Accreditation, credits and the bodies that run the field
Health professionals earn continuing education credits to keep their licence or certification, and organisers seek accreditation so that their activities award them. The number of credits a clinician needs differs by country, profession and state, and in Germany a law sets it. Separate organisations accredit the providers that award the credits, certify the people who work in the field and speak for the field as a whole.
CME and CPD
Continuing medical education (CME) and continuing professional development (CPD) both aim at improving physicians' clinical competence and skill, but each has a different focus. CME consists of educational activities that serve to maintain, develop or increase the knowledge, skills and professional performance physicians use to provide services for patients, the public or the profession, and its content is the body of knowledge and skills generally recognised and accepted by the profession as within the basic medical sciences, the discipline of clinical medicine and the provision of health care to the public. CPD consists of education that enables physicians to maintain clinical competence, broaden their knowledge and skills, and develop the personal qualities needed to carry out professional and technical duties throughout their working life, and its content teaches physicians how to respond to challenges in relationships and communication, changing health needs, and the social, political and economic factors of practising medicine.
How many credits a clinician must earn
For decades most physicians, nurses and other health professionals have had to earn a set number of continuing education credits each year to maintain their professional certification, and the amount varies by state and subspecialty.
In the United States the requirement differs by profession as well as by state. The average minimum hours of education a year are 12 to 50 for physicians, 20 for nurse practitioners, 50 for physician assistants, 12 to 20 for pharmacists, 0 to 15 for practical and registered nurses, 6 to 20 for clinical psychologists and 10 to 15 for registered dietitians. For several of these professions the state of licensure sets the exact number, some designations may recertify by an examination that may not require credits, and many states have practice hours as an additional or alternative requirement for nurses.
The Accreditation Council for Continuing Medical Education (ACCME) sets the standards for physicians' accredited CME, and its definition of CME can be adapted to other health professions. Other professions have their own continuing education accreditation bodies: the American Association of Nurse Practitioners, the American Academy of Physician Associates, the Accreditation Council for Pharmacy Education, the American Nurses Credentialing Center, the National Board for Certified Counselors, the Accreditation Council for Education in Nutrition and Dietetics, and Joint Accreditation for Interprofessional Continuing Education.
In the UK, general practitioners must demonstrate each year that they have taken part in a range of educational activities and accumulated an average of at least 50 credits a year. Those credits can be awarded by a range of approved organisations whose role is to assess the educational value, the quality of the content and the unbiased nature of the activity.
Credits set by law
In Germany the healthcare modernisation law (GKV-Modernisierungsgesetz) has required doctors since 2004 to acquire 250 CME points every five years, and a doctor who fails to can suffer financial losses and, in the worst case, the withdrawal of their licence. Points can be earned by attending lectures, by going to conferences, or by completing CME modules in certified journal articles. To offer modules in print, a journal must be certified by the relevant regional medical association, and a scientific paper is considered for the programme only once it has passed an independent review and its authors have declared their conflicts of interest.
Every doctor in Germany receives Deutsches Ärzteblatt, the largest medical journal in the country and the official publication of the German Federal Medical Association and of the National Association of Statutory Health Insurance Physicians. With special editions for retired and non-clinical doctors and for practising clinical psychologists, its circulation is about 470,000, and CME articles appear in every edition.
In a Deutsches Ärzteblatt CME module, the reader answers ten multiple-choice questions on the article as proof of participation, and can find online further information compiled by the authors together with a case example that illustrates the topic in practice. Readers who answer 70% of the questions correctly are awarded three points, and after answering they are asked to score the article for quality and for relevance to their own clinical work. Unlike medical school finals and specialisation exams, the questions are not an examination in the strict sense: they are intended merely to demonstrate whether the article has been read. By 2016 the journal had published 155 CME papers since September 2004, and by 12 August 2016 readers had logged on more than three million times to complete a final evaluation form.
Each module is accessible for three months, after which every successful participant receives a certificate. Where a question contains an error in its actual content, an application has to be made to the certificating body, the Academy for Continuing Medical Education of the North Rhine Medical Association, to withdraw the question, and an erratum is published after the three-month access period ends. The North Rhine Medical Association can remove approval for CME if too many participants fail the test.
Why organisers seek accreditation
Participation in meetings and events is part of a health professional's CPD, and an organiser has to gain accreditation for CPD in order to attract delegates. The organisers of one accredited conference found CPD credits a major attraction for doctors and a mark of credibility that lends authority to a programme. Many industry-sponsored events are not eligible for accreditation.
The bodies that run the field
The Alliance for CME was formed in 1975 to represent all segments of the growing CME industry, and its membership is open to anyone involved in CME, staff and freelance medical writers included. By 2010 it had more than 2,500 members, most of whom had been in the field for at least a decade. Its officers then served on advocacy committees with the American Medical Association, the ACCME and the Institute of Medicine, and had been on the front line in answering congressional criticism of CME. Its annual winter meeting, live webinars and two-day CME basics course in the summer were open to non-members as well as members, and members received several publications free. Perhaps the greatest value of membership, as with other professional associations, was networking: the members included leading decision makers at virtually every provider and funding entity in CME, and many of them decided when and whether to hire medical writers.
The associations serving the field include the ACCME, the Alliance, the National Commission for Certification of CME Professionals, and two smaller niche organisations, the North American Association of Medical Education and Communication Companies (NAAMECC) and the Society for Academic CME. NAAMECC has endorsed a code of conduct for commercially supported CME. Its board encourages other organisations dedicated to CME best practice to review and endorse the code.
Only properly accredited institutions and organisations within the ACCME's system can provide CME credits, and the Certified CME Professional credential does not make its holder eligible to provide them.