>>MARTIN: I want to let you know that we have several staff members who are joining us, who you may hear from your today. Our president and CEO is with us, Graham McMahon.
>>McMAHON: Hi, everybody.
>>MARTIN: Thanks, Graham. As well as Kate Regnier, our Executive Vice President.
>>REGNIER: Good morning!
>>MARTIN: Steve Singer, our vice president of education and outreach.
>>SINGER: Hello.
>>MARTIN: Tamar Hosansky is also on the line, she is our Vice President of Communications. And we have Melody Latham with us, operating the technical aspects of the webinar. So thank you Melody for your support. And again, my name is Marcia Martin. So with that, we're going to go ahead and get started. And one more quick question, I'll answer while I see it because this is a great question and I should've worked it into my introduction. We are recording this webinar, and we'll be posting it to our website within the next couple of days, on that Accreditation with Commendation page, so that you can listen to it again, so you can share it with other colleagues, etcetera. So thanks for that question. Yes, we will be... We are recording and we'll be posting this later. Okay, so right now I'm going to go ahead and introduce to you our president and CEO, Graham McMahon, and I'm going to turn things over to him. Graham?
>>McMAHON: Hey. Thanks so much, Marcia, and good morning everybody who's calling in from all across the country. It's a pleasure to be with you this morning, to describe all of the work that we've been doing to elaborate our criteria for commendation, and essentially create a mechanism to celebrate the work that all of you are doing every day in elaborating the quality and delivery of continuing education to the physician and interprofessional community that we all serve. And it's important to recognize that these are an optional mechanism, but ACCME is more than just a regulator. We obviously set the standards and, as you know, participate in audits of the activities that you're doing to make sure that we have a functioning system, but we're also here to try and support and nurture all of you who are educators in trying to do the best you can to develop new and interesting approaches to engage a changing audience of learners that is multi-generational and has new technical expectations, and take advantage of many of the amazing advances that we're discovering in how to create optimal learning environments that are longitudinal, that are based on the best educational principles and adult learning theory. And that's exactly what you're going to see reflected in our commendation criteria, as we go through them.
These are the exemplars of best practices in education that we're really hoping that many of you will engage with to essentially meet the needs of our changing audience. So that's what we've described in our commendation criteria. And I really think that they are the principle, the values, the aspirations of our community, and anticipate those evolving learner needs. So in this overview, what I'd like to do is encourage and reward best practices to these programs, in pedagogy, evaluation, change management, and generating meaningful outcomes. And remember that these are from you. We've met with you repeatedly over the last several years, in my programs, in webinars like this and conference calls, and you've shared with us the direction that continuing education is going, and what we've learned from many other organizations and our community of learners in other professions as well. So these are from you, they are for you, and they're here to support the work that you're doing and make sure that you're delivering value in your organizations. I'll finally remind you that commendation has always been, and is always, completely optional. Of course we would absolutely love to reward everybody who's a provider in our community with commendation because that exemplifies high-quality work in continuing education.
But you don't have to achieve commendation, and you can do your work and be proud of the work you're doing as an accredited provider without commendation, and that is perfectly fine. So as many of you who've seen our criteria will know, we've designed the commendation criteria to sit on top of our standard criteria, and ultimately these will replace our existing commendation criteria. And the way we've designed this is to create a menu approach, and the menu is divided up into these five larger sections. These five larger sections are, of course... Promotes team-based education, addresses public health priorities, enhances skills, demonstrates educational leadership, and importantly, achieves outcomes. And we've created, on your request and with your input, 16 criteria in these 5 categories from which ultimately we'll ask you to choose. Now of the 16 criteria, we would ask you to choose 7 from any of the 16, but you must choose at least one from the outcomes section. So that can mean that you should really look over these criteria and decide which ones are in your strategic mission, which ones are going to help you deliver your mission to your community and your learners and, in doing so, choose the criteria that fit your organization, big or small, urban or rural, with surgeons or physicians, with interprofessional education or without.
