estherhelen | Twenty20

CME refers to educational activities that serve to maintain, develop, or increase the knowledge, skills, and professional performance and relationships that an individual uses to provide services for patients, the public, or the profession. The content of CME is the “body of knowledge and skills generally recognized and accepted by the profession as within the basic medical sciences, the discipline of clinical medicine, and the provision of healthcare to the public,” according to the American Medical Association (AMA), which authorizes CME credits.

CME is closely associated with physicians who seek to demonstrate that they have participated in educational activities and obtained CME credit to document meeting the requirements of state medical boards, medical specialty societies, specialty boards, hospital medical staff, the Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations), insurance groups, and others. In practice, CME allows doctors—who typically spend four years in medical school and three to five years in residency training—to expand their expertise throughout their professional career. It can help them drive improvements in practice and optimize the care, health, and wellness of patients. “Whether physicians work in clinical care, research, healthcare administration, executive leadership, or other areas of medicine, accredited CME is designed to be relevant to their needs, practice-based, and effective,” the Accreditation Council for Continuing Medical Education (ACCME) states on its website.

However, CME is mandatory for many medical professionals, not just physicians. Most US state and territory medical boards have compulsory CME requirements for license renewal. CME requirements for licensure and license renewal vary for different individuals according to the jurisdiction. In Alaska, for example, all medical professionals must have a minimum number of professional continuing education credits to renew their professional licenses, according to Jennifer Gehrke, clinical educator for Foundation Health Partners in Fairbanks. Foundation Health Partners includes Tanana Valley Clinic, Fairbanks Memorial Hospital, and Denali Center. “Physicians need fifty hours every two years, and two of those hours must be in pain management and opiate use and addiction,” Gehrke says. “Registered nurses need thirty continuing education hours every two years to renew their professional licenses. Many nurses and physicians have additional certifications in their specialty, which require additional hours.”

As another example, the state of Alaska also requires emergency medical technicians (EMTs) to complete CME for their recertification. EMTs can earn CME in a variety of ways, depending on their needs and interest. They can take certain amounts of CME training courses per certification period, including advanced cardiac life support, advanced burn support, basic trauma life support, CPR, anatomy, and physiology.

EMTs can also receive up to twelve hours of CME per certification period for serving as an examination proctor, simulated patient and/or certifying officer, according to the Public Health Division of the Alaska Department of Health and Social Services. Another option is self-study CME that includes internet-based CME training, as well as EMS-related videotapes and magazines.

Clinical education experts indicate that the importance of continuing medical education cannot be overstated. Keeping up with continuing professional education is crucial, according to Gehrke. “Medicine is a field that is constantly changing as new research is done, and it is important for medical professionals to provide current evidence-based practice to give our patients the best care possible,” she explains.

Jennifer Fielder has a similar perspective. “Maintaining a knowledge base of current, up-to-date best practice is needed by all medical professionals to ensure the best patient outcomes from our united operations and execution of care,” says Fielder, a nurse educator with the Clinical Education/Continuing Education Department at the Alaska Native Tribal Health Consortium (ANTHC). “Outside of collegiate classrooms, by having local or online education opportunities available, when in collaboration with multiple medical professions, the learners will experience a more broad-based learning—especially as multiple professions come in contact with any patient during any treatment,” she says.

Continuing education is essential in all industries and relevant material is needed to support ongoing learning, Gorba says. “In order to be knowledgeable and current in your specialty, the education for that gap must come from somewhere,” she says. “Advances are made very quickly in healthcare and maintaining relevance can be a challenge…To get our providers to engage with continuing education, we need to provide content that will improve the knowledge, competence, and performance.”

To Shane Coleman, continuing education is about staying current and effective, among other things. “It’s brushing up on things that you’ve already studied to make sure you have a good knowledge base to ensure you’re providing good care,” says Coleman, a psychiatrist and medical director of the Behavioral Services Division for Southcentral Foundation.

From a practical standpoint, most professionals focus on CME because they need units for their maintenance of certification. When physicians obtain their medical license it sets a minimum competency to diagnose and treat patients. Board certification is voluntary and demonstrates exceptional expertise in a particular specialty or practice. “By doing specific activities or taking specific training, they are showing continuous development,” Gorba says. “Physicians who use CME for [maintenance of certification] can provide a higher quality of care.”

