CME 101: Debbie Platek, MS Remembering the Basics President, CME - - PowerPoint PPT Presentation

CME 101: Remembering the Basics

Debbie Platek, MS President, CME Mentors

Where we’re going today (and how fast)

through the CME accreditation/credit systems

Fly

through some principles of adult learning

Jog

through the Accreditation Criteria

Walk

• n a few of the Accreditation Criteria

Camp

The CME/CE Landscape (and where you fit in)

A Mult lti-layered Landscape

A Mult lti-layered Landscape

The CME/CE World

AOA AMA ANCC ACPE AAFP

ACCME FMA

“Alphabet Soup”

• ACCME = Accreditation Council for

Continuing Medical Education

• FMA
• AMA =American Medical

Association

• AOA = American Osteopathic

Association

• AAFP = American Academy of

Family Physicians

“Alphabet Soup”

• CME = Continuing Medical

Education

• Physicians
• CE/CNE/CEU = Continuing

Education for:

• Nurses, Advanced Practice

Nurses, Physician Assistants

• Pharmacists
• Other health professionals
• IPCE = Interprofessional

Continuing Education

• CPD = Continuing/Continuous

Professional Development

In In your Groups Share:

Your Name Organization and Role How long in CME Type(s) of credit given

Educational Path for r Physicians

Undergraduate Medical Education

“UME”

Graduate Medical Education

“GME”

Continuing Medical Education

“CME”

Physicians use CME credit for:

• Medical Licensure
• State Licensing & Regulations
• Board Certification
• “MOC”
• Hospital Credentialing
• Privileges

U.S .S. . CME Credit Systems

• American Academy of Family Physicians

(AAFP) - 1947

• AAFP Prescribed and Elective Credit
• American Osteopathic Association (AOA)
• 1973
• AOA 1A, 1B, 2A and 2B Credit
• American Medical Association (AMA) -

1968

• AMA PRA Category 1 Credit™
• AMA PRA Category 2 Credit™

Our Focus: AMA PRA Credit System

• Developed and owned by the AMA
• Monitored by the AMA
• AMA Council on Medical

Education determines the requirements and formats for AMA PRA credit

• Credit = “Currency”
• Awarded by the AMA and by other

“accredited providers”

ACCME

• Controls the Accreditation System

that allows providers to award AMA PRA Category 1 CreditTM

• Has requirements providers must

meet:

• ACCME Accreditation Criteria
• ACCME Standards for

Commercial SupportSM

• ACCME Policies

ACCME

Recognized State Medical Society Accreditors

ACCME Accreditation System

A Mult lti-layered Landscape

The CME/CE World

AOA AMA ANCC ACPE AAFP

ACCME FMA

Next xt Up

through some principles of adult learning

Jog

How Do Adults Learn? What Makes Adults Change?

Effective Adult Learning Practices …

Support active participation Draw upon learners’ experiences Allow learners to set goals Provide practice with realistic examples Support self-directed learning Provide feedback to learners Facilitate learner self-reflection Role-model behaviors

Adapted from Mary Martin Lowe, PhD

3 Theories: How Adults Learn and Change

• Malcolm Knowles:

Self-directed Learning

• David Kolb:

Experiential Learning

• Donald Schön:

Reflection in/on action

Engaged Experience Relevant & Impactful Problem-

• riented

Don’t just tell me.

Malcolm Knowles: S Self-Directed Le Learning

How does this matter to me? Will this solve a problem I have? I want to be involved.

Engaged Experience Relevant & Impactful Problem-

• riented

Don’t just tell me.

Malcolm Knowles: S Self-Directed Le Learning

How does this matter to me? Will this solve a problem I have? I want to be involved.

Self-directed Learning

Experiential Le Learning

Learning

Experience

Reflection Thoughts & Concepts Practice

David Kolb:

Schön: Refl flection in in Actio ion v. . Refl flectio ion on

• n Actio

ion

What? So what? Now what?

Effective Adult Learning Practices …

Support active participation Draw upon learners’ experiences Allow learners to set goals Provide practice with realistic examples Support self-directed learning Provide feedback to learners Facilitate learner self-reflection Role-model behaviors

Experience: Why is is it it so cri ritical to le learning?

• Your leaners are trying to

solve the real problems they encounter

• Experience is the link

because it:

• Gives context to the

problem

• Allows time for practice
• Aids in problem solving

What can you do?

