Continuing Medical Education How to stay smarter than

How to stay smarter than a 5 th Grader • • CME grantors CME

CME Grantors • Which of the following organizations is the primary grantor of continuing

ACCME • The ACCME's Mission is the identification, development, and promotion of standards

ACCME member organizations • • ABMS - Am Board of Medical Specialties AHA -

CME Requirements • How many hours of CME are physicians required to complete each

CME Requirements • You may find that there are several organizations that will require

Local Hospitals • Middlesex Hospital requires 100 hours of CME every 2 years •

State Licensing Boards State Hours required Time for completion Special requirements CT 50 2

American Board of Family Medicine • The ABFM requires 50 hours/year averaged out over

American Academy of Family Physicians • AAFP requires 150 hrs of credit over a

AAFP Credit • Which of the following forms of AAFP credit is the most

AAFP Prescribed Credit “Prescribed credit is designated for those activities which are intended primarily

AAFP Elective Credit “Activities not individually approved by the AAFP as Prescribed credit but

AAFP EB-CME Credit “Clinical content presented with key practice recommendations supported by evidence that

EB-CME Approved sources (free) • Agency for Healthcare Research and Quality Clinical Guidelines and

EB-CME Approved sources (pay) • • • Clinical Evidence - BMJ Publishing Cochrane Database

AMA - PRA • What does the acronym AMA-PRA stand for?

AMA - PRA • What does the acronym AMA-PRA stand for? American Medical Association

AMA-PRA • In 1968 the AMA developed a system to certify the quality of

Types of AMA credit • AMA PRA Category 1 Credit™ • AMA PRA Category

AMA PRA Category 1 Credit™ requirements – Conform to the AMA definition of CME

AMA PRA Category 2 Credit™ requirements • • All educational activities not designated for

Local Courses • List 2 common types of local courses/conferences that usually qualify for

Grand Rounds • Different clinical departments often hold their own Grand Rounds – Medicine

Tumor Board • Multi-disciplinary conference with oncologists, surgeons, radiologists, radiation oncologists and primary care

Morbidity & Mortality M&M • Recent cases with an adverse outcome are discussed by

Case Conferences • Recent interesting cases are discussed, so all physicians can learn from

Clinical Pathology Conf. • A physician is given the clinical facts about a recent

CME credit for local conferences • Usually AMA Category 1™ • Requires the hospital

State/Regional Courses True or False? The STFM Northeast Regional meeting is the only annual

STFM NE Regional Mtg • The STFM is divided into 5 regions – –

State meetings • Most state academies of FP have their own annual CME meeting

National Courses • Where is the 2008 Annual Spring Conference of the national STFM

STFM National Meeting • The STFM national meeting is held every spring at a

AAFP Courses • The American Academy of Family Physicians has an Annual Scientific Symposium

AAFP Scientific Assembly • Largest gathering of FPs in world, typically 5, 000 -10,

AAFP Scientific Assembly • • Expensive - $500 registration fee Many lectures require an

AAFP Scientific Assembly • This is a must at least once in your career

Journal CME • Which of the Family Medicine Journals offers free CME for just

Journal CME - AFP • A Clinical quiz is included in each issue of

Journal CME • Many other journals offer CME • Most require you to pay

Internet CME • What level AMA-PRA credit can you get for doing an Internet

Internet Po. C Learning • The AMA has set up a mechanism to give

Internet Po. C requirements • Three elements needed – Review the original clinical question

MH Internet Po. C form Clinical question Resources used Application to practice

Internet Po. C credits • Each individual search is worth 0. 5 Category 1

Other Internet resources • Medscape (from Web. MD) – Offers free CME to physicians

Documentation of CME • Which family medicine organization has a system for documenting CME

AAFP CME documentation • Two ways to submit hours – Paper-based via mail or

CME record • Report can be printed from AAFP web site and submitted as

Other CME activities documented through AAFP

Other CME activities documented through AAFP • Publication of original research paper – 45

