Osteopathic Continuing Medical Education
http://www.100md.com
《美国整骨期刊》
the Council on Continuing Medical Education and the Division of Continuing Medical Education in the Department of Education, American Osteopathic Association.
The author provides an update on trends in osteopathic continuing medical education (CME) programs and details minor changes to CME requirements for state licensure. In addition, this article explains changes to several policies of the American Osteopathic Association (AOA) with regard to the Association's awarding and recording of CME credits, expanded online access for physician-members who wish to obtain and track CME credit hours, and the terminology used to define the Association's key CME requirements and CME sponsor–accreditation process.
Current Requirements: CME Program Cycle, 2004–2006
Continuing medical education credit hours granted by the AOA are from one of four categories: 1-A, 1-B, 2-A, or 2-B (Figure 1). In general, category 1 is osteopathic (ie, AOA) CME credit; category 2 credit is nonosteopathic CME credit; A credit is granted for formal, didactic courses; B credit is for less formal CME activities, such as hospital committee work and reading the scientific content in JAOA—The Journal of the American Osteopathic Association in conjunction with completing THE JOURNAL's CME quizzes. A more detailed description of how CME credit is categorized by the AOA can be found in Table 1.
As announced in THE JOURNAL's Osteopathic Medical Education 2003 issue,1 the AOA Board of Trustees (BOT) approved an updated CME requirement for Association membership at its February 2003 meeting. At that time, the BOT set the requirement for AOA membership in the 2004–2006 CME cycle at 120 credit hours with a minimum of 30 hours dedicated to earning category 1-A credits. No waiver for this 120-hour requirement will be granted unless due cause or inability to obtain hours is demonstrated to the Council on Continuing Medical Education (CCME). The remaining 90 hours of the 120-hour requirement may be obtained by completing and/or combining CME credits from any of the four categories (ie, 1-A, 1-B, 2-A, or 2-B). A maximum of 60 hours of category 1-B preceptoring may be applied to the 120-hour requirement.
For those physicians who have specialty board certification through the AOA, of the total 120-hour requirement for CME credits, 50 hours must be earned in CME activities related to the primary specialty field in either category 1 or category 2—though the total CME requirement for physicians certified by the American Osteopathic Board of Family Physicians is higher, at 150 hours per 3-year CME cycle.2 Failure to fulfill this CME requirement may result in loss of AOA specialty board certification.
Continuing medical education requirements are reduced according to a proration schedule based upon the date when the osteopathic physician joins the AOA after the beginning of a 3-year CME cycle. The CCME considers exemptions, reductions, and waivers to its CME requirements on a case-by-case basis. Again, the CCME will grant no waivers without due cause or inability to obtain hours unless policy advises otherwise.
As noted, the current CME cycle began on January 1, 2004, and ends on December 31, 2006. All AOA members, other than those exempted, are required to participate in the CME program and to meet specified CME credit-hour requirements for the 2004–2006 CME cycle.
State CME Requirements
Many state licensing boards believe that CME is an important component in ensuring statewide quality in medical care. A total of 43 states have established CME requirements to qualify for relicensure (Table 2). Readers are encouraged to review the AOA US Osteopathic Licensure Summary on DO-Online.3 This document3 contains additional information about licensing requirements in each state.
Recent CME Activities at the AOA
Clinical Assessment Program
George Thomas, DO, 2004–2005 AOA President, led a task force to create and launch a performance-measurement program to further improve the quality of patient care in the United States and to engage osteopathic physicians in the process of evaluating clinical outcomes in their practices.
Practicing osteopathic physicians who are members of the AOA have been able to register for the AOA Clinical Assessment Program (AOA-CAP) through DO-Online for CME credit since July 2005 (Resolution 9: CME Credit for CAP for Physicians [A/2005]). The Web site has been ready to accept patient data (demographic and clinical) from participating physicians since September 1, 2005.
Individual physicians' outcome measures will later be compared with their peers and national measures to establish national benchmarks for patient care. As noted on DO-Online, "current clinical practices are measured and compared with evidence-based practice guidelines that represent state-of-the-art professional standards of care."4 The three main goals of AOA-CAP are:
To provide an infrastructure for a quantitative evaluation of the quality of osteopathic medical care in the United States, as provided by individual osteopathic physicians and in the aggregate.
To identify where quality-of-care improvements can be made in osteopathic physicians' offices and provide educational interventions for those physicians.
To provide osteopathic physicians with objective information on how successfully they are treating their patients.4
Physician-members who take part in AOA-CAP have the option of participating in any or all of three "measure sets": coronary artery disease, diabetes mellitus, and/or women's health screening. For each of these measure sets, the AOA-CAP input screens have required data fields for physicians entering data from their patient charts. As noted on DO-Online,4 "clinical indicators selected for measurement represent evidence-based clinical practice standards derived from large randomized controlled clinical trials, single controlled observational studies, or expert consensus." Physicians must also enter data for their patients regarding the findings of osteopathic structural examinations.
