I've spent lots of time involved in planning, producing, evaluating and participating in CME. And I've observed over the past two decades that the number of CME providers in Illinois, where I live, has been declining. But there are recent changes that indicate that it's time to reintroduce your CME program if your organization has withdrawn from the CME planning world.
Participating in CME (continuing medical education) has been a big part of my professional life. After completing my residency, and joining a hospital medical staff, the first committee I was assigned to was the “Program and Education Committee” (a.k.a. the CME Committee).
I really liked participating in this committee. It was more altruistic than some of the other hospital committees, where politics or power struggles often prevailed. We spent most of our time sorting through possible lecture topics and contacting speakers to travel from Chicago to provide a dinner or noon lecture.
Due to lack of interest by other members of the committee, I quickly found myself chairing the committee. I started attending the Illinois State Medical Society (ISMS) workshops for CME providers. I needed to understand the requirements for ongoing accreditation.
Within 18 months, we underwent our first accreditation survey. We we did pretty well. I had read the accreditation manual, so I was prepared to answer the surveyors' questions.
Joining the ISMS Committee
We were reaccredited without any major deficiencies. Shortly thereafter, the Chair of the ISMS Committee on CME Accreditation asked if I was interested in joining their committee. Technically, I was nominated by the Kankakee County Medical Society.
I joined and began attending monthly meetings. Because we were providing a service that enabled physicians to obtain high quality CME through local hospitals, I really enjoyed the work.
Sometime later, the ISMS chose me to chair the Committee on CME Accreditation. Early in my term, Murray Kopelow, the new President and CEO of the Accreditation Council on Continuing Medical Education (ACCME), visited us during one of our committee meetings. The ACCME is the body that promulgates all of the rules for achieving and maintaining accreditation for CME providers.
Getting to Know the ACCME
As a consequence of Dr. Kopelow’s visit, I later became a member of the Accreditation Review Committee of the ACCME. The ARC is the committee that reviews all national CME providers for compliance with its Criteria for Accreditation, and provides its recommendations to the Board itself for final accreditation decisions.
For more than 20 years, I have been doing surveys for new and ongoing CME providers for the ISMS and the ACCME. And I have attended many of the annual meetings of the Alliance for Continuing Education in the Health Professions (ACEHP). Hence, I have spoken with many CME planners.
And I still help in planning CME for the Kankakee County Medical Society and for a private education company that creates internet and print-based CME.
Needless to say, I have seen many changes in the CME world over the years. I have witnessed the consolidation among CME providers as they attempt to reduce costs and staffing needs.
CME Providers Give Up
I have seen providers simply exit the CME “business” because of increasing paperwork requirements and seemingly more stringent accreditation requirements. Some of these new requirements resulted from reports that CME credit was allegedly being offered for what seemed to be vacations at ski resorts and tropical islands.
Many state medical societies have seen a drastic reduction in intrastate accredited CME providers. From 2008 until 2017, the number of state accredited providers dropped from about 1,600 to under 1,200. The number of hours of instruction has also declined over the past decade.
Interestingly, the hours of instruction by national accredited providers has remained fairly stable.
In spite of these changes, there is an ongoing need for CME. Most states have requirements for their physicians to participate in accredited continuing education.
Physicians are committed to lifelong learning. They often prefer to participate in CME through local accredited providers. And they certainly want to obtain American Medical Association Category 1 Credit for their CME participation.
They also prefer to take advantage of local, low-cost education that is relevant to their practices.
And, in spite of its need to “tighten-up” the planning process (by ensuring that proper adult learning principles are applied and commercial influences are avoided), in my opinion the ACCME is committed to helping its CME providers more easily meet its requirements. For example, it has eliminated requirements that were redundant.
Reintroduce Your CME Program
I am writing today to encourage those of you that have abandoned your CME program to return to CME. And to suggest that if you have never been accredited to grant CME credit, now may be the right time to do so.
I offer the following reasons to encourage you to jump back into CME. These reasons apply to hospitals and large medical groups, primarily.
Keep in mind, too, that other groups of professionals, including nurse practitioners, physician assistants, and pharmacists, can benefit from these activities.