While CME allows professionals to maintain their medical license and credentialing at the hospitals where they see patients, it also offers added benefits. For instance, it fosters the improvement of a provider’s daily medical practice. “We accomplish that by promoting new technologies, rapidly changing advances and treatments in their fields,” Gorba says. “CME can also provide [professionals] the ability to network and advance their careers.”

There’s also the less obvious benefit that comes from interprofessional CME: the reduction of the length of hospital stays and hospital readmission rates for patients. Gorba explains: “When an educational event combines providers, nurses, and other staff, it becomes interprofessional and promotes team learning. It will improve care and communication between the entire team which, in turn, will improve patient safety.”

For Coleman, one of the key benefits of CME is having the ability to interact with peers on a professional and social level. This allows him to build networks within his specific field, which can be extremely helpful. He explains, “Building that network is important because there are times when you might have questions, or you might see something unusual.”

Like most professionals, Coleman engages in CME to meet board and state-level requirements. He typically attends at least one conference a year, which often affords him the opportunity to spend multiple days dedicated solely to continuing education. “So if you’re required to get twenty-five CMEs a year, you might be able to knock out all your requirements in a single conference,” he says.

The AMA is a premier accredited CME provider, and it assigns CME credit to two categories: AMA PRA Category 1 Credit and AMA PRA Category 2 Credit. AMA PRA Category 1 Credits are the most commonly accepted form of CME credits for physicians. They’re also the basis for receiving the AMA Physician’s Recognition Award (PRA), which acknowledges individuals who have demonstrated their commitment to staying current with advances in medicine by participating in various live and self-study CME activities. The AMA requires that at least half of the credit applied toward AMA PRA be within the physician’s specialty or area of practice.

According to the AMA’s website, physicians can earn AMA PRA Category 1 Credit in three ways: by participating in certified activities sponsored by US-based CME providers accredited by either the ACCME or an ACCME-recognized State Medical Society; by participating in certain activities recognized by the AMA as valid educational activities; and by participating in certain international activities recognized by the AMA. Activities certified for this category include live events, journal-based CME to test item writing, internet point of care learning, and participating in a residency or fellowship program.

The American Osteopathic Association (AOA) is another key accredited provider that awards CME credit for live and self-study activities. The AOA assigns credit to four different categories that are differentiated by their formality and interactivity. Formal educational programs designed to enhance clinical competence and improve patient care are awarded the most CME credit.

In Alaska, a licensee must complete fifty CME hours in AMA Category I, AOA Category I or II, a current AMA PRA, or a current certification by a specialty board recognized by the AMA or AOA, or participate in an approved residency/fellowship program, according to Gorba. The license cycle for a medical doctor is generally two years.

Medical professionals can find eligible CME activities through a variety of sources. The AMA website, for instance, provides a list of the certified CME activities that are directly sponsored by the AMA as an accredited CME provider. The ACCME also maintains a list of accredited CME providers as well as accredited CME activities on its website. In addition, professionals can find potential CME activities by contacting specialty societies, medical schools, and local hospitals that are accredited CME providers.

Physicians can identify legitimate AMA PRA Category 1 Credit activities by making certain the activity is certified by an accredited CME provider. Incidentally, the AMA requires accredited CME providers to trademark the credit phrase (“AMA PRA Category 1 Credit”). If credit is not indicated this way, physicians should question whether the activity is in fact eligible for AMA PRA Category 1 Credit.

In Alaska, Foundation Health Partners is a legitimate provider unit for continuing medical education through the Washington State Medical Association. It’s also a provider unit for nursing contact hours through the Montana Nurses Association. “Our approved provider status allows us to independently plan and implement educational activities that are designed to meet the learning needs of our staff and providers while awarding continuing education hours needed to maintain licensure,” Gehrke says.

Foundation Health Partners provides many of its own classes, which are almost always free to its staff and employed physicians. When there is a cost for a class, such as speaker travel or an honorarium, the funds generally come from the department requesting the education. “We are sometimes able to obtain funds from other agencies, such as medevac companies, in exchange for having a vendor table at the educational event,” Gehrke says. “If we do have a cost for the education, we try to make it as low as possible. For example, we offered a bear mauling class in 2019 that was co-sponsored by LifeMed Alaska and Interior Region EMS Council. Because of these sponsorships, the cost per participant was only $20.