And for your opportunity is to look through the range of criteria, choose ones that are right for you and that fit you and that you can work towards. One of the questions we've had is, "Why require outcomes?" It's the only section in which we require you to participate to achieve commendation. And we had a great deal of discussion in the community as we went to you, and of course a great deal of discussion here with our board and with our staff to decide on this particular element. And fundamentally, we decided that this was an essential component to be able to demonstrate the value of the work that you're already doing, and the work of the CME community to make a difference in our world. And we've designed the outcomes section to be meaningful and achievable at the same time, so I think many of you who will look at this and were initially concerned about the ability to achieve outcomes will be very reassured to see that much of the work you're already doing will be very readily counted in the outcomes criteria, which has set pretty modest thresholds for you. So what are the supporting documentation? Well first of all, if you haven't already, of course I'd encourage you to look at the actual commendation criteria.
You can read a lot more about them, you can even go right now to our website at accme.org/commendation and get full background as well as a whole host of resources. And Marcia will mention some more of these towards the end of the call, and we'll be elaborating many of these through the next couple of weeks and months as we build more experiences with your stories about how you're actually already doing many of these activities. We'll try and capture those on our website. But there's a ton more information on our website that you'll find very useful as you start to decide what direction you'll take your organization using these criteria to achieve commendation with us. In each of these criteria, you'll see four columns, and the four columns essentially obviously contain the criteria, but three additional important elements that you should pay attention to: First of all, we have a rationale. Not just a criteria, but why this criteria seems to be so important and why you've asked us as a regulatory organization to reflect those desires and that strategy for organizations that are doing high quality CME. So rationale describes why this criteria is there and the value of this particular approach in educational development.
The next two columns are the critical elements and the metrics themselves, and here you'll see what we would expect to see if you choose this criteria and send this documentation to meet the expectations that you asked us to represent in these criteria. So you'll see several composites of 'and' or 'ors' in the critical elements, and then you'll see the measurement we'll expect across different criteria. Underneath many of the measures, there's a key for the number of elements we'd expect to see in a file that we would look at at the time of the adjudication, and that reflects your program size, from small, medium, large or extra large, with thresholds of 40, 100, 250 or greater than 250 for those set thresholds. And that's where we retire our accreditation term. So you'll see what the expectations will be, but many of these criteria you'll see are by stipulation. You agree or you commit to having have the records that we would expect to see for each of these criteria. So we have a variety of criteria that are in the standards here, some are activity-based criteria and some are based on programs. Obviously activity are based on activity counts, depending on how you categorize activity in PARS. For program activities, our program work, for example collaboration, we'd expect you to show evidence over the accreditation term that, for example, you're collaborating with organizations effectively to achieve your mission.
So you may, if you have a long-term strategic view and fewer activities, choose more program requirements to reach commendation. While if you focus on activities and that's where your mission of development is, then maybe you'll choose more activity-based criteria. You'll also see that, as I've mentioned, we have a sliding scale to accommodate programs of different size. We had a lot of debate as we worked through the development of the criteria that we wanted to make sure that these were actionable and achievable by our entire array of ac credited providers. Some of whom are very small indeed, some of whom are very large indeed. And we didn't want to give preferential treatment, so to speak, to any particular type or size organization, and that's why there is a reflection of size in terms of the activity counts that you achieve over your accreditation term that allows us to see more work or expect more work from organizations that are doing more continuing education. As I mentioned, many of these will be by attestation. We ask you to keep records if you're able to stipulate that you've achieved these thresholds, and we'll ask for some submitted evidence for some of the criteria, much of which you may already have put into your materials as you look for accreditation using our core criteria.
For program and some activity criteria, we're not looking for entire activity files. We're looking for examples, descriptions, a paragraph or two about how you achieved this particular component of the commendation criteria. And those will be reflected in the forms, etcetera, that will support the work that we're doing to make this straightforward for you. So let's get into a couple of the criteria so that you're familiar with them, and what I hope you'll do as we go down through these is to start to circle for yourself or make a note to yourself of things you're almost certainly already doing that are captured in these criteria that you'll readily need. And maybe put an asterisk beside those that are aspirational for you, that you'd really like to start thinking about doing to achieve your educational mission and achieve commendation. So starting at the top: Promotes team-based education. All of us are fully aware that medicine as a profession and an art is moving towards collaboration as a key principle of our effective work together. And that's reflected in how we collaborate in team-based education in CME. There are three criteria here that we'd like you to reflect on: First is engaging with interprofessional colleagues in the planning and delivery of interprofessional continuing education.
