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>>MARCIA MARTIN: We have the webinar broken into several different sections. We're going to spend some time, first off just talking with you about the ACCME and ABIM collaboration, the history and strategic value, and for that, we'll hear from our CEO, Graham McMahon. We'll also take some time to actually go out to the website and show you how to register activities for ABIM MOC in PARS. We'll show you some educational resources that will be available, or that are available, on the ACCME's website to support the collaboration. We'll spend a considerable amount of time in question and answer. Many of you submitted questions in advance and we thank you for those. We'll start off with those and then go to questions that are submitted throughout the course of the beginning of the webinar as time allows. And then, we'll wrap up and talk to you about some next steps.
Okay, so let me introduce to you the staff that you'll be interacting with on today's webinar and hearing from. We have staff from both the ACCME and the ABIM with us today. Graham McMahon, our CEO, is joining us today, as well as Kate Regnier, myself, and Andrea Morgan. And with ABIM, we have Marcie Bonilla, Kevin Caviston, Veronica Jones, and Natalie Trahey joining us today. So, those are different staff that you may hear from throughout the course of the next hour and a half. Okay, so with that, we're going to go ahead and launch right into our agenda and start off by hearing a little bit about the collaboration. So, we can go ahead to the next slide. And I'm going to turn things over to Graham McMahon, our President and CEO. Graham.
>>GRAHAM MCMAHON: Thanks very much, Marcia. Graham McMahon here. Hello, everybody. Really nice to have a chance to chat with you about this collaboration and the deliberation of CME to meet the needs of ABIM diplomates across the country. ACCME's mission, just to remind us all, is to develop and promote standards for quality continuing medical education utilized by physicians in their maintenance of competence. And it's a shared mission that we have with ABIM to drive quality and education for the community of practitioners out there and for the well-being of the patients that we serve. ABIM requires that their diplomates, a number of about 200,000 nationally, earn approximately or exactly, a 100 points—MOC points—over five years. And in doing so, they've created a Maintenance of Certification program that encourages clinicians to engage repeatedly over that period of time to stay current in best practices in internal medicine and in their specialty areas.
Traditionally, the program for MOC has required a process of peer review. It's required some time to get activities approved. There have been a relatively narrow range of activities that... or formats that are recognized in that program. And for some providers, the technological requirements for engaging in those formats was a barrier to meeting the needs of their diplomates locally.
As educators, we live to make a difference in the world. Our job is to cultivate curiosity through stimulating our learners, inspiring them. To create engagement through the development of relevant, meaningful, trusted, and efficient activities. To generate the highest quality learning with progressive activities, personalized activities, and providing feedback to our learners. And we have a responsibility to support change by measuring for change, rewarding and encouraging change, developing repeated activities to support that change, and allow for reflection in the activities. And through those processes, hopefully engage not just the hearts, but also the minds of our learners, and engage them with others in collaborative learning to generate best practices.
Our collaboration really reflects that yearning for the opportunity to create the highest quality in education for the community. And to remove as much as possible, unnecessary barriers that didn't drive towards those principles of quality, and allow simplified and straightforward process for having providers be able to meet learner choice—provide a flexible range of choices, a wider range of formats and remove what could be for some people, technological or time barriers to creating activities that meet the needs of your learners, wherever they are.
One of the specific opportunities here is to meet local learners’ needs—where they live, work, and learn—through the development of local activities. But there's also a clear opportunity for national providers to be able to reach through a wider variety of formats, the needs of specialists and other individuals that need very focused activities that are best generated from national providers.
We also wanted to make sure that—and not just existing courses that you're running, and existing activities that you're running, that are high quality and meet ABIM's requirements would matter for MOC—but, of course, that you'd be able to think about new courses that you're developing to make sure that those meet their needs. And there's also opportunity in the requirements to retroactively award credit for those activities that you've been doing since January of 2014 that might have met the ABIM requirements to allow you to issue credit retroactively.
Fundamentally, though, this is a terrific collaboration to allow us, as providers, to really meet the needs of our learners through a wider range of activities, a wide range of formats, and a different way of thinking about the value of education for ABIM diplomates. And of course we hope that other boards will be engaging with us; several are in conversations with us to do similar activities to meet the local needs of their diplomates for different boards.
I just wanted to review a couple of the medical knowledge requirements for ABIM... ABIM requirements. These are, of course, listed in the Medical Knowledge Assessment Program Requirements for the ABIM and available online. All you need to do is go to ABIM's website or ours and Google this document, it's up there. There are a couple of core requirements for the Medical Knowledge Assessment Program. These are listed one, two, and three, et cetera. The first is that the activity is directly provided or jointly provided by a provider, accredited, in good standing, within the ACCME System. Secondly, that the activity is certified for AMA PRA Category 1 Credit™ in one of the following activity types. And I think you'll see here a recognizable list of activities that you're almost certainly already doing as an accredited provider within our system. And it includes a broad variety of activities that include enduring materials, internet enduring materials, journal-based CME, internet searching and learning, test item writing, and importantly, live activities that can comprise a variety of components such as committee learning, courses, internet live activities, or regularly scheduled series like your grand rounds activities.
Many of the organizations who provide CME have, for example, an annual meeting, and traditionally some of those annual meetings have only had components that might work or be accounted for MOC points. This will continue to be facilitated and allowed, in that some of your activities, within a larger context can, of course, be eligible for MOC points within those larger activities. ABIM 3 states that the activities relevant to physicians certified by ABIM, as demonstrated by the professional practice gaps and the content of activity, and the hope is that as providers, you'll be generating activities, of course, that meet your learners' needs by having relevance recognized.
The fourth requirement is that, there are some format-specific criteria. For enduring materials, journal-based, and live activities, ABIM asks that the activity is peer-reviewed during the planning process by at least two reviewers who are not the author, mostly with the intent of maximizing relevance, so that relevant activities are promoted to the learners. For test item writing, that physicians participate in a committee process that includes a minimum of three members. And for live activities, such as committee learning, internet live courses, and regularly scheduled series, that there's a comprehensive evaluation component that measures learners’ change. I think importantly, the methods for evaluation have evolved as our understanding of what matters for education and learning has changed. And it includes a wider variety of formats for measuring learning that includes, of course, multiple choice items and fill in the blank, longer form tests, or importantly, a written or shared responses, such as a reflective statement or a spoken word, spoken to a teacher or a group that qualifies as meeting the standard that you set as the provider. But of course, other formative and summative content-relevant exercises that evaluate the effectiveness of the learning allows use of creativity and opportunity to be doing measurement or doing assessment, or evaluating participation in a new or different way. All live activities must utilize evaluation methods which identify a passing standard that the provider determines, and includes feedback to the learner that includes a rationale for the correct answer and when relevant, relevant citations. And those can be provided, of course, in a written format, they can be spoken, they can be reviewed on a basis of a case that's been solved to clarify that the correct answer or how a patient did, all qualifies as meeting these requirements.