Participating physician-members can enter data for 20 patients to receive a performance analysis report from the AOA within 14 days. This initial performance score is the baseline measure for tracking future progress and making longitudinal performance comparisons. After physicians enter a second data set, they receive a second performance report and 20 hours of category 1-B CME credit. A total of 60 CME credit hours can be earned per CME cycle through AOA-CAP.
DO-Online's New CME Center
In October 2005, DO-Online launched a new online CME center, giving AOA members access to hundreds of accredited hours of online CME courses. With the help of this new online feature, AOA members can search a catalog of online CME activities, access and complete those activities online, complete CME quizzes online, and receive documentation of their activities on their CME activity report (CAR) within 24 hours (Figure 2).
As noted in THE JOURNAL`s 2003 Medical Education issue,1 physician-members can view their current CAR at any time through the DO-Online Web site (see http://do-online.osteotech.org). In addition, CARs from previous CME cycles are kept online for at least 6 full years after the end of a cycle (eg, reports for the 2004–2006 cycle will be archived on the site through 2012). However, only those physicians who are AOA members and registered DO-Online users can review their CARs online.
The AOA has always maintained the CAR as a private document. However, physician-members can download the CAR as a hard copy or attach it to an e-mail sent by the AOA to a third party, as specified by the physician-member. The AOA releases the CAR to outside agencies only on written request by the physician-member. Through DO-Online, the AOA will continue to maintain the confidentiality of this information, but individual physician-members have the added convenience of forwarding this information electronically at their discretion.
The CCME continues to believe that all CME activity should be audited. Therefore, physician-members will not be allowed to enter or update their CME records online and should continue to submit their update requests for CME credit directly to the Association's division of CME. Physician-members are encouraged to address such correspondence and requests to the following address: American Osteopathic Association, Attn: Division of CME, 142 E Ontario St, Chicago, IL 60611-2864.
AOA Publications
As announced in the JAOA,5 the lifespan of CME quizzes published in AOA custom publications has been extended to 18 months from the date of publication (ie, the date on the cover). The AOA's custom publications currently include supplements to the JAOA and to The DO magazine (ie, The Whole Patient), as well as several independent newsletters (eg, AOA's Women and Wellness, AOA Health Watch).
By standardizing the lifespan of CME quizzes in AOA custom publications, the Association is increasing the options osteopathic physicians have for earning CME credits, because the AOA is no longer inadvertently giving preferential treatment to materials published early in a CME cycle. The new protocol should also alleviate any confusion physician-members may have had about the longevity of CME quizzes appearing in AOA publications because all quiz expiration dates will be published along with the quizzes.
Quizzes in JAOA supplements carry 2 hours of AOA category 1-B credit, while quizzes in The Whole Patient carry 1 hour of category 1-B credit. Osteopathic physicians can earn 1 hour of AOA category 1-B credit for completing quizzes published in the AOA's Women and Wellness and the AOA Health Watch newsletters.
Physician-members can also earn AOA category 1-B credit from the quizzes in all issues of the JAOA for 18 months from the date of publication.6 (For more information, see the AOA Communication on page 96 of the present issue.) In addition, provided that completed JAOA quizzes are submitted during their designated life span, CME credit hours earned shall be applied toward the current CME cycle at the time of submission—regardless of the cycle at publication (eg, a February 2006 JAOA quiz with a deadline of August 31, 2007, that is received by the division of CME on August 17, 2007, will be credited to the physician-member's CAR for the 2007–2009 CME cycle—not for the 2004–2006 cycle).
Recent Activities of the CCME
First Annual CME Forum
The CCME meets three times annually (ie, in January, April, and November) to address members' concerns and routine business related to CME programming.
In November 2005, the CCME conducted its first annual CCME Forum to educate new council members. All council members were provided with orientation materials that provide an overview of the AOA's CME program and an explanation of the function of the CCME. Council members were also given an orientation on key concepts, AOA programs, and documents affecting their future work with the Council, namely:
the concept and requirements of evidence-based medicine,
information on AOA-CAP,
a frequently-asked-questions list: What constitutes a needs assessment How are CME topics determined by CME sponsors How are speakers selected for CME events
a JOURNAL article by AOA Trustee Amelia G Tunanidas, DO, and AOA staff member Diane N Burkhart, PhD,7 and
the report of the Conjoint Committee on CME.8
The goals of the AOA's CME program are continued physician excellence in patient care as demonstrated through continuous improvement in patient and public health and well-being. The program itself continues to play a critical role in the recertification process for osteopathic physicians9 and is now beginning to include ongoing skills assessments for osteopathic physicians through AOA-CAP. New quality initiatives proposed by the Conjoint Committee on CME8 are synchronous with the goals and quality initiatives of the AOA.
National CME Sponsors Conference
The AOA holds an annual conference, the National CME Sponsors Conference, to provide sponsors with up-to-date information regarding the latest requirements for maintaining their CME accreditation status. The National CME Sponsors Conference is also intended to help sponsors understand the rationale of CCME directives, clarify those directives as necessary, and explain the trends and evolution of the CME environment.