Now this means, "Are you collaborating with your colleagues in social work or with physician assistants or pharmacy or nursing?" Not just on your planning committees, but also in the delivery of meeting the needs of your audience. So if you're reaching physicians and nurses, for example, in your audience, we'd expect you to have physicians and nurses represented in your teaching staff and on your planning committee. It's as simple as that. And if you're doing that already, then this will be a very easy activity criteria to be achieved. Secondly is an important acknowledgement of the fact that this education that we're all doing is really about improving the well-being of the patients and the public that we serve, and they are our best informants as to what's important. They deliver terrific context about what's meaningful for them, and engaging them in teaching of our physician or interprofessional colleagues is a very powerful way to create engagement. That's been my experience as a teacher for many years. Every time I bring my patients to the podium, every time I bring my patients into a discussion group, they tend to enliven the conversation and make it much more meaningful to everyone participating. And this criteria encourages you to do that. Not just on the planning committee, but also in the actual teaching activities themselves, where they can share their stories or share the context.
And just a reminder that some of my best experiences teaching and learning have been with engaging patients in the educational program. And this is an opportunity to reflect not just as planners, but also teachers in your program. Whether they are patients or whether they are representatives of the public community that you're engaging with. The next criteria that I had mentioned as we got cut off was about engaging students in the health professions across the continuum, and this is a key opportunity to engage our future learners in the planning and delivery of our educational programming. Many of those students who may be residents or fellows, if they're physicians or, for example, if they are nurses in advance practice graduate programs or a nursing school, it can be very informative to help us construct educational program s that are ideal particularly for younger generations of learners. But many of these students already have expectations that they're engaging in quality improvement projects and other directive educational activities that would be very helpful to connect with you and your program. Addressing public health priorities is obviously of critical importance to us as educators, who have the opportunity to use our programs to leverage improvements in public health.
And in these criteria, essentially you'll see a range of opportunities to do exactly that and to tell us how you're engaging with the public health. C26 is really about the use of health and practice data to inform improvements. Any time you're using electronic medical record data or registry information to help a clinician understand and improve their individual or group practices, then you're achieving this criteria. Next is really about addressing factors beyond clinical care that affect the health of communities or populations. Here we're really talking about the teaching of implementation science. Not just that obesity is a risk factor for diabetes, but how you can change the public health environment or create implementation plans to get patients to actually lose weight, or change the community environment to support patients to engage in healthy lifestyle behaviors, for example. In C28, it's really all about collaboration. And I know so many of you are already actively engaged with public health societies, your public health departments, understanding how you can help your community evolve, and one of your key opportunities through this criteria is to show us the work that you're doing by creating meaningful collaborations and using continued education linked to public health and other organizations to achieve your mission.
Next criteria is really about enhancing skills, and here, we're really trying to encourage you to think beyond didactic education purely, and think about our opportunities to engage clinicians in a whole host of other competency developments. Whether those are in communications or whether those are in technical or operative skill, for example, or a high-level problem solving. And essentially, C29 here is really about the communication skills of learners, creating opportunity for you to observe your clinicians engaging in communication exercises and giving them feedback, whether that's reported information or whether that's observed behavior. Essentially using communication as a key lever for improvement, obviously an essential skill for so many in our community. The next is really about technical skills, and again, the expectation here is that you're building a skill development program where you observe and give feedback to the professional so that they can improve that skill and keep patients safe. The next two criteria are really about how you leverage your educational program to help clinicians retain and maintain the knowledge and competence and performance that you've inculcated in them and helped them achieve.