Provide case-based learning examples Allow for discussion between learners Use simulation, role- playing and modeling Other ideas?

Reflection: Why is is it it so cri ritical to le learning?

• Your leaners are trying to

solve the real problems they encounter

• Reflection gives them a way to

connect what is learned to: –their own experiences –their knowledge base –their “mental models”

What can you do?

Ask learners to make comparisons Show data about gaps, goals, progress Show information from peers Other ideas?

Dis iscuss: A Adult lt Learn rnin ing Pri rincip iples and YOU!

What? So what? Now what?

Group Debrief

So far r we took ti time to

through the CME accreditation/credit systems

Fly

through some principles of adult learning

Jog

Now let’s

through the Accreditation Criteria

Walk

Criteria Groupings (C (C 1- C13)

Meeting

Meeting your Mission (Criterion 1)

Planning

Planning your Education (Criteria 2-6)

Ensuring

Ensuring Independence (Criteria 7-10)

Evaluating

Evaluating your CME/Program (Criteria 11-13)

Criteria Groupings (C (Commendation) “Old”

Criteria 16-22

“New”

Criteria 23-38

Now let’s

• n a few of the Accreditation Criteria

Camp

Let’s Discuss Planning Criteria 2 & 3

• Educational needs
• Professional practice gaps

Criterion 2

• Designed to change competence, performance or patient
• utcomes

Criterion 3

The “Professional Practice Gap” (What’s the Problem?) Actual Practice Ideal Practice “Now” “Then” Current Proposed

“Needs” (What’s the underlying cause?)

Is it a lack of…

Information? Strategies or Tools? Application of

information, strategies and/or tools?

“Knowledge” “Competence” “Performance”

Methods for Id Identify fying Problems in in Practice

Evaluation Data from previous CME Activity Membership or Attendee Survey Data Scientific Literature (e.g., Journals, Reports) Consensus of Experts (e.g., Committees, Guidelines) Quality or Patient Data Legislative or Regulatory Change Board or License Requirement Public Health Data

Example: A Atrial Fib ibrillation (A (AFib or AF)

“AF is the most common heart arrhythmia affecting an estimated 3 million people in the United States and an estimated 33.5 million people worldwide. AF patients are five times more likely to have a stroke than people without AF. Oral anticoagulants can significantly reduce the risk of ischemic strokes; however, remain underutilized in patients with AF who are at an increased risk for stroke.”

From a white paper published in the online version of HeartRhythm and the National Stroke Association's Journal of Stroke and Cerebrovascular Diseases

As reported in PRNewswire https://www.prnewswire.com/news-releases/knowledge-gaps-and-misperceptions-on-impact-of-atrial-fibrillation-and- stroke-exist-among-patients-caregivers-and-physicians-300082316.html

Dis iscuss Possib ible le Answers

What’s the problem? What’s the underlying cause? What do you want to change?

Group Debrief

Let’s Discuss Ensuring In Independence: C Criterion 7

• “The provider develops activities/

educational interventions independent of commercial interests. (SCS 1, 2, and 6).” Criterion 7

Which Standards relate to Criterion 7?

• “The provider develops activities/

educational interventions independent of commercial interests. (SCS 1, 2, and 6).” Criterion 7

Criterion 7 and SCS 1, 2 & 6

Standard 1: Independence Standard 2: Resolution of Personal Conflicts of Interest Standard 6: Disclosures Relevant to Potential Commercial Bias

Definition of a Commercial Interest

“A commercial interest is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Note: The ACCME does not consider providers of clinical service directly to patients to be commercial interests.”

• ACCME/FMA

Not ACCME Commercial Interests

501-C Non-profit organizations Government Organizations Non-health care related companies Liability insurance providers Group medical practices For-profit hospitals, rehab centers, nursing homes Blood banks Diagnostic laboratories

Criterion 7 Standard 1.1

A CME provider must ensure that the following decisions were made free of the control of a commercial interest

• Identification of CME needs
• Determination of educational
• bjectives
• Selection and presentation of

content

• Selection of all persons and
• rganizations that will be in a

position to control content of the CME

• Selection of educational methods
• Evaluation of the activity

Criterion 7 Standard 2.1

The provider must be able to show that everyone who is in a position to control the content of an educational activity has disclosed all relevant financial relationships with any commercial interest to the provider. The ACCME defines “relevant financial relationships” as financial relationships in any amount

• ccurring within the past 12

months that create a conflict of interest.