Not every activity needs to meet the optional patient safety activities, but ABIM has currently suspended patient safety activities as a requirement, but it is still optional if you want to provide these activities then you can, and get credit for them. And I won't read through all of the lists here, you can see them on the website yourself, but if you do patient safety activities, it should comprise either foundational knowledge or prevention of adverse events.
So with that, I will come back to some questions after Andrea's had an opportunity to introduce how we'll have activities matter, and be registered on our site for automatic and instantaneous approval. And then we'll come back to some Q&A, both on the questions you've submitted as well as questions that you can write in the comments box or speak to us as we conclude the presentation. Thank you. Andrea.
>>ANDREA MORGAN: Thanks, Graham. What I am going to show now is a demonstration of both the changes that we've made in PARS to register these activities. So what I'm going to do is I'm going to start by going to PARS and logging in. Once we are in PARS, we'll want to go to the Activities tab. The first thing we're going to do is register a new activity for 2015 or 2016 that will be registered for ABIM MOC credit. I'm going to go ahead and go to the Activities tab, make sure that I'm in Reporting Year 2015, and add an activity.
Okay, so for this activity, I am going to add a course. It's going to be a case-based course, and the title is "First Aid and CPR." For this activity, I am actually going to add a lot of information, just to not only go through each field, but just for completeness, I'll go ahead and fill these in. So, this activity is in Chicago, for today. This activity is directly provided, with five hours of instruction, and five AMA PRA Category 1 Credits™. All of the fields that I've filled in so far should be familiar to anybody who's entered an activity before. These are all fields that are a part of our PARS system. So, the description of content is just an open field text form. This activity was designed to change competence and the changes in competence were evaluated. In the Competency section, I'll say, this was patient care and procedural skills and medical knowledge. There were 50 physician participants and 10 other learners. And for this activity, there was no commercial support received; and now this is where the changes come in place.
So we have added the section, it's Maintenance of Certification and this is the section where the registration for ABIM MOC activities will be completed. So for this activity, I would like to register the CME activity for MOC so that physician attendees may receive MOC credit. Okay, "With which specialty boards would you like to register this activity?" I will go ahead and check the American Board of Internal Medicine. When you check this box, more information will appear. The first thing that appears is an explanation that the activity may be eligible for ABIM Medical Knowledge MOC points as well as patient safety credit. And we provide a link here to the ABIM Medical Knowledge Assessment Recognition Program Guide, this reference is in here so that it is easy for you as a provider to access and reference the requirements for this activity. Any activity that is registered for ABIM MOC needs to follow the requirements that are outlined in this program guide.
Okay. Something that also appeared is Section A and this is an attestation section, so by checking this box, I—and then it's an agreement of all of these bullet points. "I agree to abide by the policies described in the Medical Knowledge Assessment Recognition Program Guide. I attest that this activity meets all of the relevant requirements described in the ABIM Medical Knowledge Assessment Recognition Program Guide. I agree to allow ACCME to release information about this activity to ABIM for its unrestricted use. I agree to allow ACCME to publish information about this activity on its website as a service to learners. I agree to comply with requests for information about this activity if it is selected for an MOC audit by the ACCME. And I agree to collect the required individual participant completion data and submit for ABIM MOC credit via PARS."
If I agree to all of these things, I will check this box. If I have a question about some items in here, there are references here to the ABIM Medical Knowledge Assessment Recognition Program Guide and there is also a reference circle, which has both a pop-up explanation and then also if you click on this, it will send you to the ACCME website, where this question will be addressed. I agree with all of this, so I am going to check the box. Once I have checked the box, more information appears. So in Section B, this is to indicate the specialties for which this activity is relevant. In this section, you can choose all specialties, you can choose more than one specialty, or you can just choose one but there must be at least one chosen in order to register your activity for ABIM MOC credit. Section C is to identify the number of MOC points available, this field will automatically fill according to the number that was entered in the number of the AMA PRA Category 1 Credits™ designated. However, if this needs to be edited, it is also an editable field. So you can take that out and put in something different or keep it the same. There is also a reference bubble here.
Okay, if there is a session within a larger activity, then it's possible that the MOC points would be less than the AMA Category 1 Credits™. And then the last section, Section D, "Are you seeking the optional patient safety MOC credit for this activity?" If you are, an additional attestation will appear saying that, "I attest that this activity meets the patient safety requirements described in the ABIM Medical Knowledge Assessment Recognition Program Guide.”
That completes all of the fields necessary to register an activity for ABIM MOC credit. So at this point, I'm going to go ahead and "Save and Quit" from this activity. When I do that, if I have entered all of the information needed for registering the activity, you'll be given a note that says it has been registered. And if it was registered for patient safety credit, this will also appear—that it has been added for patient safety MOC credit. So, I'll go ahead and "Continue."
That was a more complete registration for the activity. There's also a scenario where maybe you don't have all of the information needed for the activity, and that's okay. I'm going to go ahead and add another new activity with similar information, but this activity hasn't happened yet. So I don't have things like participants, maybe I just want to register this activity for ABIM MOC credit, I don't want to fill in all of the information. It's going to be a similar activity. I'm going to enter in information to open this activity in PARS. So, that would be activity type, activity title, the location for courses and regularly scheduled series, and the date. I'll also put in hours of instruction since I know that already.
Okay, so now, all I want to do for this activity is register it for ABIM MOC credit. So, for the "Would you like to register?" initial question, I'm going to click "Yes". Then I am also going to click the Specialty Board that I would like to register with, American Board of Internal Medicine. What I'm going to do now to show you some of the built in help that we have added in PARS for this section, I'm going to leave the rest of the fields blank. I'm going to go to the bottom and press, "Save and Quit." If this happens, I am going to get a pop up that says that I am missing some required MOC elements in order to register this activity and I have an option here to either “Go Back,” or “Save and Finish Later.” If I go back, and go back to the Maintenance of Certification section, I will see that there are starred, red notifications for everything that's required that I need to fill out. So I'm going to go ahead and check the box that I attest to all the information, and just to show you again what will happen if there is some missing information, is I'm going to press "Save and Quit," again and "Save and Finish Later." For this, I'll receive a notification that this activity has been added but it has not been registered to grant ABIM MOC credit. This will be important if you want to register this activity. So, if I had made a mistake and maybe pressed "Save" too soon, I would just go back, make sure I'm in 2015. In my open activities, here's the course that I entered. I'll just click "Update" and I'll go back down to the Maintenance of Certification section and I'll just fill in the information that I missed. Now when I click "Save and Quit," since I entered in all of the information, I will see that this activity has now been registered to grant ABIM Medical Knowledge and Patient Safety credit. I'll go ahead and press "Continue."