And this is about creating things like a longitudinal curriculum program where you create either individualized plans for learners that you track repeatedly, giving them feedback and opportunities to remediate and accelerate their education, and using adjunct strategies to support the maintenance of their education practice, whether that's things like reminders or handouts or other approaches to try and keep the clinician engaged for long-term and reminded of the key skill or task or knowledge that they have gained through your programming. Educational leadership is a key opportunity for a CME professional and a CME provider, and through these set of criteria, we're encouraging you to think beyond your primary educational mission and taking care of yourself as an organization and meeting the needs of the community, in general, of educators. So C33 is all about, "Are you looking at your own educational practices? Are you measuring your own effectiveness? And can you help the community evolve by sharing what you're doing and publishing or presenting about the quality work that you are investing in?" C34 is about developing a continuous professional development plan for your team. Of course it's an essential part of us growing together, is that we're all participating in our own professional development, whether we are administrators or physicians or educators of any type.
And this sets the expectation that you're doing it, and it rewards you with commendation when you are. And finally, I think everyone's favorite, which is, "Are you improving as an organization? Are you innovating? Are you doing cool new stuff that we can all point to and be really proud of?" And that's essentially, "What's innovative for you? How have you changed and evolved your program this year or this cycle to meet the needs of your community and make a difference in your educational platform?" And finally, achieving outcomes, and again, this is the only essential set of criteria that you must meet, and you can choose any one of these or all three. And it's worth remembering that a single activity or single set of program activities that achieve high level of outcomes can help you meet all three all at once if you're actually able to achieve, for example, C38. So these three criteria start with the provider demonstrates improvement in the performance of learners, so you're really talking about individual learners and their performance improvement and performance practice to, "Are you showing that the impact of your program is affecting the quality of health delivered in your organization?"
So, "Have you been able to show structural changes that have reinforced the educational mission that you're trying to promulgate? Have you engaged in your quality improvement program and shown the tangible effects of that engagement?" To finally, "Are you able to even show that your CME program has had a role in promoting the better health of the public and the patients that you serve? Are you able to link your educational strategies to changes in the outcomes for the populations that your clinicians serve?" So that's a very high level and brief overview of many of the criteria. There's, of course, a lot more specifics on our website and online, and we'll have a lot more resources to support you. But it's worth taking a bit of a breath and realizing that those of you who have several years to go have obviously got several years to think about which of these strategies you're going to implement and then show us your work when you come up for review. In the next two years, those of you who are in the cycle essentially have an option. You can, at any time, start using these commendation criteria. For those of you who are already active and doing many of the things that we would consider commendable, by all means, use these criteria to demonstrate that and you'll achieve commendation that way.
But similarly, we know that this is a change, so there's an overlap period where you can continue to use our existing criteria until November 2019. And by November 2019, we expect all of the state and nationally accredited organizations to be using the new commendation criteria. So in the next few weeks and months, we expect to have, as I mentioned, a sobriety of additional resources, and these will also be profiled at our meeting in April of next year, which we hope you'll come and join us at. But we will begin to accumulate some of your stories about how you’re reaching these compliance criteria, but also provide some evidence that we think probably wouldn't make compliance with these that you might have questions about. We'll have additional video resources and FAQs, and anytime, you can always email info@accme.org with your questions and we'll do our very best to help answer them as expeditiously as we possibly can. So we have several questions that have been submitted in advance. I think the question boxes should be live and working on your 'Go to Meeting' site. So before we go to those, feel free to start typing some of your questions and we'll come to those and try and come to those as quickly as we can, acknowledging that we are a little shorter on time than we thought because of the technical break.
So maybe first, I'll turn to some of the operational questions that were submitted in advance, and address some of those. The first... Some of these are relatively simple, some of them are a little more complicated, but let's just go through some of these and then go into each of the sections, and Marcia will try and feed me some of your questions in each of the sections as we go through them. The first question was regarding program size: "Does accreditation term mean the entire four- to six-year term of the accreditation, or does it mean annually?" And essentially, it means over all of the years added together to determine the size of the program. So if you have a standard accreditation term of four years, then that's the term over which you'd be expected to meet the expectations of the individual criteria. "For those who would only have a year or two of experience with new criteria, would you have to meet the full array of requirements?" And the answer to that question is yes.
