (ACCME) describes CME as 'educational activities that serve to maintain, develop, or enhance the knowledge, skills, and professional performance and relationships that a physician uses to provide services for patients, the public or the profession'.3 Ever since its beginning, credit for CME has been calculated by units of time and awarded in hourly increments, as traditionally CME is mainly lecture-based and could most easily be measured in hours. CME activities in and outside US are still based on one credit per 60 minutes academic activity and are a source to career advancement and salary differentials in some cases.4

Practice gaps in gastrointestinal and endoscopic surgery (2011): a report from the Society of Gastrointestinal and Endoscopic Surgeons (SAGES) Continuing Education Committee

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) [1] had its first scientific meeting in the 1980 s and has grown since to represent a worldwide community of over 6,000 surgeons and other health-care professionals who bring minimal access surgery, endoscopy, and emerging techniques to patients across the world. As part of its mission, SAGES has developed and implemented an overarching educational program to help its members improve outcomes for patients who require minimally invasive and endoscopic procedures. The program’s continuing medical education (CME) objectives are to assist surgeons in (1) improving knowledge of gastrointestinal and related diseases, (2) assessing current and emerging surgical therapies, (3) acquiring competence to perform and teach appropriate therapies, and (4) measuring effectiveness of therapies in terms of outcomes. The SAGES Annual Meeting has evolved into the major platform for CME activities and services offered by SAGES, with over 2,000 attendees. Teaching forums include scientific sessions, poster sessions, symposia, didactic postgraduate courses, and hands-on laboratory training sessions. In addition to the Annual Meeting, coendorsed programs and online educational materials through SAGES University [2] contribute to the comprehensive CME program provided by the society. The SAGES Continuing Education Committee is charged with maintaining compliance with Accreditation Council of Continuing Medical Education (ACCME) requirements overall and for individual CME programs. The ACCME accreditation process requires that ‘‘CME providers incorporate into CME activities the educational needs that underlie the professional practice gaps of their own learners’’ [3]. The ACCME also emphasizes that CME providers must show ‘‘that planning includes the identification of a professional practice gap from which needs were identified’’ [3]. SAGES identifies practice gaps through analysis of survey data collected at the Annual Meeting and at 3-month follow-up. Through this process a ‘‘Gaps Bank’’ has been created and maintained to inform the Executive Committee, Board of Governors, and program leaders about members’ self-identified learning needs as upcoming meeting topics are outlined. In addition, Session Chairs and speakers utilize the Gaps Bank when selecting and formulating specific didactic topics and associated learning objectives. This report summarizes the SAGES Continuing T. M. Farrell (&) Department of Surgery, University of North Carolina at Chapel Hill, CB 7081, Chapel Hill, NC 27599-7081, USA e-mail: tfarrell@med.unc.edu

Continuing Medical Education and Quality Improvement: A Match Made in Heaven?

Letters3 July 2012Continuing Medical Education and Quality Improvement: A Match Made in Heaven?Murray Kopelow, MD, MS (Comm)Murray Kopelow, MD, MS (Comm)From Accreditation Council for Continuing Medical Education, Chicago, IL 60654.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-157-1-201207030-00020 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We applaud Shojania and colleagues (1) for recognizing that the integration of continuing medical education (CME) and quality improvement (QI) offers the opportunity to improve the quality of health care overall. Their examples describe meaningful ways for CME providers to deliberately incorporate QI into their partnerships. We appreciate the recognition of best practices and the opportunity to learn and share effective strategies.Continuing medical education providers in the United States have been recognizing this correlation. The Accreditation Council for Continuing Medical Education (ACCME) released new requirements in 2006 (2) to reposition accredited CME as a strategic asset ...

European CME provider group raises concerns about policy statement from European Society of Cardiology

We have read with interest the above document and agree with the objectives and aspirations of continuing medical education (CME). However, some key issues have been raised regarding the provision of CME that we believe are inaccurate and do not refl ect the status and integrity of CME providers in Europe. (Published: 23 May 2012) DOI: 10.3109/21614083.2012.689269

Continuing Medical Education and Quality Improvement: A Match Made in Heaven?

New models of continuing medical education (CME) seek not only to impart knowledge but to change physicians' behavior and even play a role in facilitating organizational improvement. These CME models thus share some of the same basic goals as the field of quality improvement (QI), namely behavioral change and systems redesign to improve patient outcomes. This article provides some practical ideas about how CME providers and QI experts may beneficially integrate these 2 fields. It outlines several models for harnessing the existing engagement in traditional CME to achieve the goal of equipping practitioners with knowledge and skills related to QI, while also addressing the widely recognized problems with traditional CME. The authors touch on possible incentives to make such integrated models of CME and QI attractive to practitioners.