The AOA's 12th Annual National CME Sponsors Conference was held Thursday, January 5, 2006, through Saturday, January 7, 2006, at the Royal Pacific Resort at Universal Orlando in Fla. The theme of the 2006 conference was "Coping With a Changed Environment." Seventy-seven of the 103 participants in attendance were AOA-accredited category 1 CME sponsors. Topics addressed by speakers included:
"Pride in the Profession," Philip L. Shettle, DO, President, AOA
"How to Apply for Grants Online," Mike Saxton, MEd, Executive Director, Professional Education Support, Wyeth Pharmaceuticals (Collegeville, Pa)
"Osteopathic Continuing Medical Education to the Present and the Clinical Assessment Program," Diane N. Burkhart, PhD, Director, Department of Education, AOA; and William J. Burke, DO, Member, CCME; President, Ohio Society of American College of Osteopathic Family Physicians; Program Director, Doctors Hospital (Columbus, Ohio)
Morton Morris, DO, JD, Program Chair, 12th National Conference of CME Sponsors; Chair, CCME; Executive Director, American Osteopathic Academy of Orthopedics, Nova Southeastern University College of Osteopathic Medicine (Davie, Fla); delivered three lectures on topics of interest to conference attendees:
"AOA CME Policy Update"
"Maintaining Compliance in CME"
"What Constitutes a Needs Assessment"
"How to Market a CME Program and Prepare Brochures," Carsten D.W. Evans, PhD, Assistant Dean, Continuing Education and Professional Affairs, College of Pharmacy, Nova Southeastern University College of Osteopathic Medicine (Fort Lauderdale, Fla)
"Integrating Evidence-Based Medicine Into Your Program," Paul M. Krueger, DO, Member, CCME; Assistant Dean for Education and Curriculum, Professor of Obstetrics and Gynecology, University of Medicine and Dentistry of New Jersey–School of Osteopathic Medicine (Stratford, NJ)
"Update: What Does DO-Online Offer the CME Provider and the AOA Member in Regard to CME" Michael J. Zarski, JD, Executive Director, American Osteopathic Information Association (Chicago, Ill)
Concerns addressed in networking sessions included:
potential sources of commercial support for CME events,
improving and maintaining the quality of CME events,
payment to speakers at CME events,
certificates awarded for conference attendance,
improving attendance at CME events,
exhibits at CME events,
state licensure requirements,
CME requirements for retirees,
the reduced AOA 120-hour CME requirement.1
Recent CME Quality Enhancements
AOA-Accredited Category 1 CME Sponsors
As previously noted,1,10 the Council has had an ongoing struggle with the term affiliate organizations and who may apply as an AOA-accredited category 1 CME sponsor. Because a primary objective of the AOA CME program is to ensure that osteopathic physicians earn at least 30 hours of CME credit based on osteopathic principles and practice—a goal formalized in the new 2004–2006 requirements for category 1-A credit hours—sponsorship for category 1-A is limited to recognized osteopathic organizations, such as:
AOA-accredited colleges of osteopathic medicine (COMs),
AOA-affiliated specialty colleges,
AOA nonpractice affiliates, COM alumni groups, and philanthropic organizations (eg, foundations), and
AOA-affiliated divisional societies.
Although osteopathic hospitals can no longer apply to be recognized as AOA-accredited category 1 CME sponsors,10 hospitals and other organizations currently granted sponsor status will be able to retain this status until either hospital closure or failure to adhere to the accreditation requirements as specified in AOA Accreditation Requirements for Category 1-A CME Sponsors.11 Accredited sponsors have the discretion of allowing other non–AOA-accredited organizations, termed "providers," to conduct CME programs under their accreditation status.
There are currently 160 AOA-accredited category 1 CME sponsors (Table 3). A list of AOA-accredited category 1 CME sponsors is maintained on DO-Online (see http://do-online.osteotech.org/pdf/cme_sponscat1alist.pdf).
At the November 19, 2005, meeting of the CCME, the Council granted 1-year accreditation to Pikeville (Ky) College School of Osteopathic Medicine, as well as approval for AOA category 1 CME sponsorship. Of the 20 COMs and their 3 branch sites, 19 COMs now hold approval for AOA category 1 CME sponsorship.
All AOA-accredited category 1 CME sponsors are obligated to meet certain requirements to maintain their accreditation status. On an ongoing schedule, the CCME and AOA staff monitor sponsor compliance ("spot monitoring") with AOA policies and the CCME-approved Uniform Guidelines for Accrediting Agencies of Continuing Medical Education, which are found in the AOA Accreditation Requirements for Category 1-A CME Sponsors.10,11 In addition, AOA staff and the CCME investigate all written complaints or deviations from AOA policy using standard complaince review procedures.10,11
Further Revision of the Definition of "Faculty"—Category 1-A CME Faculty Requirement
In February 2005, the AOA's BOT further amended the 2003 resolution that a CME conference will be deemed to have met the 50% requirement under the following circumstances (the new language has been added in capital letters):
[If] at least 50% of the total education hours are presented by osteopathic physicians, [allopathic physicians], PhDs, or other professionals with graduate degrees who hold a full-time paid faculty appointment at a college of osteopathic medicine, AOA STAFF OR AOA COMPONENT SOCIETY STAFF WHO HOLD A GRADUATE DEGREE, or
at least 50% of the presenters are osteopathic physicians, [allopathic physicians], PhDs, or other professionals with graduate degrees who hold a full-time paid faculty appointment at a college of osteopathic medicine, OR AOA STAFF OR AOA COMPONENT SOCIETY STAFF WHO HOLD A GRADUATE DEGREE.
