JAOA • Vol 104 • No 11 • November 2004 • 493-502
AOA Continuing Medical Education
Delores J. Rodgers
Please address correspondence to Delores J. Rodgers, Department of Education,
American Osteopathic Association, 142 E Ontario St, Chicago, IL 60611-2864.
E-mail:
drodgers{at}osteopathic.org
This article provides an update on trends in osteopathic continuing medical
education (CME) programs and details several changes to CME requirements for
state licensure. Additionally, this article explains changes to several
policies of the American Osteopathic Association (AOA) with regard to the
Association's awarding and recording of CME credits, additional avenues for
members who wish to obtain CME credit hours, and the terminology used to
define the Association's key CME requirements and CME
sponsor–accreditation process.
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CME: Meeting and Exceeding Expectations
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The Council on Continuing Medical Education (CCME) believes that there
should be a two-tiered system of total CME requirements. The first tier is
required to maintain membership in the AOA. The second tier is used to
demonstrate to patients and evaluative bodies (ie, hospital and university
boards) the commitment of participating physicians to continued learning.
Physicians who obtain 150 hours of CME credit in a 3-year CME cycle are
recognized and rewarded by the Council and the Association by being granted an
AOA Certificate of Excellence in CME
(Figure).1
Currently, the AOA assigns CME credits as being from one of four
categories: 1-A, 1-B, 2-A, and 2-B
(Table 1). In general,
Category 1 is osteopathic (AOA) CME credit; Category 2 credit is
nonosteopathic CME credit; A credit is granted for formal, didactic
courses; B credit is for less formal CME activities such as hospital
committee work and reading the scientific content in JAOA—The
Journal of the American Osteopathic Association in conjunction with
completing THE JOURNAL's CME quizzes.
As with all general models, there are exceptions to the rules. One
exception is that all approved standardized life support courses receive
Category 1-A credit, regardless of whether the course is taught by an
osteopathic CME sponsor. Another exception is that formal osteopathic CME
programs that do not meet the Association's quality guidelines for osteopathic
content are awarded Category 2-A credit, not Category 1-A credit. A more
extensive description of the categorization of CME can be found in
Table 2. More detailed
information is available from the Association's Division of CME at
http://do-online.osteotech.org/index.cfm?PageID=cme_main.
View this table:
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Table 2 American Osteopathic Association (AOA) Continuing Medical Education
(CME) Program, 2004–2006: Categories and Requirements for CME Credits
Awarded in Three-Year
Cycle*
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Current Requirements: CME Program Cycle, 2004–2006
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As announced in THE JOURNAL's Osteopathic Medical Education 2003
issue,1 the AOA
Board of Trustees (BOT) approved an updated CME requirement for Association
membership at its February 2003 meeting. At that time, the BOT set the
requirement for AOA membership in the 2004–2006 CME cycle at 120 credit
hours with a minimum of 30 hours dedicated to earning AOA Category 1-A
credits. No waiver for this 120-hour requirement will be granted unless due
cause or inability to obtain hours is demonstrated to the CCME. The remaining
90 hours of the 120-hour requirement may be obtained by completing and/or
combining CME credits from any of the four categories (ie, 1-A, 1-B, 2-A, or
2-B). A maximum of 60 hours of Category 1-B preceptoring may be applied to the
120-hour requirement.
For those physicians who have specialty board certification through the
AOA, of the total 120-hour requirement for CME credits, 50 hours must be
earned in CME activities related to the primary specialty field in either
Category 1 or Category 2—though the total CME requirement for physicians
certified by the American Osteopathic Board of Family Physicians is higher, at
150 hours per 3-year CME
cycle.2 Failure to
fulfill this CME requirement may result in loss of AOA specialty board
certification.
Continuing medical education requirements are reduced according to a
proration schedule based on the date when the osteopathic physician joins the
AOA after the beginning of the current, 3-year CME cycle. The CCME considers
exemptions, reductions, and waivers to its CME requirements on a case-by-case
basis. Again, the CCME will grant no waivers without due cause or
inability to obtain hours unless policy advises otherwise.
