Requirements for Enduring Materials

Requirements for Enduring Materials

Enduring materials help physicians stay current with innovations in treatment and significant policy changes while ensuring they can still prioritize patient care.

Maximizing Effectiveness and Retention

Enduring materials are best suited for content that motivates learners to engage and retain knowledge independently. Their effectiveness is maximized when they are integrated with mechanisms that encourage the practical application and testing of new knowledge. For example, a video could be used as an enduring material to teach a procedure that a physician will implement as part of a Performance Improvement activity.

Enduring materials must incorporate assessments that evaluate how well learners achieve the educational objectives of the activity and set a minimum performance level. Examples include, but are not limited to, patient-management case studies, post-tests, and simulations where learners apply new concepts.

Communication

For CME activities, including those where learners participate electronically (e.g., via Internet, CD-ROM, or satellite broadcast), all required ACCME information must be transmitted to the learner before they begin the CME activity (also see ACCME’s policies regarding disclosure in the Standards for Commercial Support).

•  ACCME’s policies regarding disclosure in the Standards for Commercial Support 

The provider must communicate the following information to participants before starting the educational activity:

• Learning objective(s)
• Principal faculty and their credentials
• Medium or combination of media used
• Method of participation in the learning process
• Estimated time to complete the activity (equivalent to the number of designated credits in hours)
• Dates of original release and most recent review/update
• Expiration date of the enduring material’s certification for credit
• Disclosure summary for all planners and speakers
• Accreditation statements

For internet activities, the following also apply:

• The activity (or a link to the activity) must not be hosted on a pharmaceutical or device manufacturer’s website.
• Advertising of any kind is prohibited within the educational content.
• Links from the provider website to a pharmaceutical company or device manufacturer can appear either before or after the educational content, but must clearly notify participants that they are leaving the educational activity.
• Hardware and software requirements must be clearly stated at the beginning of the activity.
• A method must be provided for learners to contact the provider with questions about the activity.
• The provider must adhere to and inform participants of their confidentiality policy regarding internet CME activities.
• The provider must demonstrate ownership or permission to use any copyrighted materials included in the activity.

Using Live Activities to Create Enduring Materials

When an enduring material is generated from a live activity (e.g., recording a grand rounds presentation), ACCME treats this as two separate CME activities. Duplicate copies of forms such as Commitment to Valid Content forms and Speaker Checklists will be needed, but these can generally be identical to those prepared for the live activity.

CME Activity Guidelines

These guidelines are designed for accredited providers of continuing medical education (CME) activities for physicians, in accordance with the Accreditation Council for Continuing Medical Education (ACCME). The goal of CME is to help physicians improve their knowledge, competence, and professional performance in patient care.

Definition of Terms 

*New Definitions from the ACCME Standards for Integrity and Independence in Accredited Continuing Education, introduced January 2020.  

Accredited continuing education *: The term accredited continuing education replaces continuing medical education to be inclusive of all health professions. We include accredited  to explicitly differentiate between accredited and nonaccredited education providers and education. 

Activity: An educational event for physicians, which is based upon identified needs, has a purpose or objectives and is evaluated to ensure the needs were met. 

Conflict of Interest: When an individual has an opportunity to affect CME content about products or services of a commercial interest with which he/she has a financial relationship.  The role and/or financial relationships of spouse/partner must also be considered. 

Continuing Medical Education (CME): Continuing medical education consists of educational activities which serve to maintain, develop, or increase the knowledge, competence, and professional performance and relationships that a physician uses to provide services for patients, the public, or the profession. The content of CME is that body of knowledge and skills generally recognized and accepted by the profession as within the basic medical sciences, the discipline of clinical medicine, and the provision of health care to the public. 

Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services, consumed by, or used on, patients. 

Commercial Supporter: Institutions or organizations that provide financial or in-kind assistance to a CME program or for a CME activity. 

Eligible organizations *: Organizations that are eligible to be accredited in the ACCME System. 

Financial relationships: are those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit.  Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities from which remuneration is received, or expected.  ACCME considers relationships of the person involved in the CME activity to include financial relationships of a spouse or partner. 