These additions to the definition formalized by the Association's CCME at their February 2003 meeting1 are a refinement of the policy as it appears in the Standards for Osteopathic Category 1-A Programs section of the Accreditation Requirements document, and are intended to further refine the so-called 50% rule.10,11
Specialty Certification of CME Activity
In February 2005, the BOT appointed a task force on CME to develop specific recommendations and CME requirements for the recertification of osteopathic physicians holding specialty board certification.
The BOT approved a resolution at its July 2005 annual meeting (Resolution 6: Specialty Certification of CME Activity [A/2005]) to require each osteopathic specialty board—with the advice and consent of their specialty colleges—to develop and submit a document, or "template," that identifies the type and category of CME programming that will satisfy a new 50-hour requirement for specialty board–certified physicians. The division of CME remains responsible for documenting CME hours reported for osteopathic physicians with specialty certification.
Board templates were to be submitted by December 1, 2005, for review and approval by the Bureau of Osteopathic Specialists (BOS) at their meetings on Saturday, January 14, 2006, and Friday, January 15, 2006—and for subsequent review and approval by the BOT in February.
Any specialty board that did not meet the deadline for submission of its template will be required to use the BOS default template. Fourteen of the 18 of the osteopathic specialty boards were able to meet this deadline, however.
The division of CME will restart the process of applying specialty credit hours after the BOT, with the recommendation of the BOS, has formally adopted the templates at their meetings later this month.
CME Program Trends
The Association's CME program continues to grow annually, as do the number of physician-members with a CME requirement from their state or specialty boards (Table 4). As of January 12, 2006, the number of members with a state- or specialty board–mandated CME requirement was 27,583—a 70% increase from the 1995–1997 CME cycle (Table 4). As of September 2005, the AOA reports its membership numbers at 56,000; therefore, approximately 49% of AOA members now have a state-mandated CME requirement.
Interestingly, the type of CME credit recorded by the AOA has changed over time (Table 5). Earned category 1-A credit in formal, osteopathic CME programs increased steadily but incrementally from 2.5 million CME hours in the 1995–1997 CME cycle to 2.9 million hours in the 2001–2003 CME cycle. However, earned category 1-B credit, which is less-formal, nonosteopathic CME credit, has experienced more dramatic growth, increasing from 5.7 million hours in the 1995–1997 CME cycle to 8.6 million hours in the 2001–2003 CME cycle. The CCME is reviewing this data to determine whether they represent a trend or are simply a matter of definitional changes over time.
The number of osteopathic physicians whose AOA membership was withdrawn for failure to complete their CME requirement has fluctuated between a low of 43 members in the 1986–1988 CME cycle to a high of 298 members in the 1983–1985 CME cycle. Association members are given an 18-month grace period to fulfill requirements from the previous CME cycle. A total of 259 members were dropped from membership on May 31, 2005, for not meeting the 2001–2003 CME requirement. Statistics for the current 2004–2006 CME cycle will not be available until May 31, 2008.
Similarly, the total number of CME credits recorded by the AOA has increased considerably during each successive 3-year CME cycle (Table 5). This growth is a reflection of the increasing number of AOA members who have a state- or specialty board–mandated CME requirement and the steadily increasing average number of CME credits recorded per member.
Comment
The AOA serves as the primary certifying body for osteopathic physicians, and it is the accrediting agency for all COMs and osteopathic healthcare facilities.
The BOS has established and maintains standards for the various osteopathic certifying boards. The BOS oversees matters of CME policy, jurisdiction, and standards. Currently, alternative models for recertification, including a maintenance-of-certification process based on the allopathic model, are under review by the AOA's CCME, BOS, and BOT, as well as by the osteopathic certifying boards. Because continuous certification models may have an impact on CME programming and future opportunities for cultivating physicians' competency levels, the division of CME will monitor any decisions on these issues closely.
The CCME is committed to an agenda of progress in CME policies, while at the same time maintaining the high standards for which the AOA is known. The Council will continue to study the changing environment of osteopathic medicine and adjust the Association's CME program to respond to the needs of the public, physician-members, and the AOA.
References
3. American Osteopathic Association AOA US Osteopathic Licensure Summary. August 2005. Chicago, Ill: American Osteopathic Association.