Now it is possible at this time to register existing activities from reporting year 2014 for ABIM credit. If that's something that you would want to do, under the Activities tab, you will go to Reporting Year 2014. Initially, you'll see that there are no open activities, and that's the way it should be since this reporting year is already over. But under the Closed Activities tab, I'll go ahead and go under the courses, and here we have a course with a link that says "Update MOC." And if I click on this link, I won't be able to change or add any information of the typical PARS requirements for annual reporting. However, if you scroll down to "Maintenance of Certification," this field is here for 2014 activities, and it is editable. So if you want to add this activity for credit, you can go through each field, enter all of the required information, and then "Save" that information. And you will receive the confirmation that, that 2014 activity has been registered for ABIM Medical Knowledge and Patience Safety MOC credit. Those are, that's an overview and a summary of the changes that have been made in PARS, those hopefully...
>>MARTIN: Andrea?
>>MORGAN: Yes, Marcia.
>>MARTIN: Andrea, this is Marcia. I'm going to pause you just for one moment because I think we had a question submitted that's really applicable to what you just talked about. You showed editing 2014 activities and entering 2015 activities, and the question is: "How far back can we go in PARS to register activities for MOC recognition?"
>>MORGAN: That is a great question, Marcia. So, we have only made the registration available for past activities from January 2014, so anything previous to that will not be able to be registered for ABIM MOC credit.
>>MARTIN: Great. Thank you, Andrea.
>>MORGAN: Thank you, Marcia. Okay, so, that concludes the PARS demonstration, but that is part one or kind of the first step in registering these activities. By the end of this year, we will have available a participant data submission system. It's not available yet, but that is step two. So, it's important to note that registering these activities is just the first part of this process, and the second part will be making sure that participants receive their credit. If an activity is registered through PARS, we have published a list that will continue to be edited as more activities are registered, but this list can most easily be found if you go to our website; go under, “For Physicians and Healthcare Professionals,” and there's a quick link here for CME and ABIM MOC. And this will take you to a landing page that is specifically for physicians. And right around the middle of this page, you will see the ABIM MOC recognition statement and the badge. Right above that is, "Find a CME and ABIM MOC Activity." And this link will send you to, right now, a publication that is a sortable list of accredited CME activities that are registered. So, that concludes my demonstration. Marcia, I will send this back to you.
>>MARTIN: Wonderful. Thanks so much, Andrea. You all have some wonderful questions that you're submitting and we'll try our best to get to as many as possible in the Q&A section. But before we do that, I might be able to answer some of your questions by showing you some resources and support that we have available on our website. So, since we're here, we're going to go ahead and start. Let's go to the homepage, Melody, so we can show folks how to access the information about CME for ABIM MOC. So from the ACCME's homepage, we, obviously, right now, have this rotating feature which will lead you right to the page about ABIM MOC. But once that goes away, if we have something else new, let me show you how to get there permanently. So if you scroll over the “For CME Providers” tab, you're going to get this dropdown box. And under, “Quick links,” the very first link is, “CME for ABIM MOC.” So go ahead and click on that link, and that will take you to this informational page with the background that Graham discussed as well as links out to the ACCME... I'm sorry, to the ABIM Medical Knowledge Assessment Recognition Program Guide, which is a very, very valuable resource for you. A lot of the questions that you're submitting are going to be able to be answered by reviewing this guide. So, if we don't get a chance to address your question on this webinar, I'd recommend you go out and take a look at the guide. And then, if you have additional questions, you can follow up by contacting the ACCME or ABIM. If you keep scrolling, Melody, this also has links to resources, which we're going to explore in a moment. I know that some of you on the call may not be providers, but you're healthcare professionals who are looking for, for instance, that list of activities that Andrea just referred to. So let me show you another area on our website where we have information for you.
So, Melody, if we could scroll back up to the top of the page where we have our tab, if you scroll over, "For Physicians and Healthcare Professionals," again you'll get a dropdown box, and under the quick links is the “CME+ABIM MOC.” That page will provide information specifically for physicians and healthcare professionals including a link to the activities list. All right. Thanks, Melody.
For now, let's go ahead and scroll down to the bottom of this information page so we can look at some of the resources that we've provided to you as you're ramping up and getting ready to enter information into PARS. The first link under “Resources” is a tutorial page that we've created. So let's go ahead and open that page up, Melody, and we can take a look at what's included. This has background information for you about the collaboration including, again, a link to ABIM's guide that will help address many of your questions. And as we scroll down, you'll see we've created a step-by-step process to entering activity data into PARS and then registering your activities for ABIM MOC points, complete with screenshots. So if you joined us part-way through Andrea's demonstration or got called away, this is a great resource for you to take a look at. It will walk you through step-by-step how to register your activities in PARS for ABIM MOC points.
Okay, wonderful, thanks Melody. Another resource linked on that information page, go back to that page if you wouldn't mind, is a list of frequently asked questions. These are questions, we had a group that piloted this program, so they're questions we got from them as well as questions that we anticipate will be asked or have been asked. So, this is just a list, a query of all of the FAQs that we've created around registering your activities for ABIM MOC points in PARS. So, I would encourage you to take a look down through this list. You can also search, you can use our search function as usual to search on topics that may get directly get to your question. So, those are two main resources that we've provided at this point for you, and we'll continue to add resources and education to our website as you all start to use this feature in PARS and have more questions. And just one last thing. The ABIM MOC FAQs are in many different categories. There's technical questions about adding the activities the activities to PARS, but there's also question about the ABIM MOC requirements themselves. So, like I said, I would encourage you to scroll down through that list and take a look at those.
Okay. So now, we are going to take some time to tackle the questions that you've sent in in advance of the webinar as well as questions that you're typing in. And again, just be patient with me, we'll try to get to as many of those typed in questions as possible. But let's go back to our slides, Melody. We're going to look at the questions that you've sent in and the questions that are being typed in, in groups to try to categorize them, and we'll start off with questions that are related specifically to the Medical Knowledge Assessment Recognition Program Requirements. So, I'm going to go ahead and read some of these questions that have been sent in, and I'm going to ask Graham to help us by providing responses to you all. So, Graham, are you ready?