Quality Improvement • Describe a Quality Improvement activity that might be used for CME

Diabetes audit • The diabetes chart audit currently done at MH FPR would qualify

METRIC • http: //www. aafp. org/online/en/home /cme/selfstudy/metric. html#

METRIC components • • • Complete a questionnaire Review 10 charts & enter patient

CME credit for METRIC • Completing a full METRIC program qualifies you for 20

Potpourri • Which of the following is not an acceptable way to get CME

Audio Digest • Most well-known organization offering audio CME • Costs $350 per year

Curbside consultations • These actually qualify for AMA-PRA Category 2 credit • It is

Hospital committee service • This is not designated for credit • It is considered

Journal Club • These are excellent ways to get CME credit – AMA-PRA Category

Conclusions • Continuing Medical Education is an important part of the professional live of

I hope you are all able to stay smarter than a 5 th grader,

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Continuing Medical Education: How to stay smarter than a 5 th Grader (or a 1 st Yr. Med Student) Keith Sinusas, MD Associate Director, Family Medicine Residency Director of Medical Education Middlesex Hospital – Middletown, CT

How to stay smarter than a 5 th Grader • • CME grantors CME requirements AAFP credit AMA PRA Local Courses State/Regional Courses National Courses • • • Journal CME Internet CME Documentation of CME Quality Improvement Potpourri Conclusion

How to Stay Smarter than a 5 th Grader • • CME grantors CME requirements AAFP credit AMA PRA Local courses State/Regional CME National Courses • • • Journal CME Internet CME Documentation of CME Quality Improvement Potpourri

CME Grantors • Which of the following organizations is the primary grantor of continuing medical education credit? – – – U. S. government American Medical Association American Academy of Family Physicians Accreditation Council for Continuing Medical Education All of the above

ACCME • The ACCME's Mission is the identification, development, and promotion of standards for quality continuing medical education (CME) utilized by physicians in their maintenance of competence and incorporation of new knowledge to improve quality medical care for patients and their communities. • The ACCME fulfills its mission through a voluntary selfregulated system for accrediting CME providers and a peer -review process responsive to changes in medical education and the health care delivery system.

ACCME member organizations • • ABMS - Am Board of Medical Specialties AHA - Am Hospital Assoc AMA - Am Medical Assoc AHME- Assoc for Hospital Medical Educ AAMC – Assoc of Am Medical Colleges CMSS – Council of Medical Specialty Soc FSMB – Federation of State Medical Bds

CME Requirements • How many hours of CME are physicians required to complete each year? – – 20 hrs 40 hrs 50 hrs 100 hrs

CME Requirements • How many hours of CME are physicians required to complete each year? – – 20 hrs 40 hrs 50 hrs 100 hrs It Depends!!

CME Requirements • You may find that there are several organizations that will require you to document CME, and each may have different requirements – – Local Hospital State Licensing Boards American Board of Family Medicine American Academy of Family Physicians

Local Hospitals • Middlesex Hospital requires 100 hours of CME every 2 years • UPMC St Margaret also requires 100 hours every 2 years, but 10 of those have to be in the area of risk management

State Licensing Boards State Hours required Time for completion Special requirements CT 50 2 yrs ID, Risk Mgmt, Sexual Assault, domestic Violence DE 40 2 yrs none MA 100 2 yrs 40 Category 1 ME 100 2 yrs 40 Category 1 MD 50 2 yrs All Category 1 NH 150 3 yrs 60 Category 1 NJ 100 2 yrs none NY None PA 100 2 yrs 20 Category 1, incl. 12 hrs in Pt Safety & Risk Mgmt OH 100 2 yrs Pain Mgmt, Domestic Violence RI No specific # 2 yrs 2 hrs in 9 specific areas, incl. ID, Ethics, Pain VT None WV 50 2 yrs Category 1

American Board of Family Medicine • The ABFM requires 50 hours/year averaged out over your period of certification – 300 hrs over 6 yrs – 350 hrs over 7 yrs – 500 hrs over 10 yrs