Relevant Financial Relationships

Are defined by ACCME as those relationships in which the individual benefits by receiving: Salary Royalty Intellectual property rights Consulting fee Honoraria for promotional speakers’ bureau Ownership interest (stocks, stock options, excluding mutual funds) “Other financial benefits”

“Other financial benefits”

Usually associated with roles such as:

 Employment  Management position  Independent contractor (including

contracted research – research funding where institution gets grant & manages the funds & the person is the principal or named investigator)

 Consulting  Speaking and teaching  Membership on Advisory committees or

review panels

 Board membership  Or other activities from which remuneration

is received or expected

Criterion 7 Standard 2.2

An Individual who refuses to disclose relevant financial relationships will be disqualified from being a planning committee member, a teacher, or an author

• f CME and cannot have control
• f, or responsibility for, the

development, management, presentation or evaluation of the CME activity.

Criterion 7 Standard 2.3

The provider must have implemented a mechanism to identify and resolve all conflicts of interest PRIOR to the educational activity being delivered to learners

Policies Related to SCS

Includes financial relationships of a spouse or partner Conflicts of Interest…when an individual has an opportunity to affect CME content…product or services of a commercial interest...and has a financial relationship Financial relationships…create actual conflicts

• f interest when individuals have both a

financial relationship with a commercial interest AND the opportunity to affect content of… Any amount… during the past 12 months

Criterion 7, Standards 6.1, 6.2 & 6.5

Standard 6.1 An individual must disclose to learners any relevant financial relationship(s), to include the following information: the name of individual; the name of commercial interest(s); nature of relationship the person has with each commercial interest. Standard 6.2 For an individual with no relevant financial relationship the learner must be informed that no relevant financial relationship(s) exist. Standard 6.5 A provider must disclose the above information to learners prior to the beginning of the educational activity.

Dis iscuss:

How is Ensuring Independence handled at your site?

Group Debrief

Tool:

Flowchart for the Identification and Resolution of Personal Conflicts

• f Interest

Group Debrief

Let’s Discuss Evaluating your CME

• “The provider analyzes changes in learners (competence, performance,
• r patient outcomes) achieved as a result of the overall program’s

activities/educational interventions.”

Criterion 11

• “The provider fathers data or information and conducts a program-

based analysis on the degree to which the CME mission of the provider has been met through the conduct of CME activities/educational interventions.”

Criterion 12

Related Criteria

• “The provider has a CME Mission statement that includes expected

results articulated in terms of changes in competence, performance,

• r patient outcomes that will be the result of the program.

Criterion 1

• “The provider generates activities/educational interventions that

are designed to change competence, performance, or patient

• utcomes as described in its mission statement.”

Criterion 3

Remember those Adult Learning Principles?

3 Adult Learning Theories

Moore’s Updated Model of Outcomes

Community Health Patient Health Performance Competence Learning Satisfaction Participation 7 6 5 4 3 2 1

Does Shows How Knows How Knows

Moore DE Jr, Green JS, Gallis HA. Achieving desired results and improved outcomes: integrating planning and assessment throughout learning activities.J Contin Educ Health Prof. 2009 Winter;29(1):1-15.

Moore, Green, Gallis Outcomes Model

Level Outcomes Definition 1 Participation Number of participants 2 Satisfaction Degree to which participant expectations were met 3a Learning- declarative knowledge Participants can say what they were supposed to learn 3b Learning- procedural knowledge Participants can state how to do what they learned 4 Competence Learners can do what they learned in an educational setting 5 Performance Participants can do what they learned in their practice setting 6 Patient health Change in patient health status 7 Community health Change in community health status

Sample Evaluation Checklist fr from a Provider

How does your sit ite evaluate/ measure changes in in:

Competence Performance Patient Outcomes

Look how far we’ve come!

through the CME accreditation/credit systems

Flew

through some principles of adult learning

Jogged

through the Accreditation Criteria

Walked

• n a few of the Accreditation Criteria

Camped

Learning Pearls

What? So what? Now what?

Thank You!

Debbie Platek, MS CME Mentors debbie@cmementors.com