1. 1 CME, Why Me? A Guide for Administrative Professionals Copyright  2002 by: Kathy J. Kavanagh, Director Revised: 01/01/14 Continuing Medical Education, New York Medical College Room 2N-C18 40 Sunshine Cottage Road (Skyline Drive) Phone: (914) 594-2530 Fax: (914) 594-2531 Kathy_johnston@nymc.edu

2. 2 What the Heck is CME, and why should you care?

3. 3 The High Brow Answer: CME (Continuing Medical Education) consists of educational activities which serve to maintain, develop, or increase the knowledge, skills, and professional performance and relationships that a physician uses to provide services for patients, the public, or the profession.

4. 4 What this means in English: CME consists of educational activities that teach practicing doctors new information and skills so they can take better care of their patients.

5. 5 But they are doctors. They already have had years of training, why do they need more education?

6. 6 Because, as in any field, things change. New problems are discovered, as are new solutions.

7. 7 CME is one way that doctors can remain up-to-date, both in their specialty and in medicine in general.

8. 8 So doctors have a moral obligation to continue their education, why do you have to get involved?

9. 9 Because, over the course of time, CME, like many other areas, has become regulated. CME

10. 10 Many States now require that a physician obtain CME credits for re-licensure.

11. 11 Most Specialty Boards require CME for continued certification.

12. 12 Virtually every hospital requires that a physician obtain CME credits for hospital appointments and re-appointments (credentialing).

13. 13 So they need CME, but who decides how much credit, if any, a CME activity is worth? And, how does a physician prove he/she participated in CME activities?

14. 14 In 1968, the American Medical Association (AMA), came to the rescue with the Physicians Recognition Award (PRA). SS AMA

15. 15 The PRA has become the standard for recognizing physicians’ participation in CME.

16. 16 But, Can just anyone “designate” an activity for PRA credit? PRA Credit

17. 17 No. The AMA wanted to ensure that activities designated as CME for the PRA were quality activities that met their criteria for continuing medical education.

18. 18 The ACCME (Accreditation Council for Continuing Medical Education) was formed to monitor providers of PRA designated CME.

19. 19 The ACCME’s job is to help ensure CME activities are of scientific merit and appropriate for the people who participate.

20. 20 New York Medical College is accredited by the ACCME to provide CME for physicians.

21. 21 The NYMC Office of CME works to help identify and plan CME activities. CME

22. 22 In order to maintain our accreditation and ability to designate PRA credit, we must follow the rules of both the ACCME and the AMA. ACCME AMA

23. 23 And yes, there are rules - a lot of them! ACCME AMA

24. 24 These rules do have a purpose (other than to torment you and the participating physicians).

25. 25 CME Rules “The Highlights” “Rules of CME” Starring: ACCME & AMA

26. 26 The process used to plan, execute, and evaluate a CME activity must all be linked together.

27. 27 CME must: Be based on an Identified “gap in practice” What this means is that the group at which the activity is directed must have demonstrated in practice that they need to acquire new information or skills. In even plainer English, “What are the doctors not doing that they could do that would improve their patients’ health?”

28. What exactly is a “Gap?” 28 Practice Gap What Docs are currently doing in their practice What Docs should be doing to improve their patients’ health

29. 29 So, How do you “Identify the Gap”? –You must first identify the accepted standard of care and/or screening for a specific condition –You must then assess your physicians’ current practice (what your physicians {the target audience} are/are not currently doing for the same specific condition) –The difference between what your physicians should be doing and what they are currently doing is the “Practice Gap”

30. Where can gaps be found? –There are many ways in which gaps can be identified. Some examples are: QA/QI Reviews Specialty Society Guidelines Public Health Data, Chart Audits, Hospital Discharge Data Physician Self Assessment Government Mandates Current Medical Literature Program Evaluation Data 30

31. Connecting gaps to your learners… If you used data on a national or state level to identify a practice gap, you must show how you connected that gap to your own learners. 31

32. All CME Activities need to be developed in the context of desirable physician attributes (ACGME/ABMS Competencies) 32 Patient Care Medical Knowledge Practice-based Learning Intrapersonal Skills Professionalism Systems-based Practice