>>McMAHON: Yeah. Go for it, Marcia.
>>MARTIN: Wonderful. So, the first question is "What does an accredited provider need to do that's above and beyond the current accreditation guidelines? For example, are we already meeting all of the requirements as an accredited provider? If not, what additional work is required?"
>>McMAHON: So, first of all, I'll just clarify that if you're a provider and you have questions about this process, you should come to ACCME. ACCME will be handling the provider-based questions. And if you're a diplomate or a clinician, you should go to ABIM. ABIM will handle diplomate-specific questions. But in order to register your CME activity, the only thing that's required is for you to comply with the listed issues or expectations in ABIM's Medical Knowledge Assessment Recognition Program that I just went through. If you're an accredited provider, the expectation of providing a needs-based program that are independent, that are evidence-based, that are evaluated, all of those things stand, and ABIM's program is sitting on top of the expectations that we have for you as an ACCME–accredited provider. And those additional requirements are as you've seen quite modest with the hope that you will take that liberty and go and meet the needs of your learners, whoever they are.
>>MARTIN: Great. Thanks, Graham. And actually, I'm going to take a moment to address a question that was just typed in that's kind of a spin-off of that. Somebody is asking, “What about state medical society providers?”—so can you address how they fit into this system?
>>McMAHON: For sure. Absolutely no difference. State medical providers are accredited CME providers, just like nationally-accredited providers and the key opportunity here in many respects is for local providers to meet local needs. And many of those are state-accredited providers and the hope would be that everyone takes advantage of this opportunity to meet their learners’ needs everywhere they are. Same for joint accreditation, same for state-accredited providers, same for nationally-accredited providers.
>>MARTIN: Wonderful. Thanks for clarifying that, Graham. This question is related to the ABIM one requirement: "What is a provider in good standing? Is a provider who is on probation, for example, in good standing?"
>>McMAHON: A provider in good standing is any provider accredited in the ACCME System, including the state medical society system or joint accreditation, irrespective of their status.
>>MARTIN: Wonderful. Related to ABIM requirement number four, this says—and we've had actually several questions about peer reviews, so hopefully this will tackle all of them—"ABIM requires peer review for all activity content. Can you please define peer review and what are the required credentials of the reviewers? Is there any criteria for reviewing?"
>>McMAHON: The process of peer review means that the educational materials are reviewed by other clinicians who are sufficiently familiar with the material to be able to render an opinion as to whether they're fair, accurate, and free of commercial bias. Neither the requirements nor we say who needs to provide a peer review. That's at the discretion and professionalism of the CME provider who we trust to designate those who are in a sufficiently familiar position to be able to render an accurate opinion.
>>MARTIN: Wonderful. Thank you very much. Also related to ABIM requirement four, "How can a regularly scheduled series, such as challenging cases or a mortality and morbidity conference be peer reviewed in advance?"
>>McMAHON: I would say the accredited provider can determine the optimal mechanism themselves for engaging internists in a process that the activity is relevant and appropriate for their peers. The peer review process can include something like review of objectives, the content domains, the potential faculty, the evaluation approach, even the educational material, the assessment elements, or a combination of these or other. It's really, again, at the discretion of the provider to be sure they are providing an opportunity to ensure that the materials are relevant to their audience.
>>MARTIN: Okay. Fantastic. Thanks, Graham. Another question related to ABIM requirement four, we have one or two more of these: "Can you please expand on what is meant by 'shared responses' and provide an example of this, how or if it might relate to a group evaluation?"
>>McMAHON: Yeah, assessment doesn't have to be written down to count. Assessment can include verbal participation of learners, one-on-one with a teacher or a colleague, or in a group environment. And, it's really up to the provider to determine what amount of participation or what content, shared verbally or otherwise, counts and providers should be able to indicate which learners have met their standard that they've set for the participation of the learner and their adequate content sharing.
>>MARTIN: Excellent. Thank you.
>>McMAHON: So, just I can imagine producing a small group activity where the provider knows that the teacher has said that the four people who participated, participated actively, where their comments on point or by the end of the session, the learners all declared an interest or an understanding of the material and then report that to the provider, so that the provider can say, "Yes, all the four participants in that activity met the passing standard, which was the adequacy of their shared responses."
>>MARTIN: Okay, wonderful. And we've gotten a couple of chatted–in questions about using an ARS system for example, and getting feedback through a live meeting—verbal feedback. So I think that's a great applicable answer for those as well. The next question, again, this is the last one related to requirement four: "Does ABIM have any requirements for a passing standard?"
>>McMAHON: Passing standards are set according to the intent of the evaluation, so it's really up to the provider and their professionalism to say what matters. And again, we trust that the providers are going to set passing standards that are useful and appropriate. ABIM does not require a minimum passing threshold. A cut score can be determined by the provider and you don't have to rely on things like pre– and posttests. You can rely on an audience response system, for example, that's used through a presentation, rather than requiring some posttest. But similarly, you could have a posttest that you decide to put at the very end of a year-long grand rounds series, for example, where you decide to use a posttest. If you are using a posttest as an evaluation, then the activity planners and faculty can determine the minimum number of items that learners would need to answer correctly to demonstrate they've adequately absorbed the content of the activity. But fundamentally, the providers are responsible for setting what matters in terms of participation, in terms of what's shared, what's written down, what's indicated on a test to matter, to indicate that the learners achieved the objective of the activity.
>>MARTIN: Okay, great. Thanks, Graham. Moving on to the patient safety standard, requirement. ABIM PS1 requirement: "Regarding foundational knowledge, can those three requirements be offered in three separate sessions or modules and can credit be given for them as they occur?"
>>McMAHON: Thanks, Marcia. As you saw earlier on, the foundational knowledge, which is one of the two ways in which you can meet the patient safety requirement has to include three elements: Epidemiology of patient error, fundamentals of patient-safety improvement, and a culture of safety. And an activity that comprises all of those elements is eligible to fulfill these patient-safety requirements. If the coverage of the elements occurs independently in discrete sessions, then credit should be issued after completion of all the required elements.
>>MARTIN: Okay, great. I have one more question that was submitted in advance and then we're going to try to take some questions that were chatted in related to this topic. So, this last question that was submitted in advance: "In Table 2 of the ABIM Medical Knowledge Assessment Recognition Program, there's ‘Please clarify the following’ and there's two points, ‘First, will the individual names, aggregate data, or some other form or documentation be needed to verify that learners have successfully met the passing standard for an activity?’ And the second part is, ‘Will evidence that learners were informed that their participation information will be shared with ABIM through PARS belong on the submission response or in the program marketing?’"
