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Reforming and Repositioning CME Report of the Conjoint Committee on CME Context, Recommendations and Implications. Presenters. Marcia J. Jackson, PhD, Senior Advisor, Education, American College of Cardiology Bruce E. Spivey, MD, Deputy EVP, Council of Medical Specialty Societies

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  1. Reforming and Repositioning CME Report of the Conjoint Committee on CMEContext, Recommendations and Implications

  2. Presenters • Marcia J. Jackson, PhD, Senior Advisor, Education, American College of Cardiology • Bruce E. Spivey, MD, Deputy EVP, Council of Medical Specialty Societies • Bruce J. Bellande, PhD, Executive Director, Alliance for Continuing Medical Education

  3. Disclaimer Marcia J. Jackson, PhD

  4. Objective • At the conclusion of this session, you will be able to: • Initiate changes in your CME programs based on the report, recommendations and next steps of the Conjoint Committee on CME

  5. Why is CME being repositioned and refinanced? • Quality and Performance Improvement • Regulation/Accreditation • Public Scrutiny • Funding • Patient Safety and Public’s Health • Global Trends

  6. Quest for Quality in Healthcare • Quality improvement in healthcare • CME value and effectiveness • CME as a change agent • Measurement of outcomes • Change and improvement in physicians’ practice performance • Improve patient care and the public’s health • Reimbursement based on evidence of quality

  7. The Current US Ethical and Regulatory Environment Increasing Ethical Codes and Regulations

  8. Chronology of Trends in CME

  9. Profession $$ Knowledge Altruism Commitment Autonomy Ethos Trust earned Do no harm “Professionalism” Perceptions of Medical Professionalism Public • $$$$ • Jargon and secrecy • Paternalism • Self-interest • Unaccountable • Exploitation • Trust threatened • Medical errors • “Protectionism” E. Borman

  10. The Current Funding Environment in the U.S. • In 2003 commercial sources provided $943 million, or 55% of the 1.7 billion spent on education through nationally accredited organizations by the ACCME. This is up 11% from 2002. (1) • 9 of every 10 nationally accredited providers receive 40% or more of their revenue from commercial sources (2) • Accreditation Council for Continuing Medical Education (ACCME) Report 2003 • (2) Mazmanian, JCEHP 2003

  11. A New Vision Bruce E. Spivey, MD

  12. Organizations Involved • AAFP - American Academy of Family Physicians • ABMS - American Board of Medical Specialties • ACCME - Accreditation Council for CME • ACGME - Accreditation Council for GME • ACME - Alliance for Continuing Medical Education • AHA - American Hospital Association • AHME - Association for Hospital Medical Education

  13. Organizations Involved(cont.) AMA-American Medical Association AOA-American Osteopathic Association CMSS-Council of Medical Specialty Societies FSMB-Federation of State Medical Boards LCME-Liaison Committee on Medical Education NBME-National Board of Medical Examiners SACME-Society for Academic Cont. Med. Ed.

  14. Reform & Reposition CMEA New Vision • History & Process of Conjoint Committee • Recommendations • Next Steps • Priorities • Discussion

  15. CMSS Ad Hoc TF on Repositioning CME Appointed November 2000 Report March 2002 History & Process of Conjoint Committee on CME • Multi-organizational Meetings • - October 2002 - June 2003 • - February 2003 - September 2003 • February 2004 - April 2004 • November 2004 Specialty Societies Summit

  16. Recommendations and Next Steps Bruce J. Bellande, PhD

  17. Today’s CME Environment Parties Stakeholders Outcomes CME Reform and Refinancing Accreditation and Credit Grantors Laws and Regulations Resources Process

  18. Recommendations 1: Medical Education Continuum The Conjoint Committee on CME should serve as the forum of medical organizations to: • facilitate communication and coordination, • build relationships, and • ensure visibility and accountability regarding CME among all stakeholders spanning the medical education continuum.

  19. Next Steps • Establish continuous communication andcollaboration among accrediting organizations responsible for establishing standards for quality undergraduate, graduate and continuing medical education to assure that physicians engage in effective lifelong learning.

