The American Medical Association (AMA) Council on Medical Education released revisions to the AMA PRA credit system that will become effective July 1, 2011. All ACCME and state medical society accredited CME providers that certify activities for “AMA PRA Category 1 Credit™” will need to implement these changes by that date.
A PDF of the 2010 revision of “The Physician’s Recognition Award and credit system: Information for accredited providers and physicians,” which describes the modifications can be found at www.ama-assn.org/go/prabooklet. In brief, these modifications include:
Enduring Materials
The revisions require that enduring materials must include an assessment of the learner’s performance. Credit may only be awarded to participants that meet a minimum performance level including:
– Provide clear instructions to the learner on how to successfully complete the activity
– Provide 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; examples include, but are not limited to, patient-management case studies, a post-test, and/ or application of new concepts in response to simulated problems
– Communicate to the participants the minimum performance level that must be demonstrated in the assessment in order to successfully complete the activity for AMA PRA Category 1 Credit™.
– Provide access to appropriate bibliographic sources to allow for further study.
Journal-based CME activities
Journal-based CME activities must also include an assessment of the learner’s performance. Credit may only be awarded to participants that meet a minimum performance level. Requirements include:
– Meet all AMA core requirements for certifying an activity
– Be a peer-reviewed article
– Provide 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; this may include, but is not limited to, patient-management case studies, a post-test and/ or application of new concepts in response to simulated problems.
– Communicate to the participants the minimum performance level that must be demonstrated in the assessment in order to successfully complete the activity for AMA PRA Category 1 Credit™.
Manuscript review activities
Credit may only be awarded to physicians for manuscript review activities who submit a review deemed to be acceptable by the editor. To be certified for AMA PRA Category 1 Credit™, a manuscript review activity must:
– Meet all AMA core requirements for certifying an activity.
– Involve a review of an article that has been submitted for publication in a journal that is included in the MEDLINE bibliographic database.
– Involve a review of a manuscript that is an original contribution to the medical literature that requires multiple reviewers.
– Provide clear instructions to the physician on how to successfully complete the activity
– Be at a depth and scope that require a review of the literature and knowledge of the evidence base for the manuscript reviewed.
– Have an oversight mechanism to evaluate the quality of reviews submitted.
Performance Improvement CME (PI CME)
To be certified for AMA PRA Category 1 Credit™, a PI CME activity must:
– Meet all AMA core requirements for certifying an activity.
– Have an oversight mechanism that assures content integrity of the selected performance measures. These measures must be evidence based2 and well designed (e.g., clearly specify required data elements, ensure that data collection is feasible).
– Provide clear instructions to the physicians that define the educational process of the PI CME activity (documentation, timelines, etc.).
– Provide adequate background information so that physicians can identify and understand the performance measures that will guide their PI CME activity, and the evidence base behind those measures.
– Validate the depth of physician participation by a review of submitted PI CME activity documentation.
The PI CME activity must also consist of the following three stages:
Stage A: Learning from current practice performance assessment
Assess current practice using the identified performance measures, either through chart reviews or some other appropriate mechanism. Participating physicians must be actively involved in the analysis of the collected data to determine the causes of variations from any desired performance and identify appropriate intervention(s) to address these.
Stage B: Learning from the application of PI to patient care
Implement the intervention(s) based on the results of the analysis in Stage A, using suitable tracking tools. Participating physicians should receive guidance on appropriate parameters for applying the intervention(s).
Stage C: Learning from the evaluation of the PI CME effort
Re-assess and reflect on performance in practice measured after the implementation of the intervention(s) in Stage B, by comparing to the assessment done in Stage A and using the same performance measures. Summarize any practice, process and/or outcome changes that resulted from conducting the PI CME activity.
AMA Credit Designation Statement
The AMA Credit Designation Statement has also been modified to indicate the learning format for the activity:
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.
Program materials
The AMA Credit Designation Statement must be used in any program materials, in both print and electronic formats, (e.g. a course syllabus, enduring material publication, landing page of an internet activity) that reference CME credit.
Activity announcements
The complete AMA Credit Designation Statement must always be used on any document or publication, including activity announcements and all materials that references the number of AMA PRA Category 1 Credits™ designated for the activity. This applies to both print and electronic formats that are designed to build awareness of the activity’s educational content among the target physician audience.
Implementation
AMA Division of Continuing Physician Professional Development (CPPD) staff will be available to help accredited CME providers understand and apply these changes when certifying activities for “AMA PRA Category 1 Credit™.” The Winter issue of the CPPD Report, which will be distributed early 2011, will include an article about these changes.
The AMA has scheduled webinars to discuss the modifications on the following dates:
• October 6 11:00 a.m. – 12:30 p.m. CDT
• October 26 1:00 – 2:30 p.m. CDT
• November 4 2:00 – 3:30 p.m. CDT
Register for these webinars at www.ama-assn.org/go/webinarscppd.
In addition AMA will be presenting information about these changes at upcoming meetings of other organizations. To attend any of the following meetings please contact the sponsoring organization directly:
October 1, 2010
Illinois Alliance for CME/Illinois State Medical Society, Oakbrook, IL MEDCHI, Maryland State Medical Society, Baltimore, MD
October 27, 2010
Medical Association of the State of Alabama, Montgomery, AL
November 5, 2010
Massachusetts Medical Society, Waltham, MA
November 11, 2010
South Carolina Medical Association, Columbia, SC
January 27, 2011
Alliance for CME 36th Annual Meeting, San Francisco, CA
April 15, 2011
American Hospital Medical Educators Educational Institute, Denver, CO
Please plan to participate in one of these activities to ensure that your organization has the right information to remain in compliance with the new requirements.
These are reasonable changes as most providers have been moving towards performance improvement and providing outcomes. As a result, the transition to the new system will be relatively simple for providers. Physicians on the other hand will need to play close attention to the content to show change in competency to receive credit. This is a great move from the AMA to ensure their credit is taken seriously and will improve the quality of CME offerings.