Ineligible companies *: Organizations that are not eligible for accreditation. These organizations were referred to as commercial interests in the Standards for Commercial Support. The new term is intended to clarify that eligibility for accreditation is not based on whether an organization is for-profit or nonprofit but is based on its primary mission and function. Please note the definition as well as the term for ineligible companies has been updated from the Standards for Commercial Support. See the eligibility section. 

Professional Practice Gap: The difference between actual and ideal performance and/or patient outcomes. 

“In patient care, the quality gap is “the difference between present treatment success rates and those thought to be achievable using best practice guidelines.”[1] 

As CME content goes beyond issues of direct patient care, the ACCME is using professional practice gap to refer to a quality gap in areas that include but also can go beyond patient care (e.g., systems’ base practice, informatics, leadership and administration). 

Mitigate *: The term mitigate replaces resolve, in guidance related to relevant financial relationships, to clarify that accredited providers are expected to mitigate the potential effect of these relationships on accredited continuing education. The expectation hasn’t changed, only the term used to describe it. 

Provider: The institution or organization that is accredited to present CME activities. 

Relevant financial relationships: Any amount occurring within the past 24 months* that create a conflict of interest.[2] *Individuals must disclose relationships with ineligible companies within the prior 24 months (changed from the current requirement of 12 months). See Standard 3.1. 

[1] Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies.Fact Sheet. AHRQPublication No. 04-P014,March 2004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/epc/qgapfact.htm 

[2] The Accreditation Council for Continuing Medical Education. (January 2020), New Standards of Integrity and Independence for Accredited Education.  

CME Activity: Introduction

The purpose of Continuing Medical Education (CME) is to facilitate life-long learning among physicians so that their practices may reflect the best medical care for their patients. The goal of CME is to help physicians enhance their performance in practice. All involved in the CME enterprise – educators, meeting planners, faculty, authors, speakers, accredited providers, supporters, and the physician learners themselves – are responsible for fulfilling this goal. 

AnMed ensures that any activity receiving AMA PRA Category 1 credit™ meets standards established by the Accreditation Council for Continuing Medical Education (ACCME). Accreditation Rules, Policies, and Criteria have been established by the ACCME to assure physicians and the public that Category 1 approved CME activities meet accepted standards of education. These guidelines outline accepted standards for continuing medical education activities and serve as a companion to the CME Proposed Activity Application Packet for activities seeking CME Certification. 

As an accredited CME provider, AnMed CME Office must be involved in the initial planning stages of any activity for which Category 1 credit is sought. This occurs before dates, speakers, and activity content have been confirmed. It must occur prior to the preparation and dissemination of any activity announcements. 

Criteria for Involvement 

1. Return the completed application packet to the AnMed CME Office.
2. All applications must be submitted at least six months prior to the proposed activity date.
3. Complete all forms thoroughly and include necessary documentation for review.
4. All forms MUST be completed in their entirety and all appropriate documentation attached for application to be reviewed. Incomplete or handwritten applications will be returned.
5. The review process will take at least 2-3 weeks.
6. CME Approval must be obtained before confirming speakers.
7. The CME Coordinator will create the flyer to advertise the event.

Approval is based upon your adherence to the CME Guidelines and Standards provided by this office. 

Failure to adhere to these guidelines can result in the denial of Category 1 credit.

CME Activity Application  

The CME Proposed Activity Application Packet has been designed to facilitate the development of an educational activity. When Category 1 credit is awarded by AnMed, the CME Office is required to document program development and implementation, and to ensure that the activity meets all nationally established accreditation standards. 

The application packet contains the following: 

1. Preliminary Data for proposed CME Activity provides initial information about the activity including location and contact information.
2. Needs Assessment determines and documents the need for a continuing medical education activity. Identifying the educational needs of your target audience will lead directly to the formulation of activity learning objectives, content, and instructional design.
3. Learning Objectives for Content Validation should clearly link needs to instructional content and desired learning outcomes. Outlining potential topics and speakers will assist in identifying outcomes for which this activity has been planned. The final version of these objectives/outcomes will be listed on the activity brochure.
4. Outcomes Measurement In order to determine the effectiveness of the activity, changes in learners’ competence, performance, and / or patient outcomes must be analyzed.
5. Budget/Financial Support Appropriate planning requires an understanding of funding and its sources.
6. Activity Director/Planning Committee Declaration must be completed for each person who is in a position to influence the content of the activity. This includes the Activity Director(s), Planning Committee Member(s), and CME Planner(s). The Activity Director’s Department Chair/Unit Chief must review, manage and resolve conflict of interest (if applicable) and approve prior to formal CME approval. 