9. Ramirez AF. Board certification of osteopathic physicians. J Am Osteopath Assoc.2006; 106:77 –84.
11. Division of Continuing Medical Education. Accreditation Requirements: Category 1 CME Sponsors. Chicago, Ill: American Osteopathic Association; 2004. Available at: http://do-online.osteotech.org/pdf/acc_cmespo.pdf. Accessed November 19, 2004(Delores J. Rodgers, BS)
The author provides an update on trends in osteopathic continuing medical education (CME) programs and details minor changes to CME requirements for state licensure. In addition, this article explains changes to several policies of the American Osteopathic Association (AOA) with regard to the Association's awarding and recording of CME credits, expanded online access for physician-members who wish to obtain and track CME credit hours, and the terminology used to define the Association's key CME requirements and CME sponsor–accreditation process.
Current Requirements: CME Program Cycle, 2004–2006
Continuing medical education credit hours granted by the AOA are from one of four categories: 1-A, 1-B, 2-A, or 2-B (Figure 1). In general, category 1 is osteopathic (ie, AOA) CME credit; category 2 credit is nonosteopathic CME credit; A credit is granted for formal, didactic courses; B credit is for less formal CME activities, such as hospital committee work and reading the scientific content in JAOA—The Journal of the American Osteopathic Association in conjunction with completing THE JOURNAL's CME quizzes. A more detailed description of how CME credit is categorized by the AOA can be found in Table 1.
As announced in THE JOURNAL's Osteopathic Medical Education 2003 issue,1 the AOA Board of Trustees (BOT) approved an updated CME requirement for Association membership at its February 2003 meeting. At that time, the BOT set the requirement for AOA membership in the 2004–2006 CME cycle at 120 credit hours with a minimum of 30 hours dedicated to earning category 1-A credits. No waiver for this 120-hour requirement will be granted unless due cause or inability to obtain hours is demonstrated to the Council on Continuing Medical Education (CCME). The remaining 90 hours of the 120-hour requirement may be obtained by completing and/or combining CME credits from any of the four categories (ie, 1-A, 1-B, 2-A, or 2-B). A maximum of 60 hours of category 1-B preceptoring may be applied to the 120-hour requirement.
For those physicians who have specialty board certification through the AOA, of the total 120-hour requirement for CME credits, 50 hours must be earned in CME activities related to the primary specialty field in either category 1 or category 2—though the total CME requirement for physicians certified by the American Osteopathic Board of Family Physicians is higher, at 150 hours per 3-year CME cycle.2 Failure to fulfill this CME requirement may result in loss of AOA specialty board certification.
Continuing medical education requirements are reduced according to a proration schedule based upon the date when the osteopathic physician joins the AOA after the beginning of a 3-year CME cycle. The CCME considers exemptions, reductions, and waivers to its CME requirements on a case-by-case basis. Again, the CCME will grant no waivers without due cause or inability to obtain hours unless policy advises otherwise.
As noted, the current CME cycle began on January 1, 2004, and ends on December 31, 2006. All AOA members, other than those exempted, are required to participate in the CME program and to meet specified CME credit-hour requirements for the 2004–2006 CME cycle.
State CME Requirements
Many state licensing boards believe that CME is an important component in ensuring statewide quality in medical care. A total of 43 states have established CME requirements to qualify for relicensure (Table 2). Readers are encouraged to review the AOA US Osteopathic Licensure Summary on DO-Online.3 This document3 contains additional information about licensing requirements in each state.
Recent CME Activities at the AOA
Clinical Assessment Program
George Thomas, DO, 2004–2005 AOA President, led a task force to create and launch a performance-measurement program to further improve the quality of patient care in the United States and to engage osteopathic physicians in the process of evaluating clinical outcomes in their practices.
Practicing osteopathic physicians who are members of the AOA have been able to register for the AOA Clinical Assessment Program (AOA-CAP) through DO-Online for CME credit since July 2005 (Resolution 9: CME Credit for CAP for Physicians [A/2005]). The Web site has been ready to accept patient data (demographic and clinical) from participating physicians since September 1, 2005.
Individual physicians' outcome measures will later be compared with their peers and national measures to establish national benchmarks for patient care. As noted on DO-Online, "current clinical practices are measured and compared with evidence-based practice guidelines that represent state-of-the-art professional standards of care."4 The three main goals of AOA-CAP are:
To provide an infrastructure for a quantitative evaluation of the quality of osteopathic medical care in the United States, as provided by individual osteopathic physicians and in the aggregate.
To identify where quality-of-care improvements can be made in osteopathic physicians' offices and provide educational interventions for those physicians.
To provide osteopathic physicians with objective information on how successfully they are treating their patients.4
Physician-members who take part in AOA-CAP have the option of participating in any or all of three "measure sets": coronary artery disease, diabetes mellitus, and/or women's health screening. For each of these measure sets, the AOA-CAP input screens have required data fields for physicians entering data from their patient charts. As noted on DO-Online,4 "clinical indicators selected for measurement represent evidence-based clinical practice standards derived from large randomized controlled clinical trials, single controlled observational studies, or expert consensus." Physicians must also enter data for their patients regarding the findings of osteopathic structural examinations.
Participating physician-members can enter data for 20 patients to receive a performance analysis report from the AOA within 14 days. This initial performance score is the baseline measure for tracking future progress and making longitudinal performance comparisons. After physicians enter a second data set, they receive a second performance report and 20 hours of category 1-B CME credit. A total of 60 CME credit hours can be earned per CME cycle through AOA-CAP.