33. 33 Ok, now that you have a “gap” then what? Why does this gap exist? Is it due to your target audience’s lack of: –Knowledge (factual information, being aware), –Competence (Strategies for/ or knowing how to do something), or –Performance (carrying out a strategy or task)? How can you best address this gap? What do you hope to accomplish with this activity? This becomes the Activity Goal

34. 34 Once you have defined “who needs to learn what”, what do you do next? X Who X What How When Where

35. You now need to figure out the best way to achieve your activity goal. Should it be a lecture? A workshop? A computer based lesson? A hands-on skill training session? Or a combination of methods? If we are going to certify people in open-heart surgery, then it might be a good idea to have hands-on training before we let them loose in the operating room! 35

36. 36 Do you hope to improve: –Physicians’ Competence (new abilities/strategies) –Physicians’ Performance (modify practice) –Patient Outcomes You must also ask yourself what this activity is designed to change.

37. 37 Through the formulation of “learning objectives” Objectives should be: clear measurable learner oriented Example: “As a result of participating in this activity, the learner should be able to identify and define the key terms used in CME.” Going Hand-in-Hand with this is, exactly what are you hoping they will learn, and how will you know if they learned it?

38. 38 You also need to pick the right instructors for the activity. Martha Stewart might be a good choice for teaching people how to make gifts out of soup cans, but I don’t think I would want her teaching brain surgery!

39. 39 You also need to decide how to measure the activity’s success in reducing the “Practice Gap”. This “evaluation” can be in many forms but must relate to the type of change you hoped to make (competence, performance, or patient outcomes) Some examples of evaluation methods are: –Follow-up questionnaires - Pre/post tests –Review of patient data - Focus groups

40. 40 Since the goal of CME is to fill a gap in physicians’ performance to improve patient care, we should ask the learners what changes they will try to make as a result of participating in the activity.

41. 41 We can then follow-up with the learners to see if they made the change, and if they didn’t make a change, what prevented them.

42. 42 This follow-up should be done 3-6 months after the activity and can be accomplished by: Sending a follow-up questionnaire to participants Reviewing chart, QA, or hospital discharge data to see if patient care has improved Holding focus groups

43. 43 So, you have done your homework - You: identified the gap & the target audience selected the best activity method picked the most suitable instructor(s) wrote clear and measurable learning objectives to address the gap created an appropriate evaluation method to measure the activity’s success Now you just need to figure out...

44. 44 How to get people to come to the activity!

45. 45 Advertising is the Answer!

46. 46 A brochure is the most common way to advertise an activity.

47. 47 Brochures are useful because: They are relatively inexpensive They can contain all the activity details (time, place, topic, etc.) If designed well, they can generate interest in an activity They can be easily distributed

48. 48 It is important to note, however, that all advertisements need to be approved by the CME Office prior to distribution. Yup, it is those pesky “rules” again. The CME office must make sure that the correct statements are included, and that items that are not allowed, are excluded.

49. 49 Wow, You told lots of people about the great program and they all want to participate – Now, you just need to figure out how to pay for it all!

50. 50 Uh oh, you just discovered that your rich uncle didn’t leave you a fortune, How ever will you pay for all this?

51. 51 Everyone needs some help at times, and it is perfectly ok to have outside companies help support a CME activity. CME Activity

52. 52 It is ok for even Pharmaceutical Companies and Device Manufacturers to Contribute.

53. 53 Drug and Device companies often contribute to, and may even fully underwrite, CME Activities. It is legal and acceptable as long as the company does not control any part of the activity or provide any guidance on the content of the activity or on who should deliver the content.

54. 54 Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients is considered to be a “Commercial Interest” Note: providers of clinical service directly to patients are not considered commercial interests.

55. 55 To ensure that activities remain well- balanced and unbiased Certain rules must be followed by the: Commercial Interests, Activity Director, Faculty, CME Office, and Participants.

56. 56 These rules are called the “Standards for Commercial Support” (SCS, for short). SCS

57. 57 Highlights of SCS Activities must be free from commercial bias for or against any product Any off-label use discussed in an activity must be clearly identified as being “off-label” Therapeutic options discussed in an activity must be objective and balanced Generic, not brand, names should be used whenever possible All Funds from a Commercial Interest must come to and/or with the knowledge of the CME Office

58. 58 SCS Highlights, Continued No commercial promotional materials may be displayed or distributed in the same room as the educational activity –(Yes, this means that banners, pens, pads, etc. can’t be displayed or distributed in the educational room.) Support cannot be contingent on the provider relinquishing control over any part of the activity

59. 59 SCS Highlights, Continued The terms, conditions, and purposes of any commercial support must be outlined in a signed agreement between the activity director, the commercial interest, and the CME Office No payments may be made directly by a commercial interest to activity faculty or to directly pay any activity expenses All commercial support must be acknowledged in announcements, brochures, and hand-outs

60. 60 SCS Highlights, Continued Commercially supported social events at CME activities should not compete with or take precedence over the educational event(s).