Determination of Educational Need

When beginning the process of designing professional development activities, the goals and overall purpose of the activity should be established prior to any other work. A GOAL is a statement of the intended general outcome of an instructional unit or program. A goal statement describes a more global learning outcome. This is different than a learning objective, which is a statement of one of several specific performances, the achievement of which contributes to the attainment of the goal. A single GOAL may have many specific subordinate learning objectives. 

All continuing medical education certified for AMA PRA Category 1 credit is designed to change physician competence, performance in clinical practice, and / or improve patient health status. One or more of these goals must be identified in the general needs assessment section of the application. All planning and design of the CME activity will grow from the goal and purpose, including the methods of needs assessment, development of learning objectives, selection of content and instructional design, and methods of outcomes measurement. 

The educational need for each activity must be substantiated. Identification and assessment of physician continuing education needs provide the basis for formulating learning objectives and planning the activity. The needs assessment data could result from a survey of potential learners, identified new skills, and/or QA/QI reports of clinical practice. The need must identify and address clinical or organizational professional practice gaps. 

A written paragraph from the physician perspective in which you describe the need and method used to determine need for this activity is required. Your paragraph should be 4 – 5 sentences in which you very specifically answer the following questions: 

• Who is the target audience for this activity? (e.g., Primary Care Providers, MD, DO, NP, PA, RN, etc.)
• Why is this activity being planned for this audience?
• What are the gaps in clinical or organizational practice you wish to address? 

Indicate the methods used to determine educational need. Literature reviews, professional community needs and Evidence-Based Medicine Resources are just a few of the methods that may be used to support the educational need of an activity. Supporting documentation for the methods used must accompany the CME Application. 

Instructional Design/Content Proposal

The method of delivering content to help learners and teachers transfer knowledge most effectively is essential to the success of your CME activity. Matching target audience needs and learning objectives to educational content can be achieved through selection of the most appropriate learning format: large group didactic lectures, workshops/small group discussions, hands-on training, case-based scenarios, and panel discussions are just a sample of the formats that can be used for Live CME activities. 

AnMed has adopted the Accreditation Council for Graduate Medical Education’s (ACGME) Core Competency model for physician competence. All activities certified for Category 1 credit must identify and integrate one or more of the six ACGME Core Competencies into the curriculum of the activity. 

Learning Objectives

Objectives outline what participants should know or be able to do at the end of an educational activity. Stating objectives is essential to planning, implementing and evaluating desired outcomes of continuing medical education activities. Asking the question, “What is the intended result of the instruction in terms of the learner?” facilitates writing educational objectives. Objectives need to clearly link to the educational need, and should be attainable and measurable. 

Writing Objectives 

Objectives should be written AFTER educational need is assessed and the target audience is determined, but BEFORE teaching and evaluation methods are selected. There are three characteristics essential to ensuring clear statements of objectives. 

Behavior 

First, an objective must describe the competency to be learned in performance terms. The choice of a verb is all-important here. Such frequently used terms as ‘know’, ‘understand’, ‘grasp’, and ‘appreciate’ do not meet this requirement. If the verb used in stating an objective identifies an observable student behavior, then the basis for a clear statement is established. The List of Verbs for Formulating Educational Objectives is provided for assistance. 

Criterion 

Second, an objective should make clear how well a learner must perform to be judged adequate. This can be done with a statement indicating a degree of accuracy, a quantity or proportion of correct responses or the like. 

Conditions 

Third, an objective should describe the conditions under which the learner will be expected to perform in the evaluation situation. What tools, references, or other aids will be provided or denied should be made clear. 

Sometimes, one or even two of these elements will be easily implied by a simple statement. Other times, however, it may be necessary to clearly specify in detail each element of the objective. The following is an example of a completed learning objective: 

OBJECTIVE: “Given a set of symptoms the student will be able to identify the tests and lab work to order.”

Condition - Given a set of symptoms
Behavior - the student will be able to identify the tests and lab work to order.
Criterion - (implied) - the tests and lab work will be correct. 

List of Verbs for Formulating Educational Objectives