The current CME cycle began on January 1, 2004, and ends on December 31,
2006. All AOA members, other than those exempted, are required to participate
in the CME program and to meet specified CME credit hour requirements for the
2004–2006 CME cycle.
State CME Requirements
Many state licensing boards believe that CME is an important component for
their physicians to guarantee statewide quality assurance in medical care. A
total of 43 states have established CME requirements to qualify for
relicensure (Table 3).
In fact, since November 2003, two states (Idaho and Nebraska) have joined the
majority of state osteopathic licensing boards in establishing CME
requirements for physicians practicing in those states during the
2004–2006 CME cycle.
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Recent CME Activities at the AOA
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CME Records Online—The DO-Online Web Site
Osteopathic physicians can view an updated CME activity report (CAR) at any
time through the DO-Online Web site (see
http://do-online.osteotech.org).
Continuing medical education activity reports for the previous cycle will be
kept online for at least 1 year after the end of that cycle (eg, reports for
the 2004–2006 cycle will be archived on the site through 2007). However,
only those physicians who are AOA members and registered DO-Online users will
be able to review their CARs online. Access to the
DO-Online.org
Web site is a free benefit to all AOA members.
The AOA has always maintained the CAR as a private document. However,
physician-members can download the CAR as a hard copy or attach it to an
e-mail sent by the AOA to a third party as specified by the physician-member.
The AOA only releases the CAR to outside agencies on written request by the
physicianmember. Through DO-Online, the AOA will continue to maintain the
confidentiality of this information, but individual physician-members have the
added convenience of forwarding this information at their discretion.
The CCME continues to believe that all CME activity should be audited.
Therefore, physician-members will not be allowed to enter or update their CME
records online and should continue to submit their update requests for CME
credit directly to the Association's Division of CME. Physician-members are
still encouraged to address such correspondence and requests to the following
address: American Osteopathic Association, Attn: Division of CME, 142 E
Ontario St, Chicago, IL 60611-2864.
AOA Publications
JAOA
In February 2004, the BOT approved granting CME credit to osteopathic
physicians who take part in the peer review process for articles submitted to
THE JOURNAL.
The BOT also adjusted the number of credit hours granted to osteopathic
physicians who author papers submitted to and accepted by THE JOURNAL for
publication. The distribution of credit hours for each type of submission
accepted by THE JOURNAL (eg, original contribution, clinical practice article,
letter to the editor) were reevaluated by the CCME and adjusted either upward
or downward to better coordinate with the goals of the JAOA and the
osteopathic profession. For example, while credit hours granted to authors of
original contributions were raised to the highest level offered, credit hours
for other types of submissions were lowered to better reflect the relative
value of that type of contribution to THE JOURNAL and the effort required of
the author(s) in the creation of it.
The Whole Patient
The BOT approved granting osteopathic physicians 1 hour of AOA Category 1-B
credit when osteopathic physicians read The Whole Patient, complete
the accompanying CME quiz, and send it to the AOA's Division of CME.
Further, osteopathic physicians who write and review articles for The
Whole Patient will be granted AOA Category 1-B credit in accordance with
AOA CME policy.
The DO
The BOT approved a resolution for clinically related CME programs that are
published in The DO and its supplements and that include a CME quiz.
Physician-members will be granted 1 hour of AOA Category 1-B credit if they
read the publication, complete the accompanying CME quiz, and send it to the
AOA's Division of CME.
Processing Fees for Nonmembers
The AOA grants Category 1-B credit for Accreditation Council for Continuing
Medical Education (ACCME)–accredited or American Academy of Family
Physicians (AAFP)–approved CME programs provided that no equivalent
osteopathic CME courses are available.
