Clinicians have always been committed to staying current in their practice and keeping abreast of medical advances to provide the best care to patients. With the rapidly changing healthcare environment, time constraints, and increasing requirements to maintain professional standing, continuing medical education (CME) plays a key role in physicians' ongoing professional development.
In the past 20 years, CME has evolved to deliver more than just knowledge-based activities; it now includes more practice-based solutions to improve competence, skill, performance, and, ultimately, patient outcomes. In 2014, of the approximately 140,000 activities offered by accredited providers, 60% were designed to improve physician performance and 25% were designed to improve patient outcomes.
Access to online CME activities has grown over the past 20 years. In 1998, there were only 35,978 physicians participating in 1000 online CME activities, representing only 2% of all participation in CME activities. In 2005, a total of 1,348,365 physicians participated in 19,000 online CME activities, representing 18% of all participation. In 2014, there were 4,524,617 physicians participating in 36,124 online CME activities, a 40% share of all CME activities.
Over the past 20 years, the Internet has had a dramatic effect on the delivery of CME/CE to clinicians and has expanded the formats available due to advancements in technologies. Online CME allows for easier on-demand access to activities, including practice self-assessments, immediate feedback, and even patient simulation. Through video and text, physicians all over the world can now participate in—at their convenience—CME activities containing the latest advances in medicine from thought leaders as well as programs that validate current practice and reinforce best practice.
Governance of CME
Two entities govern CME and have effected change over the past 20 years.
The American Medical Association (AMA) developed a credit system for physicians continuing their medical education by conferring the Physician's Recognition Award (AMA PRA) credit for participating in activities.
The Accreditation Council for Continuing Medical Education (ACCME) was established by seven founding member organizations: the American Board of Medical Specialties (ABMS), the American Hospital Association (AHA), the American Medical Association (AMA), the Association of American Medical Colleges (AAMC), the Association for Hospital Medical Education (AHME), the Council of Medical Specialty Societies (CMSS), and the Federation of State Medical Boards (FSMB). These groups set the standards and accredit organizations that meet those standards as providers of CME activities who are authorized to award AMA PRA credits.
Changes in the Delivery of CME
Many of the biggest changes in CME occurred during the past 10 years.
2005 – ACCME updated the 1992 Standards for Commercial Support to ensure independence and content free from commercial bias. Commercial interests may provide grants to support CME activities but can have no influence over the content. CME providers were required to disclose financial relationships of faculty and planners of an activity, and to resolve all potential conflicts of interest. Transparency was enhanced for the learner.
2006 – ACCME updated Accreditation Criteria to align with ABMS' Maintenance of Certification and hospital Joint Commission standards. CME activities had to go beyond providing new information; they needed to help clinicians translate their knowledge into competency to improve their performance in practice.
2009 – ACCME, the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) collaborated to establish Joint Accreditation for Interprofessional Continuing Education (IPCE) and set standards for providers to deliver activities planned by the healthcare team for the healthcare team.
2010 – AMA revised its AMA PRA credit system to include value-based credit formats in addition to traditional time-based credits.
- Performance Improvement CME: A three-stage process completed over time in which a physician or group of physicians assesses aspects of personal performance against standard performance measures. (20 credits)
- Internet point-of-care learning: Physicians engage in self-directed online learning based on relevant clinical questions and documented results. (.5 credits)
2011 – The US Food and Drug Administration (FDA) Risk Evaluation and Mitigation Strategies (REMS) plan for opioid medications included physician participation in CME activities as a central aspect. The CME activities are based on a blueprint developed by the FDA to ensure consistency of information delivered. This was the first time that the FDA used CME as a way to advance a REMS plan. The CME activities are delivered online and through live events, and represent a collaborative effort throughout the CME community.
The Future of CME
In August 2015, ACCME and the American Board of Internal Medicine (ABIM) announced a collaboration to expand options for physicians to satisfy their Maintenance of Certification (MOC) requirements. This collaboration was developed in response to physicians and providers who need to streamline the ability to pursue lifelong learning and fulfill their professional requirements. This collaboration will allow diplomates to use identified high-quality CME to meet licensure and MOC requirements with activities that they are already completing. CME providers can create CME activities that satisfy ABIM requirements and can record participation through ACCME's annual reporting system. Roll-out of this collaboration is anticipated in 2016.
Medical education will continue to respond to environmental changes and physicians' needs to advance professional development and standard requirements.