1) Maintenance of certification (MOC) is looking at clarifying the standards for MOC in a consistent manner that will help establish a common currency across boards. The MOC process may require specific types of CME while not accepting others. The process will likely migrate to look more and more like a CPD model.

2) The AMA is establishing a task force to look at how to use levels and grades of evidence in certified CME in order help make transparent the EBM aspect of CME materials.

3) The conjoint cmte is holding mixed stakeholder meetings per the IOM recommendation to look at alternate funding models and CME as well as to assess the present funding model to see if change is required and if so in what direction.

4) The IOM held a preliminary meeting to think through some aspects of a standard CME disclosure format as well as process standards. This is work that extends from the IOM report on conflict in research, education and practice.

5) Maintenance of licensure (MOL) is proceeding as an action item by the FSMB. This will likely link state licensure to MOC by the boards. This may impact those that previously grandfathered our of MOC and a separate pathway will be required for those that are not board certified.

6) The ACCME is moving forward with PARS and this electronic reporting system will impact providers who will have to adjust internal process to accommodate electronic reporting. Programming work will surely be required.

7) SACME has met and/or is continuing to meet with all those listed above as we help shape where CME of the future. We will also be meeting with LCME in a few weeks as well as we are trying to set up a discussion with NQF.

Then a day or two after that I was back in Chicago for three separate CME meetings. The first was a grant writing session with Moss Blachman and Betsy White-Williams wherein we began a draft of a large grant that the Society for Academic CME (SACME) plans to submit to acquire funds dedicated to accomplishing the CME consensus research agenda. The next day started with a Journal of Continuing Education in the Health Professions (JCHEP) owners meeting. I serve on this in my role as president of SACME. This strategic planning session will be just the beginning of ensuring the success of this journal for the future. Finally, I concluded the three days by representing SACME and attending the Conjoint Committee session held at AMA headquarters. This broad CME stakeholder meeting worked on the issue that stem from recommendation 5.3 (independence of CME) from the IOM report on conflict of interest in education, research and practice.

After being back in the office for a short period, I was again on the move. This time I went to the University of Wisconsin in Madison where I was asked to provide the Keynote address at their education strategic planning retreat. This retreat is the seventh such retreat by the university as one is held every five years. My presentation was on CME as a value center and through interactive design facilitated their ability to self-identify their value.

CME is a strategic lever for change. Providers simply will not change unless they are educated as to why change is needed, what aspects of their practice need to change based on hard data, and a program of change that can be accomplished given barriers to care that exist within the present health care system. This sort of information and access to the experts regarding advances in care are principally provided through certified CME and thus it is fundamentally essential for improvement.

Numerous CME activities focus at quality and safety topics. The activities can and do serve a pivotal role in advancing these important aspects of health care. In case you doubt how important these topics are, at least from a fiscal perspective, recently the actuaries released a report on the cost of errors in health care (see links at bottom). They estimate “that measurable medical errors cost the U.S. economy $19.5 billion in 2008. Commissioned by the Society of Actuaries (SOA) and completed by consultants with Milliman, Inc., the report used claims data to provide an actuarially sound measurement of costs for avoidable medical injuries. Of the approximately $80 billion in costs associated with medical injuries, around 25 percent were the result of avoidable medical errors.” Key findings from the study include:
There were 6.3 million measurable medical injuries in the U.S.(2008); of the 6.3 million injuries, the report estimate that 1.5 million were associated with a medical error.

The average total cost per error was approximately $13,000.

In an inpatient setting, seven percent of admissions are estimated to result in some type of medical injury.

The measurable medical errors resulted in more than 2,500 avoidable deaths and more than 10 million excess days missed from work due to short-term disability.

