1. SMCS CME Program CME Accreditation Standards SMCS CME Approval Process Bary Siegel, M.D. Education Team Chair June 23, 2011

2. Postgraduate Medical Education

3. History Definition of CME The criteria needed for an activity to qualify for CME

5. 1904 AMA formed the Council on Medical Education 1910 Carnegie Foundation Bulletin Number 4 1940-50s Council on Medical Education increased its focus on postgraduate medical education (PGME) 1955 One third of physicians reported no formal PGME in the last 5 years 1960s AMA House of Delegates established the Advisory Committee on Continuing Medical Education 1981 Accreditation Council for Continuing Medical Education (ACCME) History of Postgraduate Medical Education

6. Accreditation Council for Continuing Medical Education (ACCME) AMA American Board of Medical Specialties American Hospital Association Association for Hospital Medical Education Association of American Medical Colleges Council of Medical Specialty Societies Federation of State Medical Boards

7. AMA PRA CATEGORY 1 CREDIT Or Equivalent American Osteopath Association American Academy of Family Practice American College of Obstetricians and Gynecologists

8. January 1996, the California Medical Association launched a new not-for-profit subsidiary, the Institute for Medical Quality (IMQ) to help improve the quality of care delivered to patients in California

9. The IMQ Accredits Our Program In order for us to award CME we must meet all of the IMQs criteria which also meet all of the criteria of the ACCME for awarding AMA PRA CATEGORY 1 CREDIT

10. What is Postgraduate Medical Education?

13. If We Create a High Quality Educational Program Do Physicians learn anything? Does patient care improve?

14. What is CME?

15. The California Legislature defines Category 1 continuing medical education as follows: Continuing medical education activities that serve to maintain, develop or increase the knowledge, skills, and professional performance that a physician or surgeon uses to provide care, or improve the quality of care provided for patients, including, but not limited to, educational activities that meet any of the following criteria: – 1. Have a scientific or clinical content with a direct bearing on the quality or cost-effective provision of patient care, community or public health, or preventive medicine – 2. Concern quality assurance or improvement, risk management, health facility standards, or the legal aspects of clinical medicine – 3. Concern bioethics, professional ethics – 4. Designed to improve the physician/patient relationship 2011 IMQ/CMA CME Accreditation Standards Manual

16. The definition expressly excludes: Educational activities that are not directed toward the practice of medicine, or are directed toward the business aspects of medical practice, including, but not limited to, medical office management, billing and coding, and marketing. 2011 IMQ/CMA CME Accreditation Standards Manual

17. What do we really want to accomplish?

18. Improve the Quality of Care Thus Improve Patient Outcomes

19. Where Do We Start?

20. NEEDS ASSESSMENT

21. If there is no need for improvement there is no need for CME

22. Needs Assessment Then call us

23. The Gap

24. The difference between where we are today and where we want to be

25. Interventions to close the gap should address the basic physician core competencies

26. Medical Knowledge This is the ability to use medical knowledge for clinical problem solving and medical decision making.

27. Competency The provision of timely, effective, appropriate, and compassionate patient care.

28. Practice-Based Learning and Improvement Understands patient care practices and assimilates necessary components for improvement. This entails the use of evidence based treatment to treat a patients health problems. This also encompasses the ability to critically interpret medical literature and use this to improve patient care.

29. Systems-Based Practice This is the ability to understand, access, and effectively utilize the resources of a health care system in order to provide optimal patient care.

30. Interpersonal and Communication Skills The ability to effectively discuss and exchange information with patients, their families, medical colleagues, and the health care professionals and other staff members.

31. Professionalism Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to diverse patient populations.

32. Closing the Gap

33. Expected Outcomes And How Will You Measure Them?

34. If you dont know where you are going how are you going to know if you get there?

35. Measuring Outcomes

36. Knowledge Pre Test/Post Test

37. Competency Intent to Change Application of skills (ACLS, simulations, etc) Post course survey

38. Performance Self Report Utilization and Review Objective Change in Practice Expert Opinion (not the strongest but useful)

39. Patient Outcomes Chart Review Quality Indicators Survival Decreased Complication rate

40. Bridging the Gap

42. Cultural and Linguistic Competency CALIFORNIA AB 1195 California requires continuing medical education activities with patient care components to include curriculum in the subjects of cultural and linguistic competency. It is the intent of the bill, which went into effect July 1, 2006, to encourage physicians and surgeons, CME providers in the State of California, and the Accreditation Council for Continuing Medical Education to meet the cultural and linguistic concerns of a diverse patient population through appropriate professional development.

43. Cultural and Linguistic Competency Linguistic Accommodations Cultural and Ethnicity data re diagnosis, incidence, treatment, clinical care Religion, faith, spirituality Nationality, Race, Ethnicity Age groups Sex, Gender, Sexual Orientation etc

45. Why Cultural and Linguistic Competency? We want to improve patient outcomes

47. Sepsis

48. Needs Assessment Our current mortality rate for patients presenting to the ER in sepsis is X% We are in the top 10% Nationally We want to be in the top 5%

49. GAP We are in the top 10% and we want to be in the top 5%

50. Intervention Analyze the problem and decide how you can effect change How can you improve performance and outcomes by addressing physician core competencies? Education – Conference and lectures – Mailings to the House Staff on the early recognition and treatment of sepsis – Posters Larger ER

51. Analysis Mortality prior to intervention and after intervention Are you where you want to be or is there still room for improvement?

52. How to Improve Patient Care Needs Assessment Outcome Program Gap

53. Regularly Scheduled Series

54. Needs assessment Gap Intervention Cultural and Linguistic Competency Evaluation

55. How to Improve Patient Care Needs Assessment Outcome Program Gap

57. References http://www.amaassn.org/resources/doc/cme/ pra-booklet.pdf http://www.imq.org/wpcontent/uploads/201 1/05/April-2011-CME-Standards.pdf