>>McMAHON: Well, first of all, the ABIM expects that the information will be kept by the provider that verifies that learner participation has been completed in order to have earned the MOC points. So that means you should retain whatever records you have to say that the learners were designated by a teacher to have met the requirements, completed engagement in the audience response system or even if you're deciding to go that way to have completed a test of some sort. And you don't have to retain the actual responses to the test or responses to these items, just that you have a mechanism for verifying that a learner's completed the requirements. It's up to the accredited provider to determine how and when to inform learners that with their permission, their completion data will be shared with ABIM through PARS. And the elements that are required to be shared with us are listed in the Medical Knowledge Recognition Program, but include the ABIM ID, the first name, the last name, the month and year of birth, the activity completion date, their PARS activity identifier, and the MOC points that are allocated. Once those seven pieces of information are provided in an Excel data chart, in whatever data transfer that you're using through PARS, then it'll be registered automatically on ABIM system.
>>MARTIN: Okay, great. Thank you. So, a couple of questions that have been chatted in, Graham, if that's okay?
>>McMAHON: Go ahead.
>>MARTIN: This one goes back to the passing standard question and this person is asking, "If each individual learner has to meet a passing standard or can a group of learners meet the passing standard?"
>>McMAHON: Well, certainly a group can meet the passing standard but their provider is responsible for verifying that every individual, to whom they want to issue MOC points to, has met the passing standard.
>>MARTIN: Okay, thank you. And also, this goes back to the ABIM requirement four as well: "Does a comprehensive evaluation component that measures learners change? Does that refer to or require that there's some kind of a pre-assessment that occurs before the activity, or can the change be measured in some other way?"
>>McMAHON: This is a flexible opportunity for the provider to indicate how to change has occurred and there's not requirement for our traditional approaches to pre– and posttests, for example. You can use whatever method you think is appropriate to demonstrate that learner change has occurred, and you can define "comprehensive" at your discretion.
>>MARTIN: Okay, thank you. Let me take a look. There's a couple questions about the requirement for an enduring material. “So, it seems clear that the evaluation component is required for live activities,” and there's a few questioners that are asking “[if] it's also required for enduring materials?”
>>McMAHON: ACCME requires that evaluation occurs for every type of activity, including enduring activities and that evaluation—and of course, it's required by AMA. So that activity covers enduring materials as well, or that evaluation covers enduring materials.
>>MARTIN: Great. Thank you. Okay, I think we're going to go ahead right now and move on to the next group of questions, if that's okay? So, Melody, why don’t you go ahead and move the slide forward.
The next group of questions that we're going to focus on has to do with Andrea's demonstration; there are questions that were submitted in advance. Some of them we may have gotten answers to, and we'll still recap them for you. And then, I'll try to get to some other questions that were chatted in about PARS data entry but related to registering ABIM MOC points in PARS. First, I'll say we've received several questions about the submission of participant data. Lots of you are anxious to find out more information. First of all, the requirements, the things that you'll need to be gathering are outlined in that program guide, so I would refer you to there—as Graham mentioned—first and foremost, to see that data points that you should be looking for and collecting.
So at this time, the instructions and specifications for submitting that data isn't yet available, but we'll make it available as soon as we can and we'll also provide the same level of support and resources for that process as we have the activity registration process, including web-based material and an instructional webinar. So we will be doing webinar once that information has been released to discuss and talk about submitting participant data, so for those of you that were asking about that.
Okay, I'm going to enlist Andrea's help to answer some of these questions about entering information into PARS. We've also received several questions related to registering MOC approved sessions that are within a larger meeting. For example, part of an annual meeting or a session in a regularly scheduled series. So Andrea, can you tell us a little bit more about how we can approach or how providers can approach registering subsections of larger meetings or meeting series in PARS?
>>MORGAN: Sure. So, for activities that have a sub set of sessions that will count for MOC points within a much larger meeting, the meeting will be registered as an overall activity and then within the MOC points field, the actual number of MOC points for only those sessions that will count, should be entered into the MOC points field. So, if the activity is 20 hours overall and only five hours of sessions are counting for MOC points, it would only be five points in that field.
>>MARTIN: Great. Thank you so much. If you have more questions on that we do have one of the FAQs that's dedicated to that question, you can also follow up with info, or either through the PARS help or info@accme.org for additional questions. Okay, Andrea, "Currently there's been one point of contact for PARS, for this provider. Will the system allow more than one person from an organization to enter events into it?"
>>MORGAN: Yes. So although there is only one user appointed as the primary contact in PARS, up to five users can be added for each organization. That's how it's always been in PARS and every user has the same administrative rights, so any user entered for an organization can also enter activities.
>>MARTIN: Great. Thank you, Andrea. Next question: "Currently PARS generates a new PARS activity identifier each year for activities like enduring material that span three years, for two, or multiple years. Will the system, will that remain intact, requiring the CME MOC provider to change the identifier every year or will a new system be implemented to allow the identifier to remain the same as long as it remains approved for CME and MOC?"
>>MORGAN: So there is no change to the process for reporting enduring materials for this. Activities need to be reported once, for each year the activity is available. So enduring materials that are available for three years will need to be reported within each year they are available.
>>MARTIN: Great. Thank you, Andrea. Finally, providers are currently able to batch upload activity information into PARS. We have got several questions about batch uploading, specifically related to the XML specifications. Andrea, what can you tell us about uploading activities via an XML upload?
>>MORGAN: Sure. So, XML uploads are currently available for registering activities for ABIM MOC. All information for these XML batch uploads, including XML Schema Definition or XSD document are currently available on the ACCME website. You can find that under “News and Publications.” And in there, there is a publication section that has XML resources.
>>MARTIN: Okay. What about the tab-delimited batch upload, Andrea? Folks have used that in the past, several are asking if they are able to use that batch upload function?
>>MORGAN: For the registration of activities, tab-delimited uploads are not available. There will be a web services, there will be web services available for registration of CME activities. Currently, that information is not available yet, but it will be and will be posted in the same section as where the XML information is.
>>MARTIN: Okay. So, those are the submitted, the questions submitted in advance, Andrea, and I'm going to—we've got a bunch of questions that are being live chatted, so I'm going to try to address a few of these if we can.
>>MORGAN: Sure. Marcia, just before we get to those questions, I do want to clarify that the providers can still upload activities using a tab-delimited batch upload, but they will just need to go back into PARS and manually register those activities for ABIM MOC credit.