American Academy of Family Physicians • AAFP requires 150 hrs of credit over a 3 yr period – At least 75 hrs Prescribed credit – At least 25 hrs of group learning

AAFP Credit • Which of the following forms of AAFP credit is the most valuable? – Prescribed Credit – Elective Credit – EB-CME Credit

AAFP Prescribed Credit “Prescribed credit is designated for those activities which are intended primarily for physicians, have content directly related to patient care and its delivery or are related to selected non-clinical topics, and have been planned and developed with input from an AAFP Active or Life member. These activities must be submitted, reviewed and approved by the AAFP Commission on Continuing Professional Development (COCPD). ” Official AAFP Definition from www. aafp. org

AAFP Elective Credit “Activities not individually approved by the AAFP as Prescribed credit but which have been designed as category 1 credit for the AMA Physician's Recognition Award or are AOA-approved are automatically acceptable as AAFP Elective credit. Up to 25 credits per re-election cycle may be reported from activities that are not AMA PRA category 1 TM or AOA-approved. “ Official AAFP Definition from www. aafp. org

AAFP EB-CME Credit “Clinical content presented with key practice recommendations supported by evidence that has been systematically reviewed by an approved source. “ Official AAFP Definition from www. aafp. org CME that qualifies for EB-CME is granted at a 2 for 1 ratio: 1 hr of EB-CME = 2 hrs of prescribed credit

EB-CME Approved sources (free) • Agency for Healthcare Research and Quality Clinical Guidelines and Evidence Reports (AHRQ) • Bandolier • Canadian Task Force on Preventive Health Care • Cochrane Database of Systematic Reviews -- abstracts • Database of Abstracts of Reviews of Effects (DARE) • Effective Health Care • Institute for Clinical Systems Improvement (ICSI) • National Center for Complementary and Alternative Medicine • National Guideline Clearinghouse (NGC) • U. S. Preventive Services Task Force (USPSTF)

EB-CME Approved sources (pay) • • • Clinical Evidence - BMJ Publishing Cochrane Database of Systematic Reviews - full reviews Dyna. Med EBM Online / Evidence Based Medicine Info. Retriever Natural Medicines Comprehensive Database Natural Standard PEPID Physicians' Information and Education Resource (American College of Physicians' PIER) • Upto. Date

AMA - PRA • What does the acronym AMA-PRA stand for?

AMA - PRA • What does the acronym AMA-PRA stand for? American Medical Association Physicians Recognition Award

AMA-PRA • In 1968 the AMA developed a system to certify the quality of CME activities & document physician participation • For a fee you can send a listing of your CME activities and have the AMA issue a certificate – $35 to AMA members – $70 to non-members • All reporting is strictly on the honor system

Types of AMA credit • AMA PRA Category 1 Credit™ • AMA PRA Category 2 Credit™ These are copywrited trademarks of the American Medical Association

AMA PRA Category 1 Credit™ requirements – Conform to the AMA definition of CME – Present content appropriate in depth and scope for a physician audience. – Conform to both the relevant CEJA opinions as well as the ACCME Standards for Commercial Support, and are non promotional in nature. – Address demonstrated educational needs. – Communicate a clearly identified educational purpose and/or objectives. – Use learning methodologies and format(s) appropriate to the activity’s educational purpose and/or objectives. – Use evaluation mechanisms to assess an activity’s quality and relevance to its purpose and/or objectives. – Include a means for the provider to record the actual credits claimed by each physician participant (physicians are ethically obligated to only claim credit consistent with the extent of their participation in a CME activity). – Are designated for AMA PRA Category 1 Credit in advance; activities cannot be retroactively designated for Category 1 credit. – Include the Designation Statement in any activity materials that reference CME, with the exception of “save the date” or similar notices