61. 61 AND, most importantly... To ensure that activities are un-biased, prior to the activity, each Activity Faculty member and Planner must disclose to the provider any significant relationship(s) with all commercial interests. If the potential for a perceived conflict of interest (COI) is identified, the provider must take steps to resolve this conflict before the activity.

62. 62 Sample Mechanisms for resolving COI End the Relationship Have an impartial person review the presentation content to ensure it is well- balanced and unbiased Remove the person from participating in the planning and presentation of the activity

63. 63 Example: Clarence Clinician, MD has been invited to give a talk about stress-reduction interventions at your annual conference Dr. Clinician indicates that he owns 50% of the stock of “Stressbusters” the manufacturer of a pill that lowers adrenaline levels It could be perceived that Dr. Clinician might be biased towards the Stressbusters drug over other therapeutic options Stress Out

64. 64 This doesn’t mean Dr. Clinician can’t be a part of our conference

65. 65 Steps must just be taken to ensure that his presentation is well balanced.

66. 66 It is ultimately up to the audience to decide if the presentation is unbiased.

67. 67 If we resolved the potential Conflict of Interest, why do speakers and planners, still have to disclose? My Name is Clarence Clinician And I own stock In StressBusters.

68. 68 Because, the audience needs to know with which companies a speaker has a relationship, to be able to determine If the presentation is influenced.

69. 69 Who Has to “Disclose”? For CME purposes, any person who has control over a CME activity (e.g. planner, presenter, moderator, instructor) is considered part of the “activity faculty” and/or “planning committee” and must provide disclosure information.

70. 70 How do you go about getting this information from the activity faculty?

71. 71 Each activity faculty member and planner is asked to complete a “Financial Disclosure Form” This Form asks information regarding financial relationships with commercial interests and/or manufacturers of products discussed in their presentations.

72. 72 The faculty member and planner must indicate either: They have no significant relationship They have a relationship (and then state the nature of the relationship) They are refusing to disclose any information regarding relationships – Note, if they refuse to disclose they CANNOT participate in the activity.

73. 73 How the heck do you figure out the number of PRA credit for the activity?

74. 74 CME PRA credits are generally designated based on the actual time spent in the educational portion of the activity.

75. 75 Sorry, breaks and lunch with colleagues don’t count.

76. 76 credits are calculated to the nearest quarter hour (15 minutes).

77. 77 If the credits are already calculated before the activity, why do you have to use those annoying “Attendance Attestations” (Proof of Attendance Forms)?

78. 78 Because, believe it or not, we are not the CME police. It is up to the participant to tell us how long he/she spent in an educational activity.

79. 79 The CME Office must then issue a CME certificate with the number of credits claimed (but not more than the maximum) for the activity.

80. 80 Information regarding credits issued to physicians must be maintained by the CME Office for 6 years.

81. 81 The CME Office’s role in all this is to assist Activity Directors in developing quality programs and ensuring that all NYMC, ACCME, and AMA policies are followed.

82. 82 Now, Here is how you can

83. 83 Forward completed paperwork to us in a timely fashion.

84. 84 If you are unsure of how to do something, ask us BEFORE you do it.

85. 85 Share your suggestions of ways we can improve our services.

86. 86 Explain the importance of the CME paperwork to resistant physicians.

87. 87 If you come across ideas for potential CME activities, let us know!

88. 88 Remember, we are here to help you with your CME activities.

89. 89 In case of questions, “Who You Gonna Call?” Director, Kathy J. Kavanagh (914) 594-2530 kathy_johnston@nymc.edu kathy_johnston@nymc.edu Assistant Director, Margaret Astrologo (914) 594-2535 margaret_astrologo@nymc.edu margaret_astrologo@nymc.edu Fax: (914) 594-2531 website: www.nymc.edu/cme