Let me start by defining some terms:
- A lecture, online educational session, conference, symposium, series of regularly series, etc., will all be referred to as an activity (rather than a program).
- The accredited entity that grants AMA (American Medical Association) credit is called the provider.
- The CME program is the structure, policies and procedures that produces activities by the provider for its audience.
One more thing: this entire article reflects my own thoughts and opinions. In no way do I represent the ACCME or its policies or opinions.
Without further ado…
Top 25 Reasons to Get Back Into CME
It's not as difficult as it used to be…
- There are more resources and support than ever. Between the ACCME itself and organizations like the Alliance for Continuing Education in the Health Professions (ACEHP), many state medical associations, and state and regional chapters of the ACEHP, there is plenty of help to start and run a CME program.
- There are more educational formats than ever. As a surveyor, I have seen every imaginable format for CME. Live lectures, conferences and national meetings are still popular. But you can use “enduring materials” such as written monographs and journal-based CME. There are also multiple forms of Internet-based activities from live activities to archived courses. I've even seen providers use Google Hangouts to offer valid CME activities.
- It does not have to be complicated. If properly planned and designed, a CME program need not be overly complicated or expensive to maintain. Many hospitals design their programs to be able to grant credit for regularly scheduled series (RSS) that they wish to hold anyway:
- grand rounds
- tumor board
- quality committees
- patient safety committees
- lung nodule clinics
- any similar meeting in which clinical information and educational content is included, as long as it meets the definition of CME and the planning requirements.
- You will achieve better patient outcomes. This is the ultimate goal of effective CME. There is good evidence that participation in CME enhances physicians' care and produces improvements in outcome for patients, especially if it is integrated with QI efforts. As I discussed in Benefits of CME/QI Integration, not only can QI be integrated into your CME planning, using QI data for needs assessment and evaluation is one of the best ways to apply your CME resources. Well designed and utilized CME helps elevate the competency of a medical group or hospital medical staff.
- New medical technologies, services and medications can be introduced. A great way to introduce new equipment and technologies that are underutilized is through a CME activity. There are countless examples of the slow adoption of new technologies and protocols. For example, screening for CAD in heart failure patients is still underutilized, as is the use of ICDs after acute myocardial infarction in older patients. Ideally, this will be part of a concerted plan to develop indications, contraindications and proper referrals for new techniques.
- Patients expect it. Patients expect their physicians to interact with experts and to continuously maintain current knowledge in their specialties. Consumers are attracted to healthcare organizations that demonstrate a commitment to using the latest technologies and systems of care.
Organizational Benefits – Improved Quality, Image and Referrals
- Producing CME can enhance your image to referral physicians and institutions. If your organization promotes its educational activities to local, regional or national audiences, and especially if you feature your physician faculty, the organization becomes known as a center of education and learning.
- Physicians can be featured and promoted.* Medical and surgical specialists often use cutting-edge technologies that referring physicians are not aware of. When experts present evidence-based protocols to primary care physicians, they generate more (appropriate) referrals for the specialist.*
- Hospital length of stay can be reduced. Hospital LOS is a measure of quality and care coordination. Developing educational activities that support care management can help reduce LOS. This will reduce costs and meet patients' desire to return home as soon as possible.
- CME can help reduce readmission rates. High readmission rates result in penalties to hospitals under the Hospital Readmissions Reduction Program. Content that focuses on care coordination, better communication with patients, medication reconciliation and prompt office follow-up are some of the topics appropriate to such efforts.
- Providing CME demonstrates a commitment to lifelong learning. Lifelong learning is important to all participants in healthcare, from support services, to nursing, physicians and executive leadership. Market the organization as a center for learning to board members, the community and other stakeholders.
- It demonstrates commitment to physician well-being.* If the organization uses CME to address psychosocial issues, burnout, or even improving productivity and patient flow, it will be seen as more concerned about its physicians. This creates good will.
- CME can be used to address organizational strategic goals.* This is often overlooked. But once your executive team has identified strategic goals for the coming year(s), CME activities can be developed and coordinated to help support the goals. This is one great way to further communicate the strategic vision of your organization to its physician stakeholders.