DO-Online's New CME Center
In October 2005, DO-Online launched a new online CME center, giving AOA members access to hundreds of accredited hours of online CME courses. With the help of this new online feature, AOA members can search a catalog of online CME activities, access and complete those activities online, complete CME quizzes online, and receive documentation of their activities on their CME activity report (CAR) within 24 hours (Figure 2).
As noted in THE JOURNAL`s 2003 Medical Education issue,1 physician-members can view their current CAR at any time through the DO-Online Web site (see http://do-online.osteotech.org). In addition, CARs from previous CME cycles are kept online for at least 6 full years after the end of a cycle (eg, reports for the 2004–2006 cycle will be archived on the site through 2012). However, only those physicians who are AOA members and registered DO-Online users can review their CARs online.
The AOA has always maintained the CAR as a private document. However, physician-members can download the CAR as a hard copy or attach it to an e-mail sent by the AOA to a third party, as specified by the physician-member. The AOA releases the CAR to outside agencies only on written request by the physician-member. Through DO-Online, the AOA will continue to maintain the confidentiality of this information, but individual physician-members have the added convenience of forwarding this information electronically at their discretion.
The CCME continues to believe that all CME activity should be audited. Therefore, physician-members will not be allowed to enter or update their CME records online and should continue to submit their update requests for CME credit directly to the Association's division of CME. Physician-members are encouraged to address such correspondence and requests to the following address: American Osteopathic Association, Attn: Division of CME, 142 E Ontario St, Chicago, IL 60611-2864.
AOA Publications
As announced in the JAOA,5 the lifespan of CME quizzes published in AOA custom publications has been extended to 18 months from the date of publication (ie, the date on the cover). The AOA's custom publications currently include supplements to the JAOA and to The DO magazine (ie, The Whole Patient), as well as several independent newsletters (eg, AOA's Women and Wellness, AOA Health Watch).
By standardizing the lifespan of CME quizzes in AOA custom publications, the Association is increasing the options osteopathic physicians have for earning CME credits, because the AOA is no longer inadvertently giving preferential treatment to materials published early in a CME cycle. The new protocol should also alleviate any confusion physician-members may have had about the longevity of CME quizzes appearing in AOA publications because all quiz expiration dates will be published along with the quizzes.
Quizzes in JAOA supplements carry 2 hours of AOA category 1-B credit, while quizzes in The Whole Patient carry 1 hour of category 1-B credit. Osteopathic physicians can earn 1 hour of AOA category 1-B credit for completing quizzes published in the AOA's Women and Wellness and the AOA Health Watch newsletters.
Physician-members can also earn AOA category 1-B credit from the quizzes in all issues of the JAOA for 18 months from the date of publication.6 (For more information, see the AOA Communication on page 96 of the present issue.) In addition, provided that completed JAOA quizzes are submitted during their designated life span, CME credit hours earned shall be applied toward the current CME cycle at the time of submission—regardless of the cycle at publication (eg, a February 2006 JAOA quiz with a deadline of August 31, 2007, that is received by the division of CME on August 17, 2007, will be credited to the physician-member's CAR for the 2007–2009 CME cycle—not for the 2004–2006 cycle).
Recent Activities of the CCME
First Annual CME Forum
The CCME meets three times annually (ie, in January, April, and November) to address members' concerns and routine business related to CME programming.
In November 2005, the CCME conducted its first annual CCME Forum to educate new council members. All council members were provided with orientation materials that provide an overview of the AOA's CME program and an explanation of the function of the CCME. Council members were also given an orientation on key concepts, AOA programs, and documents affecting their future work with the Council, namely:
the concept and requirements of evidence-based medicine,
information on AOA-CAP,
a frequently-asked-questions list: What constitutes a needs assessment How are CME topics determined by CME sponsors How are speakers selected for CME events
a JOURNAL article by AOA Trustee Amelia G Tunanidas, DO, and AOA staff member Diane N Burkhart, PhD,7 and
the report of the Conjoint Committee on CME.8
The goals of the AOA's CME program are continued physician excellence in patient care as demonstrated through continuous improvement in patient and public health and well-being. The program itself continues to play a critical role in the recertification process for osteopathic physicians9 and is now beginning to include ongoing skills assessments for osteopathic physicians through AOA-CAP. New quality initiatives proposed by the Conjoint Committee on CME8 are synchronous with the goals and quality initiatives of the AOA.
National CME Sponsors Conference
The AOA holds an annual conference, the National CME Sponsors Conference, to provide sponsors with up-to-date information regarding the latest requirements for maintaining their CME accreditation status. The National CME Sponsors Conference is also intended to help sponsors understand the rationale of CCME directives, clarify those directives as necessary, and explain the trends and evolution of the CME environment.
