Regulation of Continuing Education in Medicine

Last week we examined the history of continuing medical education (CME) in the US, and the various levels of regulation of physician practice.  Today's post explores the regulation of CME.

Initially, no one certified CME. Courses run by medical schools and local medical societies existed for the edification of those they served. Only when the AMA/PRA Category 1 Credit(TM) became necessary for practice did CME become regulated. Today we have a confusing, circuitous system of checks and balances, primarily to keep CME from becoming merely marketing for new drugs and devices.

US CME Regulation, 2010

The trip through the illustration should begin with the American Medical Association (AMA), the group that owns the coin of the realm in CME. The AMA, along with 6 other medical organizations, elects the Board of Directors of the Accreditation Council for Continuing Medical Education (ACCME). ACCME accredits national providers, including the AMA. The AMA certifies state medical societies as providers of CME. State societies can accredit sponsors of CME that serve participants from a single state; generally, the audience must be at least 70% participants from the state or region in question. The ACCME reviews and recognizes state medical societies, but has no real regulatory power; only the AMA can revoke the ability of these organizations to grant CME credit.  At present time, the ACCME certifies 727 national providers.; there are 1560 state-level providers in the US.

Over time, the ACCME has increased its regulatory heft, requiring more justification of the content of offerings, reports of conflict of interest, and other compliance efforts. Assessments for accreditation have also increased over time, along with the paperwork. It is unclear if the time and funds invested have improved the CME process, let alone physician practice or patient outcomes.

Enter the report of the Institute of Medicine which provides five broad messages for US CME:

  1. There are major flaws in the way CE is conducted, financed, regulated, and evaluated. Among various problems, health professionals and their employers tend to focus on meeting regulatory requirements rather than identifying personal knowledge gaps and finding programs to address them. Many of the regulatory organizations that oversee CE also tend not to look beyond setting and enforcing minimal, narrowly defined competencies.
  2. The science underpinning CE for health professionals is fragmented and underdeveloped. These shortcomings have made it difficult, if not impossible,to identify effective educational methods and to integrate those methods into coordinated, broad-based programs that meet the needs of the diverse range of health professionals.
  3. Continuing education efforts should bring health professionals from various disciplines together in carefully tailored learning environments. As team-based health care delivery becomes increasingly important, such interprofessional efforts will enable participants to learn both individually and as collaborative members of a team, with a common goal of improving patient outcomes.
  4. A new, comprehensive vision of professional development is needed to replace the culture that now envelops continuing education in health care. Such a vision will be key in guiding efforts to address flaws in current CE efforts and to ensure that all health professionals engage effectively in a process of lifelong learning aimed squarely at improving patient care and population health.
  5. Establishing a national interprofessional CE institute is a promising way to foster improvements in how health professionals carry out their responsibilities. The committee proposes the creation of a public-private entity that involves the full spectrum of stakeholders in health care delivery and continuing education and that is charged with developing and overseeing comprehensive change in the way CE is conducted, financed, regulated, and evaluated.

The call had been made to fundamentally change CME in this country. These are exciting times for those of us who deliver and study continuing professional development, as the IOM report suggests we rename CME.

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