To request AOA Category 1-B credit for ACCME-accredited or AAFP-approved
CME programs, physicians must submit the Formal Request for AOA Category 1-B
Credit (Non-osteopathic Programs) form (see
http://do-online.osteotech.org/pdf/cme_formsnonosteopathiccat1b.pdf)
to the AOA's Division of CME. This form allows physicians to request AOA
Category 1-B CME credit for allopathic-sponsored CME programs that would
usually be granted AOA Category 2-A CME credit. The form must be completed and
submitted to the AOA Division of CME along with a copy of the printed program
for review by the AOA's CCME, which then submits requests to the appropriate
specialty college for review and recommendation. Osteopathic physicians who
are active AOA members are not charged for processing and credit conversion.
This service is a free AOA member benefit.
As of the February 2004 BOT meeting, however, nonmembers who request this
type of CME credit conversion must now pay a $25.00 application fee for each
request in addition to a $10.00 processing fee for each program for which they
are requesting AOA CCME credit conversion. The Council requests that checks be
made payable to the AOA in care of the Division of CME.
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Recent CME Quality Enhancements
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AOA-Accredited Category 1 CME Sponsors
As previously
noted,1 the Council
had an ongoing struggle with the term affiliate organizations and who
may apply as an AOA-accredited Category 1 CME sponsor. Because a primary
objective of the AOA CME program is to ensure that osteopathic physicians earn
at least 30 hours of CME credit based on osteopathic principles and
practice—a goal formalized in the new 2004–2006 requirements for
Category 1-A credit hours—sponsorship for Category 1-A is limited to
recognized osteopathic medical organizations—such as the divisional
societies, specialty colleges, acute healthcare facilities, AOA-chartered
foundations, and colleges of osteopathic medicine.
Although osteopathic hospitals can no longer apply to be recognized as
AOA-accredited Category 1 CME
sponsors,1 hospitals
and other organizations currently granted sponsor status will be able to
retain this status until either hospital closure or failure to adhere to the
accreditation requirements as specified in AOA Accreditation Requirements
for Category 1-A CME
Sponsors.3
Accredited sponsors have the discretion of allowing other
non–AOA-accredited organizations, termed providers, to conduct
CME programs under their accreditation status.
There are currently 164 AOA-accredited Category 1 CME sponsors
(Table 4). A list of
AOA-accredited Category 1 CME sponsors is maintained on the AOA's
members'-only Web site in PDF format (see
http://do-online.osteotech.org/pdf/cme_sponscat1alist.pdf).
All AOA-accredited Category 1 CME sponsors are obligated to meet certain
requirements to maintain their accreditation status. On an ongoing schedule,
the CCME and AOA staff monitor sponsor compliance with the AOA's accreditation
requirements3 by
spot monitoring CME programs for compliance with AOA policies and the
CCME-approved Uniform Guidelines for Accrediting Agencies of Continuing
Medical Education.3
Additionally, AOA staff and the CCME investigate all written complaints or
deviations from AOA policy using standard complaint review
procedures.3
National CME Sponsors Conference
The AOA holds an annual conference, the National CME Sponsors Conference,
to provide sponsors with up-to-date information regarding the latest
requirements for maintaining their CME accreditation status. The National CME
Sponsors Conference is also intended to help sponsors understand the rationale
of CCME directives, clarify those directives as necessary, and explain the
trends and evolution of the CME environment.
The AOA's 11th Annual National CME Sponsors Conference is scheduled for
Thursday, January 6, 2005 through Saturday, January 8, 2005, at the
Renaissance Vinoy Resort and Golf Club in St Petersburg, Fla (see
http://do-online.osteotech.org/index.cfm?PageID=cme_sponsmain).
The theme of the 2005 conference is "CME in a Changing
Environment." The conference agenda will be posted online at the
aforementioned site by the end of November.
Revision of the Definition of "Faculty"—Category 1-A CME Faculty Requirement
In February 2004, the AOA's BOT amended the 2003 resolution that a CME
conference will be deemed to have met the 50% requirement under the following
circumstances (the word paid has been added, as shown in caps):
- [If] at least 50% of the total education hours are presented by osteopathic
physicians, [allopathic physicians], PhDs, or other professionals with
graduate degrees who hold a full-time PAID faculty appointment at a college of
osteopathic medicine, or
- at least 50% of the presenters are osteopathic physicians, [allopathic
physicians], PhDs, or other professionals with graduate degrees who hold a
full-time PAID faculty appointment at a college of osteopathic medicine.