“Participants can sometimes attend an educational event during the workday, but most often staff plan their continuing education for their days off,” Gehrke continues. “For physicians, a one-hour event during their clinic lunch hour seems to work best, so we have most of our physician-specific education [from] noon to 1 p.m. on weekdays.”

Like Foundation Health Partners, ANTHC also takes a strong role in supporting and encouraging continuing medical education. The mission statement for its CME program states: “The Alaska Native Tribal Health Consortium Continuing Education mission is to ensure quality-learning opportunities, providing improved changes of competence and performance for our healthcare professionals, while improving patient outcomes demonstrated in best practice services for our people and the Alaska Tribal Health System.”

ANTHC’s facility provides multiple venues and opportunities for staff on campus, according to Fielder. “During the 2019 calendar year this office provided oversight to over 100 unique, one-time, or regularly scheduled series, with most occurring within the campus,” she explains. “Most of the one-time events were large activities in collaboration with the state medical community or tribal organizations with training or courses held within and outside of Anchorage.”

ANTHC currently covers the costs of accredited live CME—as well as continuing nursing education—events for its employees, Fielder says. Plus, it has a vast library available through its learning management system with online, at-work, or from-home access.

Medical professionals can find CME in many ways, depending on their needs at the time, Gorba says. For example, some CME is offered in exotic places where professionals can vacation and take some much-needed time off while obtaining their education. Providers can also find learning opportunities online, where they can participate on their own time and from their own couch. “Still others may look locally for training offered at a local hospital or their own facility where they see patients,” she says. “That education can be more skills-based and offer hands-on training, i.e., learning how to use bedside ultrasound for diagnosis to expand your skill set. The challenge is finding the training you need to fill the gap you have.”

Southcentral Foundation for Behavioral Health also offers events that allow participants to obtain CME credits, according to Coleman. It turns different trainings and leadership development activities into viable opportunities providers can use to meet their CME requirements.

Healthcare industry experts are seeing a number of trends in continuing medical education. The biggest trend Gehrke says she’s noticed over the last few years is an emphasis on interprofessional education. “Because medicine is a team sport, we try to include the entire team when we do training,” she explains. “For example, when we train for emergencies in the operating room, we include nurses, surgeons, scrub techs, anesthesiologists, the blood bank, and anyone else who might be involved when an actual emergency happens.”

Simulation training has also increased in the last few years. Gehrke explains: “When I went to nursing school in the ‘90s, we practiced everything on real patients. Now we train in the simulation lab with high fidelity manikins… for new procedures or low volume/high risk skills or situations that we don’t see often enough to be proficient.”

She adds: “Our simulation nurses, Lori Gibertoni and Stacy Wright, do an amazing and creative job of making everything as realistic as possible. They have a vomiting intubation manikin (the ‘vomikin’) that they made with an intubation head we had and a drill from a local hardware store. Anything that we can do to create realism makes the training that much more meaningful.”

Within the field of psychiatry, Coleman has noticed more professionals investing in completing addiction CMEs lately. More specifically, treatment for opioid abuse is a popular online CME course that people are taking. Another popular CME is Eye Movement Desensitization and Reprocessing (EMDR) therapy, which is increasingly being used to treat trauma and post-traumatic stress disorder.

Gorba is also seeing diverse CME trends unfolding. For example, there are online, interactive, and on-demand options for providers who have less time available for various reasons. “The electronic health record has made some things easier and some things more difficult for providers,” she says. “Some may go home for the evening only to find themselves having to continue documenting for three or four hours after they get home. The shortages in physicians has found us now reaching out in new ways to deliver care, like telemedicine. These newer advances in technology also inspire us to provide CME about the ethics and liability of telehealth.”

Continuing, Gorba says: “To remain vital and make a difference in competence, performance, and patient outcomes, we need to fill the needs of our providers. Continuing medical education is not only a requirement but a responsibility of every hospital. When there is a gap in practice or a specific need for training, the CME educator can provide what is needed and improve patient care.”