We at the ACCME spend a lot of time face-to-face with our accredited providers, providing educational support, explaining our process, and explaining our requirements. One of the messages that we’ve got loud and clear from these conversations is that you, as accredited providers, deal with two masters. On one hand, you are providing information to us at the ACCME for your accreditation and on the other hand, you’re dealing face-to-face with your physician learners and your colleagues in education within your institutions, within your organizations. And that the needs of each of these groups is a little different. Or, maybe a lot different. And the information that you need for each of these groups is causing some confusion.
We’d like to simplify this for you. Yes, the ACCME has 22 Criteria that our process is going to use to judge your overall program of continuing medical education. The program level requirements inside these Criteria are Criterion 1 at the mission and again at Criteria 11, 12, 13, 14, and 15, when you as a program stand back and look at your overall successes and failures and identify areas where you can improve—where you want to stay the same, where you want to get better. Those are program level. Again, Criteria 16–22 are program level requirements, where special rules of engagement, manners of acting, that your institution and organization can use in fulfillment of your CME mission. In fulfillment of your CME mission. What barriers can you overcome? What factors are causing change? These are issues that you need to and can examine at an organizational level to improve the extent to which you are fulfilling your CME mission. But, those are issues between you and us and that you demonstrate at the time of reaccreditation. Yes—you live them and you work them and you do them at an organizational level all through your term of accreditation, but it’s really us at the ACCME and the reaccreditation process that you bring that information to.
The individual physician learners or the individual physician planners are not the agents of change for you in that regard. Really, what those people are doing in interacting with you, is that they want to plan educational activities. They want to create a discourse between themselves and their target audience. They have a message that they want to deliver. They have a professional practice gap that they’ve identified that they want to try to address.
So, the algorithm for change inside the Criteria and inside your interaction with them might be what we call Accreditation Criteria Light—a simpler version that you can use and simpler
language that you can use to interact with these people, with these physician learners and especially the physician planners of education—the people who come to you and say: I want to work with you do and deliver and develop continuing medical education.
Question 1: “What’s the practice-based issue you want to address?”
So, the question to start with is: What’s the practice-based issue that we want to address? What is it that is our goal, our aspiration, or our problem that we want to fix? And then let's together talk about: Why does that issue exist?
Question 2: "Why does that issue exist?"
So, if I’m going to be a CME planner and I’m coming to you, you ask me back: What’s the practice-based issue that together we want to address and why do you think that issue exists? Because, “What’s the practice-based issue,“ is the fundamental element of Criterion 2 and the need that underlies that practice-based issue is: Why does the issue exist—the knowledge, the competence or the performance issue that underlies that professional practice gap. And together, the two of you can identify that. Then together you say: What do we want to change?
Question 3: "What do we want to change?"
This is Criterion 3. We’re going to plan an activity to change what we want to change. We want to change what they know. We want to change what they’re going to do. We want to change what they actually do. We want to change their patient outcome. This is for you two to decide. But, remember when you want to change what they know, you need to be considering how that impacts on what they do or what they’re going to do. So, you say back to them: OK, we think that this professional practice gap exists, because they don’t know the basic pathophysiology. So, we’re going to teach the basic pathophysiology, but what we’re going to ask them is: This is what you’ve learned about pathophysiology. On the basis of this new information, how are you going to approach the management of your patients differently? That’s: What do we want to change? Using the answers to that question, is the fourth question that you are going to answer: Were we effective in producing change?
Question 4: "Were we effective in producing change?"
The first is: What’s the practice-based issue we want to address? The second: Why does that issue exist? The third is: What do we want to change? The fourth is: Were we effective in producing change? So, if it’s a single session, a single conversation, a single video vignette, or whether it’s a series of things that become your educational activity, you’ve evaluated whether or not you were effective in producing the change that you want. And then you say to yourself: So, is our problem solved?
Question 5: Is our problem solved?
It’s a conversation again back with the person who came to you. Or back to the data that you identified as the professional practice gap. And you look at your new data and say: So, were we effective in producing change? Is our problem solved? And that you would say to yourself: Well, no, the problem is not solved. So, we’re going to start again and we’re going to ask the question again: Why does this issue still exist? What is it that we want to change? And then let’s see if we’ve made that change.
Plan. Do. Study. Act. You’re going to plan the educational activity. You’re going to study its impact and its effectiveness. And you’re going to act to make change. And this is a simpler conversation to have with the people who come to you who want to do an activity.
If someone like me comes to you and wants to do a CME event and you hand them a form that’s eight pages long, that has five questions on each of the Criteria, including a question on: what’s your CME mission, you’re not going to get a very good response from the people who plan because there’s no context for that in their life. Those Criteria aren’t their criteria, those Criteria are yours to use to address with us and to think about each activity as they come along. How is that accumulating information in support of you meeting your mission and meeting our compliance?
So, your algorithm for dealing with the individual session and the activity can be much simpler. It can be based on these questions: What’s the professional practice gap? What’s the issue that you want to address? Why does that issue exist? What’s the need that underlies, is it knowledge or competence—why does that issue exist? What is it that you want to change amongst those many variables that are causing this issue? What’s the little piece that you want to break off, to say: This is the manageable unit for us to try to impact on with this educational session. And then you say: Were we effective in producing the change? That’s the evaluation, that’s the measurement that you do after. It can be qualitative, it can be quantitative, it can be by sampling, it can be by forms, it can be by checklists, it can be by direct observation. But, you get information with which to answer the question that says: Were we effective in producing change?
And then, it’s up to you what you do next. You put that information aside and say this is what we changed and this is what we didn’t change. Or you say: We’re not done yet. Our problem isn’t solved. And we’re going to do some more. But, we’ll use this simpler algorithm. You’ll bring all that information back when you’re looking at yourself under the evaluation Criteria of, 11, 12, 13, 14, and 15, at the end of the year or at the end of your cycle and you’ll say: This is how we’ve been effective, and this little educational activity contributed in that way. So, a simpler algorithm for change, a simpler approach to planning educational activities. And a simpler way to have a dialogue with a physician or a professional or a member of the public who wants to work with you to develop an educational intervention.