This month, the American Medical Association (AMA), through its Council on Medical Education and Division of Continuing Physician Professional Development (CPPD), discussed updates and revisions to enhance the AMA PRA credit system.
In their monthly newsletter, CPPD Report, the AMA discussed new changes and requirements under the AMA Physician’s Recognition Award (PRA) and the AMA PRA credit system.
Background
In 2009, the CPPD staff began a series of meetings with the CME stakeholders. From April 2009 through August 2009, there were 22 meetings held with more than 160 representatives from 58 organizations. These included representatives from Accreditors, ACCME, state medical societies, the American Board of Medical Specialties, pharmaceutical companies, and a number of professional societies and organizations such as the American Osteopathic Association and the American Academy of Family Physicians.
The information gathered in these meetings was summarized with the results and recommendations presented to the AMA Council on Medical Education in June 2010. The council discussed proposed changes and adopted several revisions to the AMA PRA credit requirements to be effective for all activities certified for AMA PRA Category 1 Credit™ presented or released on or after July 1, 2011. The council also approved the 2010 revision of the document “The Physician’s Recognition Award and credit system.
Changes to AMA PRA System
The newly revised booklet also provides a definition of Certified CME:
- Nonpromotional learning activities certified for credit prior to the activity by an organization authorized by the credit system owner, or
- Nonpromotional learning activities for which the credit system owner directly awards credit
Enduring materials
Enduring materials must include an assessment of the learner that measures achievement of the educational purpose and/or objective(s) of the activity with an established minimum performance level that is communicated to the physician prior to participating in the activity. The intent of this requirement is that AMA PRA Category 1 Credit™ is only awarded to a physician who demonstrates that he or she met the objectives of the activity.
The AMA has not specified the type of assessment, questions or performance level that an accredited CME provider must use. The CME provider may use different assessment types based on the enduring material (e.g., multiple-choice questions, case-based questions, short-answer, essays), as well as different levels of performance for different types of enduring materials. Whatever assessment is used, however, it must be graded to determine that the physician achieved at least the minimum level that was established by the CME provider. The CME provider must ensure that the minimum level of achievement for which AMA PRA credit can be awarded is communicated to prospective participants prior to their participation in the activity.
Journal-based CME activities
Journal-based CME activities must also include an assessment of the learner that measures achievement of the educational purpose and/or objective(s) of the activity with an established minimum performance level that is communicated to the physician prior to participating in the activity. Again, the intent of this requirement is that AMA PRA Category 1 Credit™ is only awarded to a physician who can demonstrate that he or she met the objectives of the activity. Journal based CME activities have the same requirements for these assessments and the awarding of credit as enduring materials.
Manuscript review activities
As written the current requirements for manuscript review activities could be interpreted to mean that a physician may receive credit for submitting an unacceptable review but would not be allowed to continue to participate or receive credit for subsequent reviews. The new requirement clarifies that a physician who participates in manuscript review activities may only be awarded AMA PRA Category 1 Credit™ if the editor of the journal considers the review to be acceptable. This requirement is designed to ensure that a physician only receives credit for demonstrating successful completion of the CME activity.
Performance improvement CME (PI CME) activities
There is now clarification that physicians must begin a PI CME activity with Stage A in order to assess their practice based on the chosen performance measures and establish a baseline prior to implementing changes in their practice. This enables a physician to determine the reasons for not reaching the optimal performance and to identify interventions that are needed to improve this performance.
AMA credit designation statement
The AMA credit designation statement has been modified in two areas. First, it is now required that the first sentence of the credit designation statement indicate that the activity was developed to meet the specific requirements of one of the seven AMA approved learning formats. This change lets potential learners know what type of activity they will be participating in and indicates to credentialing organizations, once the documentation of completion is submitted and received, the type of activity learners have successfully completed.
The second sentence was modified by moving the word “only” to modify “credit” rather than “claim” to make the sentence grammatically correct. The modified AMA credit designation required for all activities certified for AMA PRA credit is:
The [name of accredited CME provider] designates this [learning format] for a maximum of [number of credits] AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Within the United States, the AMA only authorizes organizations accredited by the ACCME or by a state medical society recognized by the ACCME (referred to as “accredited CME providers”) to designate and award AMA PRA Category 1 Credit™ to physicians. Each certified activity must comply with the 10 AMA core requirements as well as the format-specific requirements for one of the seven AMA approved learning formats. Only activities developed as one of these seven learning formats may be certified for AMA PRA Category 1 Credit™. These approved learning formats include:
– Live activity
– Enduring material
– Journal-based CME activity
– Test item writing activity
– Manuscript review activity
– PI CME activity
– Internet point-of-care activity
It is not acceptable to use any other language to refer to the learning formats in the credit designation statement since only these seven formats have been approved for credit by the AMA.
Presentations at the National Task Force on CME Provider/Industry Collaboration
More than 425 participants gathered for the 21st Annual Conference of the Nation Task Force on CME Provider/Industry Collaboration, held October 13–15 in Baltimore.
The keynote address “Principled partnerships: Practical or pipe dream?” was delivered by Darrell G. Kirch, MD, president and CEO of the Association of American Medical Colleges. The theme for this year’s conference, which was staffed by the AMA, was “Moving forward in an age of uncertainty: Creating innovative, practical educational solutions.” Providers who were unable to attend the meeting, can now view conference presentations online.
CPPD webinar information
CPPD staff will be hosting webinars in the coming months to help CME providers learn more about these changes and how they will impact the planning and implementation of activities certified for AMA PRA Category 1 Credit™. Each webinar will include a Q&A period with the presenters. CPPD promises to answer all questions that are received by participants during the presentation—even if time runs out during the webinar. Webinars on the 2010 revisions to the AMA PRA credit system will be held on:
– February 24, noon–1:30 p.m. CT
– June 29, noon–1:30 p.m. CT
Physician re-entry to clinical practice: Overcoming regulatory challenges
In an effort to address regulatory barriers to physician re-entry, the AMA, in collaboration with the Federation of State Medical Boards (FSMB) and the American Academy of Pediatrics (AAP), held a conference titled Physician Re-entry to Clinical Practice: Overcoming Regulatory Challenges in May 2010.
The conference resulted in the formulation of 16 recommendations that, when taken together, are designed to ease a range of barriers to physician re-entry. These recommendations were organized with the following goals in mind:
- Ensure that there is a transparent and feasible process for physicians to return to practice
- Develop policies that assure the quality of re-entry programs and their graduates
- Create an evidence-based approach that can be used in re-entry program development
- Develop means to ensure that re-entry is financially feasible
- Ensure that all stakeholders participate in planning for a physician re-entry system
The AMA said it will continue collaborating with relevant organizations to further the development of a coordinated approach to physician re-entry, including hosting another conference with stakeholders if necessary. The FSMB’s Special Committee on Re-entry to Practice is preparing a report with recommendations on the issue that is expected to be completed in 2011.
The issue of physician re-entry into the work force is growing in importance within medical boards especially with physicians who may take off two or more years for a child or have left practice and decided to come back all have to take CME courses to be relicensed.
As stakeholders work to develop re-entry policies, processes and educational approaches, it is important for the CME community to address the role it will play in the development of a coordinated approach.