ACCP Releases New CME Guidelines

In the March 2009 issue of The American College of Chest Physician’s (ACCP) journal Chest, ACCP introduced the first evidence-based guideline that evaluates the effectiveness of current continuing medical education (CME) practices and provide recommendations on how practices need to change in the future. View the guideline and recommendations online at www.chestjournal.org

The CME Center contacted ACCP, asking how the guidelines were developed and how the ACCP membership as well as the general public have reacted.

Answers from Lisa K. Moores, MD, FCCP, Co-Chair of CME Guidelines Panel and Ed Dellert, RN, MBA, Vice President of Educational Resources at ACCP appear below.

What was the major impetus for creating these guidelines? Was this a reaction to anything specific or did it just naturally rise to the top of your strategic priorities?

In 2005, the ACCP’s Medical Education committee and the Health and Science Policy committee recognized the need to assess its medical education curriculum. During this assessment process, a proposal was made to evaluate the literature to determine what CME tools and techniques are most effective in improving our physician members’ knowledge and skills. It quickly became clear that there was much more to be learned from this effort and that its potential impact could benefit not only the ACCP membership but also the medical education community as a whole. Thus, the ACCP proposed and obtained acceptance from the Agency for Healthcare Research and Quality (AHRQ) to identify and synthesize the evidence for the effectiveness of CME. Johns Hopkins University and ACCP used this literature review and expanded upon it for the development of this guideline.

What was the process for the creation of these guidelines? Were there any parts of the process that were challenging? Are there any specific tips you would give to other medical societies who are interested in creating something like this?

The purpose of this evidence-based guideline, based upon the Johns Hopkins systematic literature review, is to make recommendations to assist ACCP members, the ACCP Education Committee, and any others involved in CME to further the effectiveness of their CME programs. Although the level of evidence was generally of low quality, certain recommendations could be derived substantiating what is currently being conducted by CME providers. In addition, suggestions for further investigation and research were synthesized by the panel. During the Johns Hopkins’ literature review, a primary limitation became obvious: the differences in terminology used in CME activities and in conducting CME research. Examples of terminology variation include the terms used to define the educational interventions applied, the different target audiences, the multiple types of learning objectives, the diverse content areas, and the numerous educational teaching methodologies. This variation has led to a lack of standardized CME approaches and CME research including CME research controls. This clearly makes comparison difficult and quantitative syntheses impossible.

How do you think these guidelines will affect your CME programs? Have these recommendations been adopted by your CME committee yet, or are they planning to?

The guideline writing panel noted that a primary limitation in the literature review was the absence of or little formalized training in CME to date-- for both individual teachers and professional societies providing educational programs. Educational skills and knowledge needed by CME providers is not extensively reviewed in the literature.
Very few studies indicated or outlined the training needs necessary for CME providers. Going forward, this must be addressed. The ACCP has already begun this process by creating and implementing an educational curriculum that guides the development of all of our educational programs. In addition, the ACCP has created a 6-learning categorical system that correlates with its educational curriculum is used not only in the development of its individual activities but also is reflected in its CME certificate process as one of the end products that the physician learner can receive.

What has been the reaction you have received from your membership?

Too early to tell as far as the guideline is concerned. We anticipate feedback over the next few months to be coming in from ACCP membership and the CME community at large.

From the literature review, what was the main take-away you want executives to walk away with?

There are 7 areas that we would highlight from this guideline that executives will need to work with their education leadership toward developing:

1. Instructional techniques: That a CME program should use CME interventions with multiple instructional techniques in preference to a single technique to improve physician knowledge
2. Frequency of exposure: CME programs should use multiple exposures (sessions) to CME content in preference to a single exposure be used to improve physician knowledge.
3. CME programs should not just use AMA’s definition of CME and the terms articulated in this guideline (or their modifications) should be integrated consistently by CME practitioners and researchers as they develop CME programs and study the educational and patient outcomes of CME interventions.
4. Widespread dissemination, elaboration and clarification of the terms in this document is needed. They should be used by journal editors, specialty and professional societies and by the research community so future evidence reviews can reflect a common language and make future comparisons easier.
5. CME professionals and researchers need to explicitly consider the inclusion and documentation of teaching and learning principles in the design and implementation of further trials of CME. In addition, we suggest that, whenever possible, trials be designed to study the educational outcomes of such variables.
6. When studies of CME interventions are performed, that special attention to full descriptions of elements expressed in the Continuing Healthcare Education Study and Systematic Review Template (CHESST) be incorporated (highlighted in document).
7. We highly suggest that leaders in medical education and related fields foster (i) the identification of high priority research topics in CME research that would span the broad scope of CME and (ii) conduct scientifically rigorous studies of the process and effectiveness of CME that demonstrates the effect of CME programs on individual and collective physician learners who participate in these programs.

We thank Dr. Moores and Mr. Dellert for taking the time to prepare these answers, and we would also like to acknowledge the work of ACCP’s Senior Manager for Public Relations, Jennifer Stawarz, in facilitating this conversation.

And please let us know your opinion on the guidelines and the work of the ACCP in the comments section below.