  20. Next Steps (continued) • Partnership should be encouraged among and supported by the American Board of Medical Specialties (ABMS), American Osteopathic Association (AOA), and the Council of Medical Specialty Societies (CMSS). • Establish mechanisms to involve all specialtysocieties and their respective certifying boards to assure that all physicians engage in continuous professional development and maintain specialty certification.

  21. Next Steps (continued) • As the process evolves, make overt effort to involve other professions in integrating education. • Establish CME research agenda and dissemination strategies. • Assure high quality input from the public.

  22. Recommendations 2: Self-Assessment and Lifelong Learning Optimal patient outcomes are linked to the practice of competent physicians. Persons comprising the CME Enterprise (physician learners, CME professionals, physician educators) should engage in self-assessment of competencies and lifelong learning to maintain competency.

  23. Next Steps • Physician self-assessment and lifelong learning • CME professional self-assessment and lifelong learning • Faculty development for physician educators

  24. Recommendations 3: Core Curricula and Competencies Specialty-specific core curricula should be developed to achieve, maintain, and improve physician competencies as described in the ABMS/ ACGME/AOA core competencies. All specialties and subspecialties should reach consensus on the knowledge, skills, performance and abilities expected of their specialty.

  25. Next Steps • Competencies 2. Core curricula

  26. Recommendations 4: Valid Content: Evidence Based Medicine CME professionals, learners, accreditors and medical organizations should assure that all recommendations for patient care presented in CME are based on the current best available evidence, physician expertise and patient values.

  27. Next Steps • Design and deliver CME based on current and emerging best evidence, physician expertise and patient values. • Eliminate inappropriate bias through independence. 3. Adopt best evidence and independence in CME.

  28. Recommendations 5: Performance and Continuous Improvement A new system should facilitate evaluating CME effectiveness by using methodologies currently available to substantiate that physicians have enhanced their knowledge base and medical and professional skills and have used these for the improvement of practice performance and patient care. Parallel and complementary systems should be developed to evaluate the effectiveness of CME professionals in attaining the knowledge, professional skills and performance for the improvement of physician education and patient care.

  29. Next Steps • Evaluate the impact of CME activities on physician learning and performance. • Evaluate and measure the effectiveness of a new system of CME. • Nurture organizational collaboration to eliminate duplication of documentation.

  30. Recommendations 6: Metrics to Measure and Recognize Physician Learning and Behavioral Change Reform the current CME credit system to measure and recognize physician learning and behavioral change.

  31. Next Steps • Reform the CME credit system • Evaluate the relationship between the metric system and other leading and emerging trends in CME • Re-evaluate CME requirements

  32. Recommendations 7: Resources and Support Establish a “blue ribbon” panel of medical, entrepreneurial, foundation, and governmental and other organizational leaders to offer : • advice and guidance regarding the processes of determining, procuring and balancing the requisite resources and support necessary to focus the present CME system on societal, professional, and entrepreneurial interests as the practice and scope of medicine evolves.

  33. Next Steps • Assess financial implications of proposed change • Determine funding options and approaches to support implementation of changes

  34. Priorities Bruce E. Spivey, MD

  35. Recommendations and Next Steps Priorities 1. Core curricula 2. Reform credit system 3. Physician self-assessment 4. Evaluate impact of change in CME activities 5. Collaboration among accreditation organizations

  36. Recommendations and Next Steps Priorities 6. Establish CME research agenda 7. Competency models for assessment 8. Determine funding options 9. Collaboration of ABMS, AOA, and the CMSS 10. Eliminate duplicate documentation

  37. Journal of Continuing Education in the Health Professions Theme issue in September 2005 Reforming, Repositioning and Refinancing CME for the Future

  38. The Future Marcia J. Jackson, PhD

  39. Current and Future CME Implications

  40. Current and Future CME Implications

  41. Current and Future CME Implications (Continued)

  42. Thank you! What are your thoughts

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