The transformation of continuing medical education (CME) in the United States

Figures & data

Table 1 Institute of Medicine core competencies

Competency	Description
Provide patient-centered care	Identify, respect, and care about patients’ differences, values, preferences, and expressed needs; relieve pain and suffering; coordinate continuous care; listen to, clearly inform, communicate with, and educate patients; share decision making and management; and continuously advocate disease prevention, wellness, and promotion of healthy lifestyles, including a focus on population health
Work in interdisciplinary teams	Cooperate, collaborate, communicate, and integrate care in teams to ensure that care is continuous and reliable
Employ evidence-based practice	Integrate best research with clinical expertise and patient values for optimum care, and participate in learning and research activities to the extent feasible
Apply quality improvement	Identify errors and hazards in care; understand and implement basic safety design principles, such as standardization and simplification; continually understand and measure quality of care in terms of structure, process, and outcomes in relation to patient and community needs; and design and test interventions to change processes and systems of care, with the objective of improving quality
Utilize informatics	Communicate, manage knowledge, mitigate error, and support decision making using information technology

Note: Adapted with permission from Health Professions Education: A Bridge to Quality, 2003, by the National Academy of Sciences, courtesy of the National Academies Press, Washington DC. Available from: http://nap.edu/catalog.php?record_id=10681.⁴

Table 2 Accreditation Council for Graduate Medical Education/American Board of Medical Specialties core competencies

Competency	Criteria
Professionalism	Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to diverse patient populations
Patient care and procedural skills	Provide care that is compassionate, appropriate and effective treatment for health problems and to improve health
Medical knowledge	Demonstrate knowledge about established and evolving biomedical, clinical and cognate sciences and their application in patient care
Practice-based learning and improvement	Able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence and improve their practice of medicine
Interpersonal and communication skills	Demonstrate skills that result in effective information exchange and teaming with patients, their families and professional associates (eg, fostering a therapeutic relationship that is ethically sound, uses effective listening skills with nonverbal and verbal communication; working as both a team member and at times a leader)
Systems-based practice	Demonstrate awareness of and responsibility to larger context and systems of health care. Be able to call on system resources to provide optimal care (eg, coordinating care across sites or serving as the primary case manager when care involves multiple specialties, professions or sites)

Note: Adapted with permission from American Board of Medical Specialties.³⁸

Table 3 American Board of Medical Specialties: four-part process for continuous learning

Part	Requirement
Part I – licensure and professional standing	Medical specialists must hold a valid, unrestricted medical license in at least one state or jurisdiction in the United States, its territories or Canada
Part II – lifelong learning and self-assessment	Physicians participate in educational and self-assessment programs that meet specialty-specific standards that are set by their member board
Part III – cognitive expertise	They demonstrate, through formalized examination, that they have the fundamental, practice-related and practice environment-related knowledge to provide quality care in their specialty
Part IV – practice performance assessment	They are evaluated in their clinical practice according to specialty-specific standards for patient care. They are asked to demonstrate that they can assess the quality of care they provide compared to peers and national benchmarks and then apply the best evidence of consensus recommendations to improve that care using follow-up assessments

Note: Adapted with permission from American Board of Medical Specialties.³⁸

Table 4 Interprofessional collaborative practice competency domains

Domain	Specific competencies
Values/ethics for interprofessional practice	VE1. Place the interests of patient and populations at the center of interprofessional health care delivery
	VE2. Respect the dignity and privacy of patient while maintaining confidentiality in the delivery of team-based care
	VE3. Embrace the cultural diversity and individual differences that characterize patients, populations and the health care team
	VE4. Respect the unique cultures, values, roles/responsibilities, and expertise of other health professions
	VE5. Work in cooperation with those who receive care, those who provide care, and others who contribute to or support the delivery of prevention and health services
	VE6. Develop a trusting relationship with patients, families and other team members
	VE7. Demonstrate high standards of ethical conduct and quality of care in one’s contributions to team-based care
	VE8. Manage ethical dilemmas specific to interprofessional patient/population centered care situations
	VE9. Act with honest and integrity in relationships with patients, families and other team members
	VE10. Maintain competence in one’s own profession appropriate to scope of practice
Roles/responsibilities	RR1. Communicate one’s roles and responsibilities clearly to patients, families and other professionals
	RR2. Recognize one’s limitations in skills, knowledge, and abilities
	RR3. Engage diverse health care professionals who complement one’s own professional expertise, as well as associated resources, to develop strategies to meet specific patient care needs
	RR4. Explain the roles and responsibilities of other care providers and how the team works together to provide care
	RR5. Use the full scope of knowledge, skills, and abilities of available health professionals and health care workers to provide care that is safe, timely, efficient, effective, and equitable
	RR6. Communicate with team members to clarify each member’s responsibility in executing components of a treatment plan or public health intervention
	RR7. Forge interdependent relationships with other professions to improve care and advance learning
	RR8. Engage in continuous professional and interprofessional development to enhance team performance
	RR9. Use unique and complementary abilities of all members of the team to optimize care
Interprofessional communication	CC1. Choose effective communication tools and techniques, including information systems and communication technologies, to facilitate discussions and interactions that enhance team function
	CC2. Organize and communicate information with patients, families, and health care team members in a form that is understandable, avoiding discipline-specific terminology when possible
	CC3. Express one’s knowledge and opinions to team members involved in patient care with confidence, clarity, and respect, working to ensure common understanding of information and treatment and care decisions
	CC4. Listen actively, and encourage ideas and options of other team members
	CC5. Give timely, sensitive, instructive feedback to others about their performance on the team, responding respectfully as a team member to feedback from others
	CC6. Use respectful language appropriate for a given difficult situation, crucial conversation, or interprofessional conflict
	CC7. Recognize how one’s uniqueness, including experience level, expertise, culture, power, and hierarchy within the health care team, contributes to effective communication, conflict resolution, and positive interprofessional working relationships
	CC8. Communicate consistently the importance of teamwork in patient-centered and community-focused care
Teams and teamwork	TT1. Describe the process of team development and the roles and practices of effective teams
	TT2. Develop consensus on the ethical principles to guide all aspects of patient care and team work
	TT3. Engage other health professionals – appropriate to the specific care situation – in shared patient-centered problem-solving
	TT4. Integrate the knowledge and experience of other professions – appropriate to the specific care situation – to inform care decisions, while respecting patient and community values and priorities/preferences for care
	TT5. Apply leadership practices that support collaborative practice and team effectiveness
	TT6. Engage self and others to constructively manage disagreements about values, roles, goals, and actions that arise among health care professionals and with patients and families
	TT7. Share accountability with other professions, patients, and communities for outcomes relevant to prevention and health care
	TT8. Refect on individual and team performance for individual, as well as team, performance improvement
	TT9. Use process improvement strategies to increase the effectiveness of interprofessional teamwork and team-based care
	TT10. Use available evidence to inform effective teamwork and team-based practices
	TT11. Perform effectively on team and in different team roles in a variety of settings

