for Caroline, Maria, Hasmik, Arsinee and Jerry - and anyone else out there who loves Continuing Medical Education

Summary:

CME Accreditation allows organizations to offer  AMA PRA Category 1 Credit™  (please note the italics and superscript, these are required to use this copyrighted phrase) and offer ACCME credit for learning activities.

AMIC is considering becoming a CME provider, which would be best done through ACCME since we work internationally and could do joint providerships with our various chapters.

AAMS has offered CME credit for Congresses in Yerevan and Buenos Aires.  AAMS is accredited through IMQ, a California based organization.  So 70% of AAMS' target physician audience should be from California or neighboring states.  This is possible, as AAMS does so many local educational activities. 

Definitions:

• Provider:  The accredited organization providing CME credit for an educational activity, such as a hospital or medical association.
• Program:  Think of this as a major effort to change physician behavior in one sphere:  hypertension program, stroke program, cancer program
• Activity:  A single teaching session (lunch talk about hypertension and stroke risk) or single RSS (regularly scheduled series, like tumor board)
• Cultural and linguistic competency (CLC):  Required for all educational activities given by California based providers, it is a discussion of cultural and language factors leading to health care discrepancies.
• Regularly Scheduled Series (RSS):  Activities where the same thing is done at every meeting (like tumor board, case reviews).  In other words, a single educational activity can be spread out over many sessions.
• ACCME-defined Commercial Interest:   A commercial interest is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.  Check out this link with questions

Accreditation is done through Accreditation Council for Continuing Medical Education (ACCME).  The fees are on the order of $6000 per year.

• https://www.accme.org/become-accredited
• https://www.accme.org/sites/default/files/2018-12/110_20181217_Accreditation_fees.pdf

The California Medical Association can accredit CME providers in California and adjacent states, and does this through the Institute for Medical Quality (http://www.imq.org/).  

 IMQ holds regular workshops for CME providers to learn and brush up on CME skills, and receive important updates.  Highly recommended.

Checklist

1. Don't advertise CME credit until it is approved, signed, sealed, delivered.
2. CME committee should be involved from the very beginning.  Don't wait until the talk(s) are completed at the last minute!
3. We need financial disclosures from everyone in control of course content:
   • The speakers 
   • The CME committee
   • The Scientific Committee (for medical Congress)
   • Course planners
   • Probably a good idea to collect them from everyone planning the Congress.
   • Need to disclose information about financial relationships with commercial interests within the past year.  We don't need to know the monetary amount.
   • The CME committee, and not the speaker, is responsible for determining whether a relationship is relevant to course content.  In other words, ask the speaker about financial relationships, not relevant financial relationships.  It is up to CME committee to decide if it's relevant.
4. CME provider is responsible for all monies collected and spent.  CME provider is responsible for avoiding any commercial influence or bias.  CME provider is responsible for making sure that no advertising (including corporate logos) is included in course materials.
5. Financial relationships and lack of financial relationships (for speakers, planners, CME committee) must be disclosed to the audience prior to the educational activity.
6. Commercial support must be disclosed to the audience prior to the educational activity.
7. We're not kidding.  The collection and resolution of potential conflicts of interest related to relevant financial relationships is one of the more time-consuming parts of CME.

 Process 

1. Mission Statement - should state what the CME provider is trying to do with the massive effort and time spent offering AMA PRA Category 1 Credit™.   It should include expected results of all this effort.
2. Gap analysis - What don't we know?  What do we need to do better? What is the difference or gap between what we are now doing, and what we should be doing?  It can be expressed as:
   • knowledge deficit - new disease or technique?  wrong approach to old problems?
   • competence deficit - need to learn how to do CPR or install an aortic graft.  need to prescribe a new drug correctly.  need to accurately assess cancer stage.
   • performance deficit - using wrong or inconsistent practice techniques.  forgetting to prescribe aspirin or beta blocker after heart attack.  forgetting to clean hands (!)  Much of the performance data can be collected from electronic medical records.
   • outcome deficit impacting our patients - high sepsis mortality.  poor wound healing.  poor recovery from stroke
3. determining what will be tought to address the gap.  Sepsis mortality has many causes.  It may be difficult to address them all in a lunch meeting (do ya think?).  Which one shall we address today?  What are the specific learning objectives?  
4. Match the educational material to the audience.  Primary care docs need to learn different things about diabetic eye disease than retinal specialists.  different things about stroke management than interventional radiologists.
5. Decide your educational format.  Another lecture with stuffy air and death by PowerPoint?  How about an interactive discussion between peers?  Role playing?  Jeopardy! game?  Round table discussion?  Practice on dummies?   Online learning?  Journal club?   Remember, lectures tend not to change physician behavior.
6. What core competencies will be developed?  medical knowledge?  teamwork?  communication skills?  QI?  Informatics?  others?
7. Compliance with standards for commercial support - This is a biggie!  See the Checklist above.  
8. Managing commercial support - contracts with commercial supporters, honorium policy, policy, policy, policy!
9. Separate promotion from education.  Get the ads, logos, commercial breaks out of the educational activity.  Eliminate trade names if possible.
10. Your role is to advance health care, not to promote a drug or device.
11. Evaluate what your audience learned as a result of all the effort you spent.  Did they learn a new technique?  How do you know?  Did they say so on an evaluation form?  Did you actually watch them demonstrate their skill?  Are the patients actually benefiting in a measurable way?
12. How is your CME program going?  Is it helping you meet your Mission Statement?
13. What changes do you need to make to the program to better meet your Mission Statement?

• ACCME criteria (pdf)  Includes proposed new Commendation Criteria
• Introduction to Cultural and Linguistic Competency (diversity wheel)
• Suggestions to the speaker

Plenary sessions:  (this is from 2017)

Healthcare development and strategies in Armenia

Speakers:  Rafi Avitsian, Shant Shekherdimian, Jerry Manoukian, someone from MoH, Pablo Elmassian

Gap:  pretty straightforward.  Diaspora has poor understanding of strategies for developing health system in Armenia/NKR and we need to regroup and restate our priorities every few years.

Objectives:  Restate the priorities for healthcare development in Armenia/NKR

Telemedicine

Robert Istepanian,

Gap:  New technology, used throughout developing countries, including M health, telemedicine.  

Gap:  New technology, Artificial Intelligence, including neural networks and other technology that can help drive telemedicine, assist in medical decisionmaking and possibly stimulate the economy in Armenia

Objectives:  Recognize opportunities for telemedicine use and develop ideas for its deployment