Benefits of Activity-Level Certification for Continuing Medical Education Activities

Response from the American Academy of Family Physicians to the Commentary on Provider Accreditation by Kopelow and Campbell

Dear Sir,

In response to the March 2013 Journal of European CME commentary, The benefits of accrediting institutions and organisations as providers of continuing professional education,¹ the American Academy of Family Physicians (AAFP) would like to provide additional context for consideration when evaluating the benefits of activity-level certification of Continuing Medical Education (CME) activities.

The value of certified CME supports the advancement of scientific knowledge, competence, and performance. The AAFP CME Credit System provides the foundational structure for CME that allows physicians to maintain their ethical obligation to lifelong learning. It also provides certification for the education that helps family physicians improve in practice, maintain certification and licensure requirements, obtain hospital privileges, meet payer guidelines, and most importantly, improve the care they provide to patients.

The AAFP, the American Medical Association,² and the American Osteopathic Association (AOA)³ each have a unique set of guidelines that define the CME credit they award. The credit systems collaborate to ensure alignment and have defined a reciprocity agreement between them. While there is a desire for alignment of the systems, based on the differing needs of respective practicing physician populations, there are intentional distinctions between the credit systems. One distinction is that the AAFP certifies CME at the activity level.

In 1947, realizing that the family doctor's effectiveness depends on sound, up-to-date continuing education, the AAFP's founders wrote into the Bylaws the requirement that members in the AAFP's active membership category must complete a minimum of 150 hours of approved continuing education every 3 years to retain membership. The requirement, unique at its time of origin, has, through the years, become a standard for an increasing number of other medical groups. The AAFP CME Credit System was the first national CME accrediting body in the United States, and since its creation over sixty years ago, has consistently assured that AAFP-certified CME is objective and relevant, and free from the inappropriate influence of external support or other factors that could introduce bias. CME provider organizations define the educational gaps of their learners to create learning objectives, identify expert faculty, develop CME formats, and incorporate evaluation methods. Activity-level review enables the AAFP to immediately determine whether the activity aligns with the continuing professional development and compliance criteria for family physicians.

The AAFP CME Credit System includes defined guidelines and policies to provide physicians, faculty, and CME provider organizations, as well as consumers of credit (licensing boards, specialty boards, hospitals, etc.) with confidence that the certified CME in which they participated has been individually reviewed for quality and relevance by the AAFP.⁴ The Accreditation Council for Continuing Medical Education (ACCME) is not a credit system. Rather, it serves as an accrediting body used by the American Medical Association (AMA) Credit System (established in 1968) to ascertain whether an organization should be allowed to award AMA PRA Category 1 Credit^™. The ACCME, established in 1981, accredits CME provider organizations, and recognizes state and territory medical societies as accreditors through their accreditation criteria, the ACCME’S Essential Areas and Elements, and the ACCME Standards for Commercial Support.⁵

The AAFP believes that activity-level review is a commitment to learners that each AAFP-certified CME activity is relevant, unbiased, and aligned with the scope of care provided by family physicians. Activity-level certification provides a detailed level of validation. As physician certification and licensure become more specific to an individual physician's scope of care,⁶ the AAFP's activity-level review supports them in maintaining alignment with professional requirements. In contrast, institutional accreditation evaluates CME provider organizations operational processes and 15 sample CME activity files in a reaccreditation audit every 4 or 6 years.

A physician-led governing body establishes and maintains the guidelines for the AAFP CME Credit System. The subject matter expertise of these leaders in the field of family medicine provides validation for the criteria and established review processes. CME activities awarded AAFP CME credits must also adhere to the Accreditation Council for Continuing Medical Education's Standards for Commercial Support, which the AAFP participated in developing.

In conclusion, as we evaluate and review the standards established to meet certification criteria for CME, the author agrees with Dr. Kopelow and Dr. Campbell that these standards must meet the defined needs of physicians. The more closely accreditors align with the specialized needs of the practicing physician, the greater the value of the CME to physicians. Rather than spending time seeking to establish one model as superior to the other, the credit systems and accreditors should focus on their long-standing collaborative relationship in a way that brings value to the CME community and the physicians they serve.