If a provider chooses during the transition period to use the new criteria, then we would expect that you're able to show compliance with the 7+1 core commendation or additional commendation criteria because we suspect those are things you've already been doing for several years, or certainly doing for a recent past, and be able to reach the very modest thresholds that we've set for achieving commendation over that period in time. "How will you compute the 10% threshold participants credits each activity for which a certificate is offered? Would each session of our journal club throughout the year, for example, have the same individual weight as one annual meeting?" The answer to this is it really depends on how you're counting activities and... Or registering activities in our database, called 'PARS'. Regularly scheduled series, like Grand Rounds and Journal Clubs, are often listed as a single activity that has multiple episodes and, as a result, that would count as a single activity in PARS. And that's how we would measure it. If you choose to register all your different Grand Rounds separately, then that's your prerogative, but it also counts to your denominator for the number of activities that are in the system.
And so I think that gets us through the operational questions. The first set of questions on team-based education on C23 are really about, "Doesn't professional continuing education include administrators as professionals?" And the simple answer to that, of course, is yes, administrators are actually the key to the efficacy of our system and their professional development is also important, but should also be based on their individual needs. "Would the inclusion of the interdisciplinary membership on the CME committee count towards C23?" And the answer to that questions is it depends. Many people, when they use the word “interdisciplinary,” are actually referring to the difference between, for example, cardiologists and endocrinologists and nephrologists on a committee, and that's not really what we're referring to. We would consider all of those physicians and that would not be inter-professional. When we use the word inter-professional, we're meaning the collaborations between the professions; nursing, pharmacy, physician assistants, social workers, physical therapists, you name it.
So depending on the audiences that you're meeting, collaborative education should reflect those communities in both your planning and in the delivery of your continuing education. And there's good evidence that that makes a difference to the quality of the work that you're doing. So maybe before I go on to the next set of criteria, Marcia, were there questions about promoting team-based education that we should touch on?
So addressing public health priorities: Regarding C28, "Do the four examples of collaboration aimed at improving population health have to be CME?" And the answer to that is they should be a key focus on CME in the activities that you're doing, so they should include CME in some capacity to improve the efficacy of your work. Regarding C28, "Please define organizations for this criteria, for example. If the CME collaborates in several departments within the hospital, or another hospital within the same system, does that meet the expectation?" And I would say the answer to that is no, the expectation of this criteria really supposes that you're working with external organizations, whether you're... We would consider you're a single health system, even if it contains multiple hospitals, as being internal. So we will be expecting you to achieve this criteria to be working with external organizations rather than internal. The second part of this, "Would working with the local Public Health Department, medical records company, or a public advocacy group, count as organizations that would meet the requirement?" The answer to that is clearly yes. Those are external organizations, all of which can help you achieve your mission to inculcate higher quality work for your clinician community. And will be great examples of this particular one.
So what about enhancing skills? One commenter noticed that observed behavior is challenging to do, and, "Why is it part of the critical element?" And I would say that those of us who do skill development recognize the particular power of feedback for this particular skill development, and feedback, of course, requires observed behavior for what are demonstrable skills, whether they are communications or technical skills. But observation can be done in lots of different ways. It can be done potentially by surrogates. It can be done by video. It can be done in a sim lab. It can be done live with people observing each other and writing reports of what they're seeing based on some guidance that you're giving the groups, whether they're doing role play or others. So there's lots of ways of doing observed behavior that don't have to be complex, expensive, or challenging to do. But the key element here is that there's a structure and that you're giving feedback to the learner that drives quality in their work. Did I miss a question? Sorry. "What are examples of how a provider conducts periodic analysis to determine the effectiveness of strategies designed to reinforce or sustain change?" And here, there's lots of ways in which you could do this.
