Stakeholders Offer Feedback on ACCME's Strategic Goals
The ACCME Board of Directors engaged in strategic planning in 2011 to discuss the future of the ACCME system and the role of accredited CME in supporting practice-based learning and health care quality improvement. Through this process, the Board identified three strategic imperatives:
1. Foster ACCME Leadership and Engagement
2. Evolve and Simplify the Accreditation Standards, Process, and System
3. Explore and Build a More Diversified Portfolio of ACCME Products and Services
The Board incorporated feedback from stakeholders to identify these priorities, and then, throughout last year, the ACCME continued engaging with stakeholders about how to fulfill them. The ACCME convened more than 20 focused discussions about the strategic imperatives with more than 1,100 stakeholders including member organization liaisons, ACCME volunteers, Recognized Accreditors, ACCME-accredited providers, and intrastate providers. These discussions were held in a range of national, regional, and state forums, including accreditation workshops, town halls, volunteer meetings, Recognized Accreditor conferences, and events for intrastate CME providers.
In addition, the ACCME actively engaged with leadership organizations across the health professions and continuum of medical education, nationally and internationally, to support a more effective, aligned system of physician accountability. The ACCME Board of Directors invited special guests to its meetings to address these issues.
The constructive and rewarding stakeholder interactions have generated a wide range of thoughtful ideas and insights. The ACCME will continue to engage with the stakeholder community and identify potential strategies for simplifying and evolving the accreditation standards, process, and system. The ACCME is committed to facilitating ongoing dialogue and reflection and looks forward to working together with stakeholders to shape the future of our CME system.
Summary of Key Themes from Stakeholder Conversations
- Clarity: The ACCME should communicate its expectations clearly. It will be a lot easier for providers to do what the ACCME asks if they can easily understand the ACCME’s expectations. Commercial support requirements could be restructured to more easily apply to various scenarios such as activities that are commercially supported, those that are not commercially supported, and those that do not include advertising and exhibits.
- Fewer criteria may suffice: Some expectations are redundant (for example, Criterion 4, scope of practice); some are not readily measured (Criterion 5, choice of educational format); and some could be collapsed into one (Criteria 12-15, self-assessment and improvement).
- Criterion 16‑22 are too easy: Stakeholders pointed out that some providers could be in compliance with Criteria 16 and 22 by virtue of their organizational structure and CME processes. Also, engagement with the environment is not the only way an accredited provider can be commendable.
- Evolve the Commendation Criteria: Providers want to retain a criterion-referenced system for Accreditation with Commendation, but they want more attributes to be recognized as commendable. They like the concept of a menu of options, from which they could choose a certain number to fulfill in order to achieve Accreditation with Commendation.
- Maintain high expectations: Stakeholders do not want the ACCME to lower the bar. They value the Plan-Do-Study-Act approach combined with the Standards for Commercial Support.
- Push providers to higher level outcomes: Stakeholders feel that the ACCME should evaluate whether CME providers cause change—not just measure change—in learners. This should be an ACCME measurable, if not an actual requirement. Also, while stakeholders recognize that learners’ achievement of knowledge and competence are necessary steps in the change process, some stakeholders believe these objectives may no longer be adequate outcomes, if the accredited CME system is positioning itself as a strategic asset for initiatives to improve health care and public health.
- Keep pushing stakeholders: Stakeholders expect and want the ACCME requirements for the accredited CME enterprise to be drivers for their organizations’ change and improvement–—so that their CME programs are in fact relevant and serve as strategic assets to initiatives to improve health care and public health.
- Require organizational competence and-buy-in: It may be time to reintroduce requirements that organizations explicitly demonstrate their commitment to CME. (This expectation was specified in previous ACCME requirements.) Examples could include expecting CME staff to meet certain qualifications, evidence of direct, hands-on oversight by CME leadership, explicit involvement of senior organizational leadership.
- Retain three-part reaccreditation process: Providers see the triad of self-study report plus performance-in-practice review plus interview as a valuable process that should be retained, although they offered suggestions for improvement. One suggestion was to make interviews optional. To ease documentation requirements, providers suggested that the ACCME develop a structured abstract for providers to use when verifying performance-in-practice, which would take the place of labels and facilitate the process of submitting activity files.
- Retain verification by documentation: Providers feel that creating and maintaining adequate documentation of compliance is a lot of work—but that the ACCME’s random selection of activities for performance-in-practice verification is critical to the credibility and overall validity of the accredited CME enterprise in the eyes of our customers. The providers have asked that the ACCME examine how documentation requirements can be reduced while maintaining the important benefits of performance-in-practice verification.
- Templates: Providers want the ACCME to develop (optional) tools, instruments, and resources for providers to use in order to streamline the reaccreditation process and to promote compliance findings.
- Formative feedback: Providers want information about their compliance during their term of accreditation, as opposed to every four or six years. They want to know how they are doing in real-time and they want the opportunity to make mid-course adjustments, so as to avoid noncompliance findings.
- Engage leadership: Stakeholders believe that their institutional leadership and the leadership of the health care system in general is not engaged with continuing professional education—and this engagement must be developed in order to realize the full value of CME. They want the ACCME’s help in achieving this engagement.
- Regulatory alignment: Stakeholders believe that it is critical to achieve a congruence of values and expectations across regulatory systems.
- Validation by MOC and MOL: Stakeholders believe that the accredited CME enterprise needs explicit validation from the emerging systems of Maintenance of Certification® (MOC) and Maintenance of Licensure (MOL) in equal measure.
- Support MOC and MOL: Stakeholders believe that the accredited CME enterprise must fulfill the needs and expectations of the emerging systems of MOC and MOL. In addition, and perhaps more important, the accredited CME enterprise must fulfill the needs and expectations of those directly involved in improving health care or population health.
Members of the Committee for Review and Recognition (CRR) discuss the ACCME’s strategic goals with the Board of Directors and member organization liaisons. At head of table, from left, CRR members: Melvin Freeman, MD; Karen Hutchinson, MD; Patrick Sweeney MD, PhD, MPH; Carol Havens, MD, CRR Co-Chair, and member, ACCME Board of Directors