AMA PRA Category 2 Credit™ requirements • • All educational activities not designated for Category 1 that: comply with the AMA definition of CME; comply with the AMA ethical opinions on Gifts to Physicians from Industry and on Ethical Issues in CME (i. e. , are not promotional); and a physician finds to be a worthwhile learning experience related to his/her practice. Examples – – – – – teaching residents, medical students unstructured online searching and learning reading authoritative medical literature Participating in live activities not designated for AMA PRA Category 1 Consultation with peers and medical experts Small group discussions Self assessment activities Medical writing Preceptorships Research

Local Courses • List 2 common types of local courses/conferences that usually qualify for CME

Local Courses • List 2 common types of local courses/conferences that usually qualify for CME • Grand Rounds/Grand Professor Rounds • Tumor Board • Morbidity & Mortality conf. (M&M) • Case Conferences • Clinical Pqthology Conferences

Grand Rounds • Different clinical departments often hold their own Grand Rounds – Medicine Grand Rounds – OB/Gyn Grand Rounds – Pediatric Grand Rounds • The department arranges for a local or out -of-town speaker to discuss a single topic of interest to the entire department

Tumor Board • Multi-disciplinary conference with oncologists, surgeons, radiologists, radiation oncologists and primary care physicians • Recent cancer cases are discussed and treatment recommendations are made (in real time)

Morbidity & Mortality M&M • Recent cases with an adverse outcome are discussed by a multi-disciplinary team • Recommendations are made on how to prevent this adverse outcome from occuring again • Safe from lawyers!

Case Conferences • Recent interesting cases are discussed, so all physicians can learn from the experience of others • Similar to Tumor Board, but not necessarily designed as problem-solving

Clinical Pathology Conf. • A physician is given the clinical facts about a recent clinical case, but not the final diagnosis • Physician presents the differential diagnosis and guesses at the real diagnosis • Local pathologist gives the answer, often based on autopsy findings or the result of a biopsy or a specific diagnostic test

CME credit for local conferences • Usually AMA Category 1™ • Requires the hospital or medical center to schedule in advance and check the credentials of speaker • Usually at no cost to attendees

State/Regional Courses True or False? The STFM Northeast Regional meeting is the only annual regional meeting cosponsored by the STFM

STFM NE Regional Mtg • The STFM is divided into 5 regions – – – Northeast North Central Southeast South Central West • The Northeast Region is the only one to meet annually, the others meet sporadically

State meetings • Most state academies of FP have their own annual CME meeting • Many state medical societies have an annual CME meeting as well

National Courses • Where is the 2008 Annual Spring Conference of the national STFM being held?

National Courses • Where is the 2008 Annual Spring Conference of the national STFM being held? Baltimore, MD

STFM National Meeting • The STFM national meeting is held every spring at a different city • It is a great opportunity for family medicine educators to get together to share new innovations in residency education • The 2007 meeting was held in Chicago and provided attendees with up to 30. 75 AAFP Prescribed credits • It is also a wonderful venue for students and residents to learn about family medicine and to network with the leaders of the specialty

AAFP Courses • The American Academy of Family Physicians has an Annual Scientific Symposium each fall in a different city – 2007 Chicago – 2008 San Diego

AAFP Scientific Assembly • Largest gathering of FPs in world, typically 5, 000 -10, 000 Physicians • Large variety of clinical courses to choose from, given by renowned experts • Up to 40 hours of AAFP prescribed credit available, more if you go to EB-CME courses

AAFP Scientific Assembly • • Expensive - $500 registration fee Many lectures require an extra fee Pharmaceutical exhibits are massive Can be challenging to get from one lecture to another, since the convention centers are large

AAFP Scientific Assembly • This is a must at least once in your career • A good way to meet former colleagues from around the country • Many programs for your family to attend if they come with you

Journal CME • Which of the Family Medicine Journals offers free CME for just reading it each month? American Family Physician

Journal CME - AFP • A Clinical quiz is included in each issue of American Family Physician • Read the journal, answer the quiz questions and get 4 -6 hours of AAFP prescribed credit • Answers can be entered online