The provider might evaluate how many learners are using the support strategies, for example, are engaging with a reminder system or logging on to a network opportunity to actually remind them. You might survey learners about which of the resources that should be used. You might wander into a clinic where you've given patient hand-outs and stickers or something like that and see, "Are they in use and are people actually distributing them?" So lots of ways of determining whether implementation of your longitudinal strategy has been effective. I'll move on because we haven't had questions that I can hear just yet and just continue to addressing the outcomes. "Is there any activity that would not have an effect on the public health, everything that drives physicians change, competence or performance increases public health?" And this is really about purposefully uniting education and collaboration that focuses on public health imperatives, not a more indirect intent to change physician performance which in turn affects public health. So the important element here is to be intentional about who you're engaging with and ensuring that you're not just looking at intent to change but creating a collaboration that's meaningful and impactful.
The last general questions before we open up, hopefully, to some of your questions: Do I anticipate the changes in definitions or requirements made by the ACCME and the AMA Bridge Committee? Will the PACT health providers comply with the new criteria for accreditation with commendation? And the answer to that is clearly yes. We've been working pretty closely with the AMA to ensure that we're removing barriers and including flexibility for how you can do your educational program, particularly as it pertains to doing things like blended learning and using multiple approaches to achieve your educational mission. And we are working to simplify and align and, as much as possible, get out of your way so that you can do longitudinal and innovative educational programming that meets your community's needs. And as a result, we anticipate that once we have the final approval from our bridge committee and our work together, that you will have greater flexibility and simpler approaches to work with the AMA's PRA Category I CME credit system. And the last one is: Can I suggest the top three things that a program should tackle when going for accreditation with commendation? I would say the first thing is look at yourselves internally.
What is the best fit, of these criteria, with your mission which will help you get to your mission the most? Is it working inter-professionally? Is it working with students? Is it developing the CPD-peer CME professionals? Is it developing high-level outcomes? Is it developing interventional strategies that affect communication or skill development in other ways? The second is to evaluate the focus of your organization. If you're at a hospital or a health system or if you're at another organization, what are the key challenges that they're facing and how can you leverage the commendation criteria to help you get there, and bridge those two in the development and construction of your education program? And the third is, really think about where are you trying to drive your mission for your organization and which of these might be innovative and interesting for you to both explore and practice with, as you evolve your educational approach to go beyond a unidirectional didactic education, which has been at the forefront of much of the approaches that have been used in CME for a long time.
So I think those are starters, examples, to help you get going. That's an overview from the top of what might... What's been approved by our board, and we look forward to working with you as you work to share your stories, but also work to understand these to a greater degree. So I'm going to turn it over to, I think, Steve, who might have a couple questions that he could share with us.
>>SINGER: Thanks, Graham, and thanks to all of you for your patience through the webinar. We apologize for the technical problems, but we're getting a lot of questions in, which is great. So the first thing that I wanted to address before I direct a question back to you, Graham, is we've got a series of questions about the materials in the webinar itself. So the webinar will be edited and archived and available on our website for viewing, as will the slides from today, but the best resource, really, for digging in more about this information is the communications package that was issued last week via our website. And if you come into our website, right on the home page you'll see accreditation with commendation, or go to that URL that Graham shared earlier, which is accme.org/commendation. That will take you to sort of all these documents that Graham has been referencing. So with that, there were several questions where people were asking about the menu, and how the menu works. So you explained that it's seven from any plus one, at least, from outcomes. Can you just explain that again or help to clarify that for people who are struggling? Does that mean that they don't have to necessarily choose an option from all of the categories?
>>McMAHON: Yeah, that's exactly right, Steve. It's no expectation. You can skip entire categories if you've got a total of eight criteria, and the only category that you can't skip is the outcomes category. Otherwise, from the 16 categories... The 16 criteria, you can choose any other seven, but one must be from the outcomes category.
>>SINGER: And that's also saying that, for people who would like to, they could do one, two, or three from the outcomes category.
>>McMAHON: Absolutely. And remember that any single activity may count towards multiple categories.
>>SINGER: Great. Okay, so I have a couple questions each for some of the different sections. So the first category you talked about promotes team based education, which is criterion 23, 24, and 25. Sort of two interesting questions: One person asked about, "How do you define students?" I'll let you answer that first and then I have another one about that same criterion.