Given the focus on quality and safety as key components of health care reform and the clear focus on cost control, the role that certified CME can play in this domain is critically important and frankly quite exciting. Certified CME can make health care reform work!

http://tinyurl.com/25vj8ru
http://tinyurl.com/29mnart

This short position statement is from a group of faculty who specialize in Oncology who have gotten together to craft this position statement regarding their concern for the conflict and funding pendulum swinging too far. We all have experienced that once we decide to change there is a tendency to change too much too fast and these clinicians and researchers have come together to voice their opinion. One of the unique aspects here is this is a grass roots style approach and first I am aware of this nature.

Read the short statement and form your own opinion. Realize as you read it that you bring base assumptions to it and will likely interpret based upon those preconceived opinions, but at least read it to be informed about this perspective.

http://www.mayoclinicproceedings.com/content/85/2/197.full

Attendees filled out evaluations on the last day. 100% stated objectives were met and 100% stated that they would recommend the activity to a colleague. Only one attendee stated that they would not change their practice, but added the caveat that the course did validate and reinforce changes they have recently initiated.

The most common improvements to present practice stated by attendees included succession planning, enhanced use of strategic planning, especially strategic abandonment and economic evaluation of current system using Porter’s model. That being said team building, conflict management, and media training were also frequently mentioned.

In approximately 60 days a more robust follow up through the online Moodle classroom will be initiated. In addition, a follow up at approximately 9 months will also be pursued. The attendees and faculty will stay engaged through the Moodle classroom/networking site.

The planning team will be debriefing in the next few weeks and then subsequent plans for continued engagement by and with this cohort will be entertained as well as planning for a subsequent SLI with a new cohort.

The majority of the attendees come from university settings, but a still significant number come from teaching hospital and professional society practices. Attendees come principally from US and Canadian practices. The attendees match the intended audience as they serve in roles that range from Directors of CME offices to Associate Deans of CME, Professional Development, and/or Medical Education.

Several of the attendees are relatively new to their role in education while the majority has served in this capacity for a longer period of time. The attendees have identified enablers and barriers to change in their environment and these are not too surprisingly relatively consistent across the group.
Stay tuned for future blogs on the outcomes and results of the inaugural SACME SLI!

It is quite an honor to achieve such a mark. The Office of CME is integral to such success. Our involvement in education in almost every single department helps strategically support advancements in care. We help improve Hopkins through our participation in grand rounds, case conferences, morbidity and mortality meetings, and tumor boards. We serve on steering committees for innovation, quality & performance, education, and simulation. Such a pivotal position truly enables us to function as a strategic lever for change through learning.

Our high quality educational activities that are designed for an audience outside of Hopkins not only help improve attendee’s knowledge and ability and thus contribute to the rankings, but these activities contribute to the Hopkins image simply be being high quality and cutting edge, while maintaining pertinence to the clinician today.

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It would seem prudent for CEJA to consider a different approach. The last versions have all called for some ban on funding, have used outdated information and publications, and have not been based in ethical principles. Importantly, they continue to establish the benchmark for conflict and bias at any possibility instead of the more scientific probability basis. In addition, in trying to craft some allowance for funding they create regulatory and documentation burdens that interfere with education and will only drive up the cost of CME. Anyone involved in CME can see that the two things this field does not need are greater cost and regulatory/documentation burden.

Furthermore, the CEJA standards that presently exist may in fact be sufficient and CEJA may want to consider holding off instead of trying to submit a new report at each and every possible cycle. This would allow for all of the changes that exist in CME and in health care in general that are related to relationship management, transparency and conflict to settle out and be measured for effect. Thus any change to the CEJA reports and guidance could be evidence-based instead of historically-based.

The conference was opened by welcomes from both the Dean of the Johns Hopkins University School of Medicine Dr Edward Miller and Commissioner Goddell. The conference was led by Kostas Lyketsos, MD.

Dr Lyketsos opened the meeting with a broad review of the topic as well as explained the evidence-based scoring system chosen to assess the published literature. Four plenary sessions followed. At the end of the conference areas for future research were established and prioritized.