5. 25 AAFP Prescribed credits

Journal CME • Many other journals offer CME • Most require you to pay a fee to receive the credit • Reading journals can also be claimed as AMA-PRA Category 2 credit

Internet CME • What level AMA-PRA credit can you get for doing an Internet search to find an answer on a current patient? Category 1 or Category 2

Internet Po. C Learning • The AMA has set up a mechanism to give Category 1 credit for doing an Internet search on a clinical question called “Internet Point of Care (Po. C) Learning” • This can only occur if your hospital or medical center has set up a process to grant credit

Internet Po. C requirements • Three elements needed – Review the original clinical question – Identify the relevant sources among those searched – Describe the application of their findings to practice

MH Internet Po. C form Clinical question Resources used Application to practice

Internet Po. C credits • Each individual search is worth 0. 5 Category 1 credits • There are no limits to the number of credits allowable

Other Internet resources • Medscape (from Web. MD) – Offers free CME to physicians – Log on, read an article, answer some questions and you get credit • CMELectures – Offers CME for a fee – Log on, read an article, answer some questions, enter your credit card number and you get credit

Documentation of CME • Which family medicine organization has a system for documenting CME hours? ABFM – American Board of Family Medicine AAFP – American Academy of Family Physicians STFM – Society of Teachers of Family Medicine

AAFP CME documentation • Two ways to submit hours – Paper-based via mail or fax – Online • Used to verify CME requirements for active status • Transferred to ABFP for board eligibility

Paper documentation

Online documentation www. aafp. org

Online documentation

CME record • Report can be printed from AAFP web site and submitted as documentation for privileges or licensure

Other CME activities documented through AAFP

Other CME activities documented through AAFP • Publication of original research paper – 45 prescribed credits (limit 15 per paper) • Presentation or publication of a paper – 30 elective credits (limit 10 credits per paper) • Presentation of a scientific medical exhibit – up to 15 elective credits • Teaching – up to 20 prescribed credits • Enrichment – 25 elective credits – This is for attending a course designed for other health professionals, e. g. a nursing course

Quality Improvement • Describe a Quality Improvement activity that might be used for CME credit

Quality Improvement • Describe a Quality Improvement activity that might be used for CME credit Office chart audit for chronic illness, such as • Diabetes • CAD • Asthma • COPD

Diabetes audit • The diabetes chart audit currently done at MH FPR would qualify for CME credit • AAFP METRIC • • • Measuring Evaluating and Translating Research Into Care

METRIC • http: //www. aafp. org/online/en/home /cme/selfstudy/metric. html#

METRIC components • • • Complete a questionnaire Review 10 charts & enter patient data Assess your performance Build an action plan Implement the plan Remeasure and reassess on 10 charts

CME credit for METRIC • Completing a full METRIC program qualifies you for 20 hours of prescribed credit • This would also meet your QI requirement for ABFM recertification

Potpourri • Which of the following is not an acceptable way to get CME credit? – Listening to audio CD of a medical lecture – Getting curbside instruction from a colleague – Participating in a local hospital pharmacy & therapeutics committee – Attending a local journal club

Audio Digest • Most well-known organization offering audio CME • Costs $350 per year • Includes 24 CDs • Each CD is worth 2 hours of AMA-PRA Category 1 credit

Curbside consultations • These actually qualify for AMA-PRA Category 2 credit • It is based on time in 0. 25 hr increments • You would have to spend at least 15 minutes discussing a case with a colleague • These would have to be documented on an AMAPRA application form • Almost nobody claims these

Hospital committee service • This is not designated for credit • It is considered part of your obligation for medical staff membership

Journal Club • These are excellent ways to get CME credit – AMA-PRA Category 2 – AAFP Prescribed Credit • Based on time of participation in 0. 25 hr increments

Conclusions • Continuing Medical Education is an important part of the professional live of all physicians • There are many ways to receive CME credit Take advantage of them all! • The AAFP should be your primary source for documenting CME

I hope you are all able to stay smarter than a 5 th grader, or at least a 1 st yr medical student!