>>MARTIN: Great. Thank you for that clarification. So if providers are doing that at the end of the year and maybe five of them qualify for MOC, they could batch upload them and then go ahead and register individually the ones that meet the requirements.
>>MORGAN: Exactly.
>>MARTIN: Okay. And this question goes along with that, so maybe just to reiterate, “Do we have to enter activities before they occur or can we wait until the end of the year or an interval to register them for ABIM MOC?”
>>McMAHON: So this is Graham here. I would just say you can do it anytime of the year that you like, but for the credit to appear in the learner profile, you should register it preferably, as Andrea outlined, in advance. Have the activity appear on the search list so that clinicians can find your activity. Tell your learners that they can be able to see their credit at a timeline that's right for you, but many learners really appreciate seeing credit appear overnight after an activity's been completed. And that would essentially encourage you to be using PARS more dynamically throughout the year to list activities and to list completions, and upload when it's available, the participant data.
>>MARTIN: Excellent. Thank you, Graham, for pointing that out. Let me just take a look at some of these questions and see if there's another that we can ask related to actually entering information into PARS. I think we have a lot of other questions that we'll answer. Let's move onto the next screen, the next slide, Melody. We had just some miscellaneous questions that we're going to ask Graham to go ahead and weigh in on, and then I'll pull in some more of these questions that were chatted in, and we'll get through as many as we can before we wrap up. So, first is related to the audit process. Graham, this person is asking, "Can you elaborate more on the auditing process? How much lead time will be afforded to providers to send ACCME the documentation? Will the documentation need to be emailed in a PDF format, and how many average audits per year can an MOC provider expect to undergo?" So maybe just elaborate a little bit more about this auditing process.
>>McMAHON: Sure. ACCME has, and your providers have, a long history of working with us around audits, particularly for those of you who've been producing REMS activities that have been subject to audit for the FDA. Our goal is to work with you collaboratively to help you improve and develop your activities, and this is a service to ABIM to give them information about what's happening around ABIM's MOC program. Activities will be selected for audit on a quarterly basis, beginning in early 2016. We'll ask you to send us back the materials that you've collected for that activity within 30 days and submit it electronically via PDF. And our goal will be to audit 10% of activities that have been registered for ABIM MOC with one activity from each provider selected. A provider may certainly have more than one selected activity depending on how many they provide. And obviously our intent is really to promote quality control for ABIM and to give formative feedback to the accredited CME community, and help us all deliver on the needs of our ABIM diplomates nationally by developing lots of activities to meet those needs. So I wouldn't be discouraged by the fact that we have an audit process. The audit process is designed to be helpful and designed to help us as a system do the best things that we can to meet the needs of learners.
>>MARTIN: Great. Thank you, Graham. This is just a general MOC question, maybe you can shed some light on. This submitter is asking about another Board: "Previously, the American Board of Anesthesia allowed accredited providers to submit data directly to the ABA for MOC credit for anesthesiologists. It seems that the ABIM's method is different and requires additional information to be made known to the learners. My concern is that other specialty boards will develop their own tools for MOC CME credits, and accredited providers will be managing a myriad of forms for individual programs and will be a demand on the workforce. My question: Is there one MOC format for all sub-specialties?"
>>McMAHON: Boy, I wish there was. Our goal is to simplify and align and meet the needs of our learners and providers by creating as much of a unified and simplified system as we possibly can. And this is our effort with ABIM to try and do that. Your activities are already being listed in PARS. This is an auto approval of activities for MOC, and hopefully you'll find it, as I think it is, a very simplified and straightforward process to get activities immediately registered so that you can plan an activity this morning and put it on that afternoon if you so wish. And obviously, Boards differ and reserve the right to identify and stipulate the unique requirements for their diplomates and diplomate candidates. So we would welcome any opportunity to collaborate with and harmonize requirements for several boards. And, as I mentioned, at the top of the call, we're talking with several right now, and hope to be talking with as many as we possibly can to help to achieve that goal of simplification and alignment as much as we possibly can. So if you know some board people, tell them to call us.
>>MARTIN: Great. Thank you, Graham. So one more question that has been submitted in advance, and then we're going to try to get to as many live questions as we can in about 15 more minutes. Someone is asking about the transition and whether or not we'll be providing access to a demo or test system that we can use to work out the kinks before we begin submitting live data. “When can we begin to test using this web service?”
>>McMAHON: This is Graham here and I would say, we recognize that need and we plan to meet that need by putting up exactly that, a test system for allowing participants to play with the system and allow us to make sure we don't enter any erroneous patterns or problems. And we are hoping to have such a system up in the next couple of weeks. Obviously, the specific timeline depends on the tech build. We've already accelerated this process very quickly to try and meet ABIM's needs and the community's needs as efficiently and quickly as possible, so that system isn't quite ready yet, but we, as Marcia outlined and Andrea outlined, we will have an opportunity to do tutorials, formats, and testing in advance of live submission.
>>MARTIN: Okay, great. Okay, so let's go ahead and jump to some live questions. Before we get into these, we've had several folks ask about whether we're posting the slides, and I just want to remind everyone, we hadn't planned to post the slides independently, but we are recording this webinar, and we'll be archiving it to our website, by the end of the week is our plan, if all goes well. So I think that will be a far more valuable tool to you than just the slides. So those of you that are asking about getting a copy of the slides, or whether or not we're archiving the webinar, we are recording this and will be posting it to our website, to that ABIM information page, the main one that I showed you, later this week. Okay, so with that in mind, Graham, I have a question. Will there be a cost for the MOC?
>>McMAHON: There's no cost right now either from ABIM or from ACCME to participate in the program. Obviously, we may have to revisit that in the future, but we don't anticipate any costs to the providers.
>>MARTIN: Okay, great, thank you. Several folks are asking about marketing this, Graham. Can you talk to us about specific wording that should be used in the marketing materials, or that CME badge that we just saw a few slides ago?
>>McMAHON: So I would say, market away. I mean, the opportunity here is to really meet the needs of ABIM's diplomates. That's through the diversity and range of remarkable and terrific activities all of you are doing. So you can use the badge. You can talk about this program with your learners locally or nationally. And you can use the statement about the ABIM credit that's listed in the Medical Knowledge Program Guide from ABIM. I just really hope that you will market and develop activities and use these MOC points for your existing activities and get them registered and get these MOC points starting to be flowing out there, so that your learners will appreciate them and appreciate the education that your organization can provide.
>>MARTIN: Great, thank you, Graham. We have a question about, "What if an activity is not open to the public; do we have an option to indicate that in PARS?"