>>McMAHON: Well any health profession and any level of students across the continuum, all the way from school to the graduate program to their postgraduate education program. Essentially if they are physicians-in-training, when they're in medical school, if they're in residency, if they're in fellowship, all of those would entirely count. And similarly for nurses: If they're in nursing school or if they're in postgraduate educational fellowships or advanced practice nursing programs, those would be entirely considered students.
>>SINGER: Okay. And then another question was regarding that same criterion 25, "Can health profession students help to plan activities that primarily benefit students and not necessarily practicing physicians?"
>>McMAHON: I think that it depends. I think you'd have to look at the individual components of the program. In many cases, Cross-continuum educational programs, let's say around patient safety, that involved students and professional practitioners, would of course count. So planning of students in a collaborative program like that would of course be entirely appropriate, and likely very beneficial for the construction of the program and count towards the criterion.
>>SINGER: Great. Thanks. A question about criterion... Sorry, criterion 24, "Patient public representatives are engaged in the planning and delivery of CME." Someone asked if patient advocacy groups suffice as patient involvement.
>>McMAHON: Yes.
>>SINGER: Great. Okay, so there were several questions, I won't go into all of them, but I think they revealed an educational need that we will of course be happy to respond with resources to, about definitions for certain terms. Like, "How does the ACCME define public health?" Or population health, "How does the ACCME define quality improvement?" Any of those you want to speak to right now or should we just say that we're...
>>McMAHON: I think that those will all be on our website and our FAQs and other places, and we'll use a lot of the questions that you're typing in as the basis for constructing more elaborated responses to many of these issues. So refer to our website. It's probably not helpful to go through definitions on a webinar like this.
>>SINGER: Okay, great. So for the... For the CME team that is in Criterion 34: "The provider supports continuous professional development with the CME team" So when you refer to CME team, are we considering the term to mean staff plus faculty and teachers and volunteers? How do we look at this...
>>McMAHON: I think that's up to the provider, they set... You determine who is your team. It may be, for example, your planning committee, it may be your administrator and physician staff, who direct the educational program, or all of the above. But the CME team is who's delivering your educational program and working to improve it and support it.
>>SINGER: Great. Another provider asked a question that maybe raises to the level sort of about... Sort of applying to several of the criteria, and they wrote, "We're engaged in several of these commendation criteria, but these activities are not necessarily part of a CME activity. Does this qualify or does our engagement have to be related to a CME activity?"
>>McMAHON: I think, again, it depends. Obviously our focus is on professional development, which incorporates a lot of work in quality improvement, work to evaluate practice data, registry information, and engage in other systems like QI or MOC or other types of activities. And all of those are, of course, eligible to be CME. It is often a mistake that people think that performance improvement and quality improvement activities aren't CME-able, to coin a phrase, but of course they are. They're perfectly eligible, as are individual physician activities. So I would ask the question why are they not CME if they're important to the development of the organization and ensure that the CME department or the CME professional is working to promote quality improvement and working collaboratively, both with the C Suite, if it's at a hospital for example, and the QI Department, again if it's at a hospital or a health system, to attain the type of quality improvement that you're working on and make it all sing together.
>>SINGER: Right, thank you. So for criterion 31, which is under 'Enhances Skills”, it says, "The provider creates individualized learning plans for learners." The person on the phone has a question, "Would there be a limit on the number of credit hours awarded to clinicians engaged in individualized learning plans?
>>McMAHON: I'm not sure of the answer to that question. I think we'd have to follow up by email or otherwise to clarify the intent of what you're really looking for. Questions about credit allocation and credit calculations are generally answered by our colleagues at the AMA to determine the criteria for the actual credit.
>>SINGER: Great, thank you. So switching gears here, to criterion 33. It says, "The provider engages in CME research and scholarship." The question is, "For research criteria to demonstrate change, must it be statistically significant change, or a simple or directional change in practice?"
>>McMAHON: That's in the outcomes criteria...
>>SINGER: Yeah, right, exactly.