This one-word addition to the definition formalized by the Association's
CCME at their February 2003
meeting1 is a
refinement of the definition of the term faculty as it appears in the
Standards for Osteopathic Category 1-A Programs section of the Accreditation
Requirements document, and is intended to further refine the 50% rule
established at the 2003 BOT
meeting.1,3
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CME Program Trends
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The Association's CME program continues to grow annually, as do the number
of physician-members with a CME requirement from their state or specialty
boards (Table 3). As
of October 12, 2004, the number of members with a state- or specialty
board–mandated CME requirement is 26,976—a 68% increase from the
1992–1994 CME cycle (Table
5). As of August 2004, the AOA reports its membership numbers
at 54,000; therefore, approximately 50% of AOA members now have a
state-mandated CME requirement—a 4% increase over last year and the
highest percentage reported to
date.1
Interestingly, the type of CME credit recorded by the AOA has also changed
over time (Table 6).
Earned Category 1-A credit in formal, osteopathic CME programs increased
steadily but incrementally from 2.3 million CME hours in the 1992–1994
CME cycle to 2.9 million hours in the 2001–2003 CME cycle. However,
earned Category 1-B credit, which is less-formal, nonosteopathic CME credit,
has more than doubled from 4.1 million hours in the 1992–1994 CME cycle
to 8.6 million hours in the 2001–2003 CME cycle. The CCME is reviewing
these data to determine whether they represent a trend or are a matter of
definitional changes over time, and the possible causes of such rapid growth
in Category 1-B credit.
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Table 6 American Osteopathic Association Total Number of Continuing Medical
Education (CME) Credits Recorded (in Millions) for Each 3-Year CME
Cycle
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The number of osteopathic physicians whose AOA membership was withdrawn for
failure to complete their CME requirement has fluctuated between a low of 43
members in the 1986–1988 CME cycle to a high of 298 members in the
1983–1985 CME cycle. A total of 219 members were dropped from membership
on May 31, 2002, for not meeting the 1998–2000 CME requirement. Because
Association members are given an 18-month grace period to fulfill requirements
from the previous CME cycle, statistics for the 2001–2003 CME cycle will
not be available until May 31, 2005.
Similarly, the total number of CME credits recorded by the AOA has
increased considerably during each successive 3-year CME cycle
(Table 6). This growth
is a reflection of the increasing number of AOA members who have a state- or
specialty board–mandated CME requirement and the steadily increasing
average number of CME credits recorded per member.
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Comment
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The CCME is committed to an agenda of progress in CME policies, while at
the same time maintaining the high standards for which the AOA is known. The
Council will continue to study the changing environment of osteopathic
medicine and adjust the Association's CME program to respond to the needs of
the public, physician-members, and the AOA. The Council encourages members to
send suggestions on CME issues to the Council for consideration.
Ms Rodgers is secretary to the Council on Continuing Medical Education
and director of the Division of Continuing Medical Education in the Department
of Education, American Osteopathic Association.
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References
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1. Rogers DJ. AOA continuing medical education. J Am Osteopath
Assoc. 2003;103:531-538. Available at:
http://www.jaoa.org/cgi/reprint/103/11/531
Accessed November 19, 2004.
2. American Osteopathic Board of Family Physicians. Verification and
Maintenance of Certification. 2000. Available at:
http://www.aobfp.org/verification-cert/index.html.
Accessed November 19, 2004.
3. Division of Continuing Medical Education. Accreditation
Requirements: Category 1 CME [continuing medical education] Sponsors.
Chicago, Ill: American Osteopathic Association; 2004. Available at:
http://do-online.osteotech.org/pdf/acc_cmespo.pdf.
Accessed November 19, 2004.
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