The AOA's 12th Annual National CME Sponsors Conference was held Thursday, January 5, 2006, through Saturday, January 7, 2006, at the Royal Pacific Resort at Universal Orlando in Fla. The theme of the 2006 conference was "Coping With a Changed Environment." Seventy-seven of the 103 participants in attendance were AOA-accredited category 1 CME sponsors. Topics addressed by speakers included:
"Pride in the Profession," Philip L. Shettle, DO, President, AOA
"How to Apply for Grants Online," Mike Saxton, MEd, Executive Director, Professional Education Support, Wyeth Pharmaceuticals (Collegeville, Pa)
"Osteopathic Continuing Medical Education to the Present and the Clinical Assessment Program," Diane N. Burkhart, PhD, Director, Department of Education, AOA; and William J. Burke, DO, Member, CCME; President, Ohio Society of American College of Osteopathic Family Physicians; Program Director, Doctors Hospital (Columbus, Ohio)
Morton Morris, DO, JD, Program Chair, 12th National Conference of CME Sponsors; Chair, CCME; Executive Director, American Osteopathic Academy of Orthopedics, Nova Southeastern University College of Osteopathic Medicine (Davie, Fla); delivered three lectures on topics of interest to conference attendees:
"AOA CME Policy Update"
"Maintaining Compliance in CME"
"What Constitutes a Needs Assessment"
"How to Market a CME Program and Prepare Brochures," Carsten D.W. Evans, PhD, Assistant Dean, Continuing Education and Professional Affairs, College of Pharmacy, Nova Southeastern University College of Osteopathic Medicine (Fort Lauderdale, Fla)
"Integrating Evidence-Based Medicine Into Your Program," Paul M. Krueger, DO, Member, CCME; Assistant Dean for Education and Curriculum, Professor of Obstetrics and Gynecology, University of Medicine and Dentistry of New Jersey–School of Osteopathic Medicine (Stratford, NJ)
"Update: What Does DO-Online Offer the CME Provider and the AOA Member in Regard to CME" Michael J. Zarski, JD, Executive Director, American Osteopathic Information Association (Chicago, Ill)
Concerns addressed in networking sessions included:
potential sources of commercial support for CME events,
improving and maintaining the quality of CME events,
payment to speakers at CME events,
certificates awarded for conference attendance,
improving attendance at CME events,
exhibits at CME events,
state licensure requirements,
CME requirements for retirees,
the reduced AOA 120-hour CME requirement.1
Recent CME Quality Enhancements
AOA-Accredited Category 1 CME Sponsors
As previously noted,1,10 the Council has had an ongoing struggle with the term affiliate organizations and who may apply as an AOA-accredited category 1 CME sponsor. Because a primary objective of the AOA CME program is to ensure that osteopathic physicians earn at least 30 hours of CME credit based on osteopathic principles and practice—a goal formalized in the new 2004–2006 requirements for category 1-A credit hours—sponsorship for category 1-A is limited to recognized osteopathic organizations, such as:
AOA-accredited colleges of osteopathic medicine (COMs),
AOA-affiliated specialty colleges,
AOA nonpractice affiliates, COM alumni groups, and philanthropic organizations (eg, foundations), and
AOA-affiliated divisional societies.
Although osteopathic hospitals can no longer apply to be recognized as AOA-accredited category 1 CME sponsors,10 hospitals and other organizations currently granted sponsor status will be able to retain this status until either hospital closure or failure to adhere to the accreditation requirements as specified in AOA Accreditation Requirements for Category 1-A CME Sponsors.11 Accredited sponsors have the discretion of allowing other non–AOA-accredited organizations, termed "providers," to conduct CME programs under their accreditation status.
There are currently 160 AOA-accredited category 1 CME sponsors (Table 3). A list of AOA-accredited category 1 CME sponsors is maintained on DO-Online (see http://do-online.osteotech.org/pdf/cme_sponscat1alist.pdf).
At the November 19, 2005, meeting of the CCME, the Council granted 1-year accreditation to Pikeville (Ky) College School of Osteopathic Medicine, as well as approval for AOA category 1 CME sponsorship. Of the 20 COMs and their 3 branch sites, 19 COMs now hold approval for AOA category 1 CME sponsorship.
All AOA-accredited category 1 CME sponsors are obligated to meet certain requirements to maintain their accreditation status. On an ongoing schedule, the CCME and AOA staff monitor sponsor compliance ("spot monitoring") with AOA policies and the CCME-approved Uniform Guidelines for Accrediting Agencies of Continuing Medical Education, which are found in the AOA Accreditation Requirements for Category 1-A CME Sponsors.10,11 In addition, AOA staff and the CCME investigate all written complaints or deviations from AOA policy using standard complaince review procedures.10,11
Further Revision of the Definition of "Faculty"—Category 1-A CME Faculty Requirement
In February 2005, the AOA's BOT further amended the 2003 resolution that a CME conference will be deemed to have met the 50% requirement under the following circumstances (the new language has been added in capital letters):
[If] at least 50% of the total education hours are presented by osteopathic physicians, [allopathic physicians], PhDs, or other professionals with graduate degrees who hold a full-time paid faculty appointment at a college of osteopathic medicine, AOA STAFF OR AOA COMPONENT SOCIETY STAFF WHO HOLD A GRADUATE DEGREE, or
at least 50% of the presenters are osteopathic physicians, [allopathic physicians], PhDs, or other professionals with graduate degrees who hold a full-time paid faculty appointment at a college of osteopathic medicine, OR AOA STAFF OR AOA COMPONENT SOCIETY STAFF WHO HOLD A GRADUATE DEGREE.