>>McMAHON: And we're not looking for statistical significance, we're just looking for directional improvement. And that's fundamentally what we're all about. The outcomes criteria just allow us the opportunity to demonstrate that to our external community and stakeholders, and show the brilliance of what all of you are doing in your work to promote best practices in the community.
>>SINGER: Thank you. So another question raised on the call, "I noticed in criterion 36," which is, "The provider demonstrates improvement in the performance of learners." "References performance improvement only and not competence." So I think they're referring to our criteria, or current Criterion 11, which references competence performance patient outcomes. Is there a reason?
>>McMAHON: Well, we would consider change in performance to be essentially measured changes in learner's behavior. Like higher patient communication ratings, more appropriate prescribing, lower rates of complications, fewer coding errors, greater participation in team meetings, all of those would be behavioral metrics. That performing level data, that could emerge from self-reported changes, from practice-level data, or from other types of sources. I would say improvements in competence, as we refer to what a learner would do in practice, an intent to change would not really meet the expectation of that Criteria.
>>SINGER: Great. And here are a couple of additional questions about criterion 36, or sort of broadly the outcomes criteria. "Is self reported or subjective measurement acceptable for criterion 36?"
>>McMAHON: Yes.
>>SINGER: Okay. The person on the phone said, "We offer a faculty development course on milestones and assessment of residents. What would be considered evidence of performance improvement?" And I think that they're suggesting aggregated milestones data, trends in continued accreditation, board pass rate improvements. So I think they're talking about sort of these derivative outcomes with regard to graduate medical education.
>>McMAHON: The first thing I'd say is that faculty development is absolutely part of our CME community, and when you're doing faculty development, the outcomes are obviously the skill, competence, performance of your faculty as you might measure through a variety of mechanisms. Ultimately, if you want to extend the efficacy of your faculty development program to the performance of your residents, that's at your discretion, but the primary outcome variables you'd expect from a faculty development program would be about faculty competence and performance.
>>SINGER: Great. So a couple more general questions. The examples of compliance posted on the ACCME's website are very helpful. Does the ACCME plan to post examples of compliance with these new requirements? And if so, when?
>>McMAHON: Absolutely. We would love to receive your examples and, again, you can email all of that material to info@accme.org and we will work to post those as much as we possibly can and share those with the community. And we would love to have as many examples as we can for both compliance and non-compliance so we can help support you to do great work and see what other organizations are doing in education so that you can learn from each other.
>>SINGER: Great, thanks Graham. There's a question about PARS, PARS is ACCME's program activity reporting system. And wondering if PARS, at some point in the future, will be a receptacle for data regarding these criteria?
>>McMAHON: Well it won't surprise you, we thought about this ourselves. We can't commit to evolution in PARS just yet, but it's our intent to be as supportive as we can for the community. We would love to move towards a place where, as you do activities, you can designate them for various criteria and then create a dashboard around which we can accumulate those criteria achievements and let you know how you're doing, and make it as easy as possible for you. We're not at a point to where we have that capability just yet, but we would love to have that capability in the future.
>>SINGER: Great. Thanks, Graham. So again, we... I think we're going to wrap up the call with a couple slides just at the end about resources. So thank you, Graham, very much for your comments, and thanks to all of you for participating. Just to repeat what we had said earlier, we have already provided some initial resources that you can find on our website, including an introductory, a short video with Graham, talking about the basics of how this implementation is going to work. We've also published some general FAQs about commendation, and, in the future, we will be continuing to develop additional resources that are specific to the individual riteria in the categories. As well, many of you know that we are having a meeting in April of 2017, which is going to be sort of an expanded meeting beyond our accreditation workshop. And it will focus primarily on addressing each of these new criteria, and specifically with an opportunity for you really to sort of take a deep dive into understanding the expectations and getting strategies and ideas for how you might achieve them. So at that point, we'll thank you for your participation. This webinar will be archived and available soon. And thank you again.
This is a transcript of Introductory Webinar—Menu of New Criteria for Accreditation with Commendation (ARCHIVED) - http://www.accme.org/education-and-support/video/commentary/introductory...
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