>>McMAHON: I don't think we have anticipated that particular issue. Obviously, what we have done in PARS is, or what we will have done in PARS in the listing of activities is link out the provider, and you can set your own admission guidelines, depending on your requirements. There's no requirement that activities listed in the MOC directory are open to the entire community.
>>MARTIN: Great. Thank you, Graham.
>>McMAHON: I'll just mention, Marcia, one of the other questions, just for clarification, that there may be different points for the activity. So let's say you have an annual meeting that has 20 AMA PRA Category 1™ Credits, five hours of that activity are designated for MOC, but the learner only attends one hour. The learner will get one MOC credit designated on the report form that would be submitted to PARS on their behalf, even though the activity may be allowed to have up to five. So that the learner doesn't have to complete the entire five hours of activity to get a point associated with an element of that activity that's approved for one point.
>>MARTIN: Great, thank you so much for that clarification. Here's another question and this is a question about the receipt of MOC points. "If an activity is registered for MOC points, do all relevant physician participants automatically receive those points? And then, therefore, do we need to collect the appropriate information or can each participant select whether or not they want to receive MOC points?"
>>McMAHON: So, you can work out, the provider can work out with their learners which learners want to claim MOC credits for their activity, and you can report those activities through PARS for any learner who has successfully been verified to have met the requirements of the ABIM program.
>>MARTIN: Great, thank you. Sorry, let me... like I said, there's a ton of questions. Let me scroll through some more of these. We talked about auditing. So, a lot of you are asking for more examples about evaluation, and I will just point out that several of the FAQs go through the different types of evaluation that you could use, so I would strongly recommend you go ahead and take a look at those FAQs because it talks through the different types of evaluation mechanism.
>>McMAHON: Maybe I'll just say a quick word about that, Marcia.
>>MARTIN: Sure
>>McMAHON: It's really important that we think about alternative ways of verifying physician engagement and understanding of the material and there's a broad permission here to allow the provider to verify a clinician's understanding in a variety of ways. And we should be creative and obviously appropriate about how we use those criteria to designate that the learner has completed and verified their completion of the activity appropriately. But it can include a smaller group; people talking amongst each other as they work through a complicated case and having a leader of that session designate that and verify that the learners by the end of the discussion really understood the elements of the case.
It could be a reflective statement when the component of the activity is really about understanding or planning for a change or thinking about an ethical or other element that's much more qualitatively analyzed or assessed. If you have longitudinal programs, it can be a more typical somewhat of assessment at the end of the activity block, or you can use intermittent assessments throughout the activity like with an audience response system or using paper-based quizzes where you ask people, "What would you do with this case?" Ask people to write down in an open text box what their first response was, then you go on to the next element and you say, "What would you do now?" And you collect those pieces of paper with that have indicated people's ability to recognize opportunities for knowledge but also opportunities for change and improvement. So lots and lots of different ways to assess activities, and I hope that the community really adopts that flexibility to engage clinicians in a program.
>>MARTIN: Great. Thank you, Graham. As we're scrolling down through these questions, I see that a lot of them are consistent and are repeating some of the things that we've answered, so I think we're getting to a lot of these questions, which is great. Andrea, this might be a question for you to address for us. This provider is asking, or this participant is asking, "Who ACCME's point of contact would be on technical issues with PARS and ABIM uploading?"
>>MORGAN: That's a great question, so the best place to e-mail questions into is our info e-mail box, so that's info, I-N-F-O, at ACCME dot O-R-G. Those problems, or those questions, rather, will probably be addressed by either myself or Edward Kennedy, or Sarah Fleming, John Sweeney. There are multiple of us here to address those questions, and they will be sent to whoever will best address those questions or the next best person available.
>>MARTIN: Okay, great. Thank you so much, Andrea. I'm going to do one or two more typed-in questions, and I think we're going to take a few minutes just to open up a few lines. So let me recap the instructions for that while I'm seeing if we have another submitted question to address. If you want to ask a live question of either Graham or Andrea or, we have ABIM staff with us as well, you can use the hand-raising icon on your panel. Everybody should be green right now, and if you press it when it's green, that means you're raising your hand. So it's the direction you're lifting your hand up, and then once you lift it up, you'll see the hand now has a red arrow. You would click it again to lower it, so if you want to have your line unmuted and ask a question live, please go ahead and raise your hand, and while you're doing that, I'll take a look and see if we can... and we'll try to get to maybe three or four of those, and then we have some feedback that we'd like to get from you.
One of the questions, Graham, was related to whether this is meeting the expectations of Part II or Part IV of the Maintenance of Certification requirement.
>>McMAHON: Yeah, this is squarely Part II. We are certainly having conversations about meeting the needs of Part IV activities, which are currently on hold at ABIM right now, but this is all about Part II.
>>MARTIN: Wonderful, thank you. Okay, so I think we're going to go ahead and take some live questions, so Melody, I'm looking at a raised hand from Cory, and I apologize, I'll do my best with your name, Cori Maroszek. So Cori, we're going to, oh, I'm sorry. Actually, Cori, you haven't entered your Audio PIN, so we're not going to be able to hear you. If you do want to ask a question, it's imperative that you've entered your Audio PIN, otherwise, we're not going to be able to unmute your line, so we'll pause and Cori, you can go ahead and try to enter your PIN, and I'm going to go ahead to Carol Schlismann. Carol, your line is unmuted, so go ahead with your question.
>>MARTIN: Carol, are you there? Okay, we're going to move on then to Regina Walker, and if you've joined via mic and speakers, you need to have a microphone available to be able to talk to us. It looks like Regina has put her hand down, so how about Kathy Bellisle. Kathy, we're going to go ahead and unmute your line. Go ahead with your question.
>>KATHY BELLISLE: Hi, Marcia.
>>MARTIN: There we go.
>>BELLISLE: Hi, we have a question about peer review, and part of our review process is through a CME committee that's part of the approval process but they also preview the content. They may or may not be the subject matter experts on the particular content, is that acceptable for peer review, or does this require a deeper level?
>>McMAHON: Hi, Cathy, thanks for that. The CME committee can be a terrific source for peer review of activity and planning around activities, and it's really up to you to determine if they are sufficiently informed as internists or specialists to be able to designate the content as meeting their needs. Just be sure they are not the authors because that's a requirement of ABIM, that they are not the authors. But you have pretty wide discretion and trust to be able to designate the correct reviewers for your activities. And you may have two general reviewers who are clinicians and maybe one specialist reviewer, or a combination of various reviewers that you decide is right for that type of activity.
>>BELLISLE: Okay, thank you.
