Limitations of CME concept

CME is a popular and familiar term and typically means AMA PRA Category 1 Credit ™, but like other terms it is limited and being eclipsed by changes outside of CME.
  • It only applies to physicians. Other professionals receive/require a different type of credit for education/training.
  • It is a legal term that almost always refers to an educational experience in compliance with the ACCME's rules that qualify for AMA PRA Category 1 Credit ™ (AMA, 2010)
  • Credits are seen as equivalent even if one prioritizes practice improvement and improved outcomes
  • CME has become a requirement if one wishes to maintain their license, certificate and thus has a strong motivation component). (ACCME, 2008). Most states simply require a certain amount of credits be earned, not that specific outcomes be achieved. 
  • Content, delivery and time are controlled by the particular accreditation agency and is not in sync with local needs of health provider organizations.
  • Typically not coordinated with other provider training/education.
  • Structure provides consistency but it limits innovation and thus hinders potential benefit. Call for change (such as McMahon, 2011) are often met with resistance.
Perhaps we need a new organization principal outside of CME to support more rapid changes and rid the field more quickly or practices which are less effective (Institute of Medicine, 2009, ABMS White Paper, 2011).
References
  1. The Physician’s Recognition Award and credit system: Information for accredited providers and physicians [monograph on the Internet]. Chicago, IL: American Medical Association; 2010. Available from: http://www.ama-assn.org/resources/doc/cme/pra-booklet.pdf.
  2. CME as a bridge to quality: Leadership, learning, and change within the ACCME System [monograph on the Internet]. Chicago, IL: Accreditation Council for Continuing Medical Education; 2008 Jan. Available from: http://www.accme.org/dir_docs/doc_upload/e2843247-7cae-40fe-a0eb-27a982b8fcc0_uploaddocument.pdf
  3. John W. McMahon, Sr., MD, Chair, Financial Relationships with Industry in Continuing Medical Education, REPORT OF THE COUNCIL ON ETHICAL AND JUDICIAL AFFAIRS, CEJA Report 1-A-11, 2011 (http://www.acme-assn.org/imis15/aCME/PDFs/Advocacy/2011_AMA_CEJA_Report_1-A-11.pdf)
  4. Institute of Medicine. Redesigning Continuing Education in the Health Professions. Washington, DC: National Academies Press; 2009. Chapter 5. Pages 93-114 Available at: http://www.nap.edu/openbook.php?record_id=12704&page=93
  5. White Paper: CME for MOC ABMS/ACCME Joint Working Group on MOC CME January 2011, Available at: http://policymed.typepad.com/files/moc-cme-abms-white-paper-11-10-2-1.pdf
  6. Carol Havens, MD; Jeffrey Mallin, MD, Climate Change: It’s Not About the Weather—Continuing Medical Education and Maintenance of Certification and Licensure. The Permanente Journal, Summer 2011 - Volume 15 Number 3. Available at: http://www.thepermanentejournal.org/issues/2011/summer/4157-cme-editorial.html
Copyright 2011, Bradley Tanner