Organizational Benefits – Improved Teams
- Multidisciplinary activities promote more effective teams and collaboration.* By developing educational activities that involve whole teams, such teams can be made more collaborative and effective. Some activities might address teamwork directly. Others might present clinical topics, but with a focus on the unique role of each of the disciplines. A good example is the kind of training that occurs an Advanced Cardiac Life Support (ACLS) courses.
- CME can promote the (desired) organizational culture.* This requires executive leadership to be involved in planning. Then as activities are developed, attention to desired the mission and vision of the organizations can be woven into the CME planning process.
- Physician engagement will be improved. As discussed previously, physician engagement is a problem at many institutions. It has numerous negative consequences for the physicians and their employers. Properly planned and implemented CME can be used to encourage teamwork and a focus on quality improvement. These are issues that physicians are passionate about.
- You can improve physician productivity.* When engagement is better, physicians are more passionate about, and involved in, their work. This leads to more energy, more ambition and higher productivity.
- Turnover in staff can be reduced using CME.** By participating in CME as a team, a shared sense of mission can be instilled in the participants. This results in more cohesive, productive teams. For this to work, the CME enterprise must focus a significant part of its efforts on multidisciplinary team education.
In the next section, I list some of the direct benefits to practicing physicians. Keep in mind that any benefit to physicians will also accrue to medical groups or hospitals trying to attract physicians, and will often benefit patients.
- Providing CME meets physician expectations. When asked, physicians consistently indicate that they want local sources of CME and expect their employers/hospitals to provide it for them. It is a benefit that will attract physicians to your medical group or health system. Most physicians believe that investment in education demonstrates an investment in them.
- Local CME reduces the cost of education for physicians. Continuing education can be costly for the participant, whether involving travel or registration fees. Physicians appreciate being able to obtain required educational credits at a low or nominal cost.
- Live activities promote interaction between colleagues. If planned appropriately, live CME activities can foster interaction among participants that builds relationships and collegiality. Working together through participative CME encourages better coordination of care outside of the “classroom.”
- It's an opportunity to provide mentorship to young physicians.* Presenters, lecturers, and authors of CME content can serve as formal or informal mentors. Such mentors can support participants and develop long-term relationships with those involved.
- You can address non-clinical aspects such as professionalism, communication, process improvement, and self-care.* Most of us have been involved in organization that have pockets of disruptive behavior, poor communication, and growing burnout in its professionals. CME can be used to address those topics directly, or can tackle it more tangentially while addressing patient care issues.
- Local CME will improve interaction between medical students, residents, fellows and practicing physicians (what ACCME calls the “medical education continuum”).* By creating activities that involve physicians at all stages of their careers, faculty can model best practices and develop life long relationships. Involving all levels of learners provides mentoring for the younger members, and a feeling of continuity in the more senior members.
- Regular interactive CME can improve morale, increase physician loyalty, and reduce burnout.* Anything that enhances inter-professional teamwork, networking, goal setting and deeper engagement can combat burnout. When physicians believe that their needs are being addressed, and work in teams on meaningful projects, loyalty improves.
Its Time to Reintroduce Your CME Program
There is no more rewarding endeavor than providing a service that helps physicians, improves teamwork, promotes the workplace and improves patients' lives. That's what CME can do when well-planned and implemented with pride.
Follow these steps to restart your CME program:
- Survey your physicians to assess their interest.
- If there is interest, get someone from your finance department to help you put together a pro forma. Realistically assess the costs of running a bare bones program that will provide at least one monthly activity, including the costs of initial and ongoing accreditation.
- Present a proposal to the CEO or executive team of your organization to form a team to investigate the feasibility of starting a CME program. Don't forget to include the benefits listed in this post when making your case!
- If you get the approval to proceed, start by accessing the resources of the ACCME and the ACEHP.
I welcome your comments and questions. And I am happy to assist in any way I can, if you decide to proceed.
John Jurica @ Vital Physician Executive
*These reasons are taken from commentary published by Graham T. McMahon, MD, MMSc, President and CEO, ACCME, that can be downloaded by following this link:
**From a recent report on interprofessional education titled: By the Team for the Team: Evolving Interprofessional Continuing Education for Optimal Patient Care
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