>>McMAHON: And it can be done in an ongoing way, or it can be done in an advance, or again at your discretion.
>>MARTIN: Wonderful. Thanks for the question, Kathy. Next we're going to unmute Ruth Smerchek’s line, so Ruth, your line is unmuted. Go ahead with your question.
>>RUTH SMERCHEK: I'm just asking about how to get a high resolution logo, so that we can get marketing on this because we're excited to start it in January.
>>McMAHON: Thanks, Ruth. It will be available on our website soon, and we look forward to seeing it all over your materials.
>>SMERCHEK: Thank you.
>>MARTIN: Great, thanks for your question Ruth. Let's move on to Diane Ezard. Diane, your line is unmuted, so go ahead with your question.
>>DIANE EZARD: Hi, thank you. You sort of addressed my question, and it was regarding enduring materials and the peer review process, but I just wanted to clarify. I believe in the guide book, it talks about, "during the planning process." But, Graham, it sounded like when you were talking about this, you said it could be, not necessarily before the activity or while you're... could any of the peer review be done after the activity?
>>McMAHON: Well, planning is a continuous process that allows you to improve and develop your activity as it's going on, so a longitudinal process. You could certainly have planning that concurs or is concurrent with your activity. Afterwards would be a stretch.
>>EZARD: Okay, got it, and if we do have follow up questions about things related to the ABIM guidebook, who is the best person to contact for that?
>>McMAHON: So if you're a provider, you should come to info@accme.org, and come to us and we'll answer your question and work with you to make sure you have all the information you need.
>>EZARD: Okay, thank you.
>>MARTIN: Thanks, Diane. We're going to pause the questions there because we do want to take a few moments to get some feedback from you all on this webinar and on this information and your comfort level with this whole process. So we're going to actually ask you to participate in some interactive polls that we have prepared, so let's go ahead, Melody, and launch that first poll. We want to know from you about the process, so the process for registering CME activities for ABIM, MOC in PARS, how comfortable are you with that, at this point? Does it seem easy and clear, somewhat clear, but you'll need to try it out, somewhat difficult, or very difficult and cumbersome? So if you could take a minute to go ahead and click on a response, just go ahead and click on it to one of these polls. Or I mean to one of these answers.
We'll just take a few more seconds to collect your responses and then we'll share them. Okay, Melody, let's go ahead and close the poll and take a look at what you are seeing, so we'll share the results.
>>McMAHON: That's terrific, thanks everyone for your comments and sharing your perspectives. The goal here was to try and create a very straightforward system, and it looks like we're on a good track.
>>MARTIN: Excellent, thank you. Thanks for your feedback. Let's go on to our next question. We want to know if you've had the chance to discuss this new opportunity with your organization's leadership, so please let us know if, yes you have already done that, no, but it's in your plans, or no, and you don't at this point have any plans to. Great, the responses are coming in.
We'll give you a few more seconds to submit your responses. Okay, Melody, let's go ahead and close the poll, it looks like the responses have slowed down and share the results.
>>McMAHON: That's great. This is really a terrific opportunity for CME providers of all types, all across the country to be able to meet the 200,000 or so ABIM diplomates' needs for ongoing support for longitudinal learning. Engaging your organization's leadership is key to helping them recognize the value that the CME provider community can offer to ABIM diplomates and all sorts of learners.
>>MARTIN: Wonderful, wonderful. Thank you for your feedback, we just have two more quick questions for you. So, Melody, let's go ahead and put up the next question. Approximately how many CME activities do you think you'll register for ABIM MOC in the next 12 months? Can just give us a ballpark or a guess, based on what you've heard today related to the entering process and what you're currently doing?
Okay, we have about 60% of you that have voted, so let's wait a few more seconds to see if we can get some additional responses. Okay, Melody, looks like we've slowed down, so let's go ahead and close the poll and share the results.
>>McMAHON: Great. As I said, I think it's a terrific opportunity, there's lots of the forms and formats that you're already delivering that are going to be able to be eligible for MOC. The important thing is to go out there and click the boxes and gather the data to be able to report these MOC points for clinicians so that you're meeting their needs and their expectations.
>>MARTIN: Excellent. Okay, thank you all. So, the last question that we'd like to hear from you on is, when you would expect to begin registering CME activities for ABIM MOC now that you've had this initial exposure to how to do it and you know where the tools and resources are to help you with that. How many... When do you think you'll begin entering activities, registering activities?
Okay, we've got 60% that have voted, so let's wait a few more seconds to see if we can get some additional folks. Still coming in, good. Okay, looks like we've slowed down Melody, so let's go ahead and close the poll and share the results.
>>McMAHON: Great, the hope is that we start to take advantage of this and show the community and more broadly, that the CME provider community can meet these MOC expectations and meet learner needs, and the hope will be that you will get in there and start registering activities and start making activities that count and matter for ABIM diplomates.
>>MARTIN: Excellent, okay, thank you all so much for your participation for those questions, that's really helpful to us, gives us some great information. And I'm going to just go ahead and we're going to go back to the slides and I'm going to turn things over to Graham to talk about just what the next steps are. And I thank you and I'll turn things over to Graham.
>>McMAHON: Thanks very much, Marcia and for everyone's participation in the call, and for Andrea's help navigating through PARS. ACCME is here to support you as providers and we will continue to support you with additional communications, education through the next couple of weeks and months and don't hesitate to send us and ask us questions as you come across them. So look for communications in another webinar later in the year regarding the uploading participant data, we'll have lots of ways of being able to upload that data. But I would say, the next steps, from your perspective hopefully, will be to look at the Medical Knowledge Requirements and interpret them broadly, and then engage with and plan for activities that are going to matter. Those are current activities that you're doing but also potentially new activities that meet ABIM diplomates' needs and then go ahead and start registering the activities in PARS even if it's well in advance of when you proposed to put the activities out there for education and learning. And as I said, feel free to ask us if you have any questions. And I would just wrap up by saying thank you to our ABIM colleagues for this partnership which has been wonderful and terrific. And I'd certainly turn to them at this moment and ask them if they have anything to add as we come to the close of the call.
>>VERONICA JONES: Great, thank you, Graham, this is Veronica Jones from ABIM. I just want to thank you and your team for hosting this informative webinar today. We're very much excited about this partnership and the opportunity to streamline the process for CME providers, so thank you again for inviting us to participate today.
>>McMAHON: Great, well, thank you, Veronica, it's been a pleasure working with you guys and we look forward to working with the CME provider community of all sorts and look forward to collaborating with you for a long time in the future. Take care and goodbye.
>>JONES: Great, thank you.
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