These additions to the definition formalized by the Association's CCME at their February 2003 meeting1 are a refinement of the policy as it appears in the Standards for Osteopathic Category 1-A Programs section of the Accreditation Requirements document, and are intended to further refine the so-called 50% rule.10,11
Specialty Certification of CME Activity
In February 2005, the BOT appointed a task force on CME to develop specific recommendations and CME requirements for the recertification of osteopathic physicians holding specialty board certification.
The BOT approved a resolution at its July 2005 annual meeting (Resolution 6: Specialty Certification of CME Activity [A/2005]) to require each osteopathic specialty board—with the advice and consent of their specialty colleges—to develop and submit a document, or "template," that identifies the type and category of CME programming that will satisfy a new 50-hour requirement for specialty board–certified physicians. The division of CME remains responsible for documenting CME hours reported for osteopathic physicians with specialty certification.
Board templates were to be submitted by December 1, 2005, for review and approval by the Bureau of Osteopathic Specialists (BOS) at their meetings on Saturday, January 14, 2006, and Friday, January 15, 2006—and for subsequent review and approval by the BOT in February.
Any specialty board that did not meet the deadline for submission of its template will be required to use the BOS default template. Fourteen of the 18 of the osteopathic specialty boards were able to meet this deadline, however.
The division of CME will restart the process of applying specialty credit hours after the BOT, with the recommendation of the BOS, has formally adopted the templates at their meetings later this month.
CME Program Trends
The Association's CME program continues to grow annually, as do the number of physician-members with a CME requirement from their state or specialty boards (Table 4). As of January 12, 2006, the number of members with a state- or specialty board–mandated CME requirement was 27,583—a 70% increase from the 1995–1997 CME cycle (Table 4). As of September 2005, the AOA reports its membership numbers at 56,000; therefore, approximately 49% of AOA members now have a state-mandated CME requirement.
Interestingly, the type of CME credit recorded by the AOA has changed over time (Table 5). Earned category 1-A credit in formal, osteopathic CME programs increased steadily but incrementally from 2.5 million CME hours in the 1995–1997 CME cycle to 2.9 million hours in the 2001–2003 CME cycle. However, earned category 1-B credit, which is less-formal, nonosteopathic CME credit, has experienced more dramatic growth, increasing from 5.7 million hours in the 1995–1997 CME cycle to 8.6 million hours in the 2001–2003 CME cycle. The CCME is reviewing this data to determine whether they represent a trend or are simply a matter of definitional changes over time.
The number of osteopathic physicians whose AOA membership was withdrawn for failure to complete their CME requirement has fluctuated between a low of 43 members in the 1986–1988 CME cycle to a high of 298 members in the 1983–1985 CME cycle. Association members are given an 18-month grace period to fulfill requirements from the previous CME cycle. A total of 259 members were dropped from membership on May 31, 2005, for not meeting the 2001–2003 CME requirement. Statistics for the current 2004–2006 CME cycle will not be available until May 31, 2008.
Similarly, the total number of CME credits recorded by the AOA has increased considerably during each successive 3-year CME cycle (Table 5). This growth is a reflection of the increasing number of AOA members who have a state- or specialty board–mandated CME requirement and the steadily increasing average number of CME credits recorded per member.
Comment
The AOA serves as the primary certifying body for osteopathic physicians, and it is the accrediting agency for all COMs and osteopathic healthcare facilities.
The BOS has established and maintains standards for the various osteopathic certifying boards. The BOS oversees matters of CME policy, jurisdiction, and standards. Currently, alternative models for recertification, including a maintenance-of-certification process based on the allopathic model, are under review by the AOA's CCME, BOS, and BOT, as well as by the osteopathic certifying boards. Because continuous certification models may have an impact on CME programming and future opportunities for cultivating physicians' competency levels, the division of CME will monitor any decisions on these issues closely.
The CCME is committed to an agenda of progress in CME policies, while at the same time maintaining the high standards for which the AOA is known. The Council will continue to study the changing environment of osteopathic medicine and adjust the Association's CME program to respond to the needs of the public, physician-members, and the AOA.
References
3. American Osteopathic Association AOA US Osteopathic Licensure Summary. August 2005. Chicago, Ill: American Osteopathic Association.
9. Ramirez AF. Board certification of osteopathic physicians. J Am Osteopath Assoc.2006; 106:77 –84.
11. Division of Continuing Medical Education. Accreditation Requirements: Category 1 CME Sponsors. Chicago, Ill: American Osteopathic Association; 2004. Available at: http://do-online.osteotech.org/pdf/acc_cmespo.pdf. Accessed November 19, 2004(Delores J. Rodgers, BS)