Note: Excerpt from interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, DC: Interprofessional Education Collaborative.⁵

Table 5 Outcomes framework developed by Moore et al³³

CME framework	Description	Data source
Level 1 – participation	Number of physicians and health care professionals who participated in the CME/CPD activity	Attendance records
Level 2 – satisfaction	The degree to which the setting, and delivery of the CME/CPD activity met the participants’ expectations	Questionnaires completed by attendees following the CME/CPD activity
Level 3A – learning: declarative knowledge	The degree to which participants can articulate what the CME/CPD activity intended to convey	Objective: pre and post-test of knowledge(br/)Subjective: self-report of knowledge gain
Level 3B – learning: procedural knowledge	The degree to which participants state how to do what the CME/CPD activity intended for them to do	Objective: pre and post-test of knowledge(br/)Subjective: self-report of knowledge gain
Level 4 – competence	The degree to which participants demonstrate/show in an educational setting how to do what the CME/CPD activity intended them to be able to do	Objective: observation in an education setting(br/)Subjective: self-report of competence: intention to change
Level 5 – performance	The degree to which participants do what the CME/CPD activity intended them to be able to do in practice	Objective: observation of performance in patient care setting: patient charts, administrative databases(br/)Subjective: self-reports of performance
Level 6 – patient health	The degree to which the health status of patients improves in response to changes in practice behavior of CME/CPD participants	Objective: health status measures recorded in patient charts or administrative databases(br/)Subjective: patient self-report of health status
Level 7 – community health	The degree to which the health status of a community of patients changes in response to changes in the practice behavior of CME/CPD participants	Objective: epidemiological data and reports(br/)Subjective: community self-report

Note: Used with permission: Moore DE Jr, Green JS, Gallis HA. Achieving desired results and improved outcomes: integrating planning and assessment throughout learning activities. J Contin Educ Health Prof. Copyright © 2009. The Alliance for Continuing Education in the Health Professions, The Society for Academic Continuing Medical Education, and The Association for Hospital Medical Education.³³

Abbreviations: CME, continuing medical education; CPD, continuing professional development.

Table 6 Alliance for Continuing Medical Education competency areas and descriptions

Competency area	Description
Adult/organizational learning principles	Comprehend evidence-based adult and organizational learning principles that improve the performance and outcomes of the physician learner and the organizations in which they work
Educational interventions	Apply and improve educational interventions using evidence-based adult and organizational learning principles in appropriate contexts (learners, content, and settings) that produce expected results for the physician learners and organizations in which they work
Performance measurement	Use appropriate data to assess two components: (1) educational – the success of learning interventions, especially physician performance (CME activities); and (2) administrative – the performance of the CME program
Systems thinking	Recognize that physicians and CME professionals are part of a complex health care system with processes, other health providers, and patients that must be considered in providing learning interventions
Partnering	Identify and collaborate with key partners and stakeholders in accomplishing their CME mission
Leadership	Provide leadership for the CME program, which emphasizes continuous improvement, professionalism, and appropriate ethical practice
Administration/management	Manage office operations to meet personnel, finance, legal, logistical, and accreditation standards
Self-assessment and lifelong learning	Continually assess individual and organizational performance and make improvements through relevant learning experiences

Note: Used with permission by Alliance for Continuing Medical Education (now Alliance for Continuing Education in the Health Professions). Alliance for Continuing Medical Education’s Competency Areas for CME Professionals. Copyright © 2008.³⁶

Institute of MedicineHealth Professions Education: A Bridge to QualityWashington DCNational Academies Press2003 Available from: http://nap.edu/catalog.php?record_id=10681Accessed August 22, 2013

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