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Address correspondence to Delores J. Rodgers, BS, Department of Education, American Osteopathic Association, 142 E Ontario St, Chicago, IL 60611-2864. E-mail: drodgers{at}osteopathic.org.

The current continuing medical education (CME) cycle began on January 1, 2007, and will end on December 31, 2009. Statistics for the 2004-2006 CME cycle will not be available until May 31, 2008. The author provides an update on trends in osteopathic CME programs and details minor changes to CME requirements for state licensure. In addition, this article explains changes to several policies of the American Osteopathic Association with regard to the Association's awarding and recording of CME credits for physicians who hold specialty board certification.

View larger version (52K): [in this window] [in a new window]   Figure 1. Members of the American Osteopathic Association (AOA) exempted from the AOA's continuing medical education (CME) credit-hour requirements. Life members in active practice have a CME requirement.

View larger version (21K): [in this window] [in a new window]   Figure 2. The four categories of continuing medical education credit granted by the American Osteopathic Association.

View larger version (66K): [in this window] [in a new window]   Figure 3 Material that is new since the publication of THE JOURNAL's 2006 Osteopathic Medical Education issue6 is indicated in boldface. AAFP indicates American Academy of Family Physicians; ACCME, Accreditation Council for Continuing Medical Education; AOA, American Osteopathic Association; COMLEX-USA Level 2-PE, Comprehensive Osteopathic Medical Licensing Examination-USA Level 2-Performance Evaluation; CCME, Council on Continuing Medical Education; CME, continuing medical education; NBOME, National Board of Osteopathic Medical Examiners. *The optional category 1A requirements listed in this table are interchangeable. One may select 90 additional hours from any of the four CME credit types given and in any combination, as long as the mandatory 30-hour requirement for category 1 credit hours is met. Osteopathic physicians who exceed the maximum limit of 10 credit hours of category 1A CME credit for faculty development programs can apply those excess credit hours to category 1B CME credit if the programs were provided by an AOA-accredited category 1 CME sponsor. JAOA—The Journal of the American Osteopathic Association grants 2 hours of category 1B CME credit to osteopathic physicians who complete quizzes on the scientific content in THE JOURNAL and its supplements. To apply for CME credit, AOA members who are registered users of DO-Online can take JAOA CME quizzes online (http://www.docmeonline.com). Alternatively, readers can complete the JAOA quiz and mail it with their AOA number to the Division of CME. Physicians who obtain 150 hours of CME credit in a 3-year CME cycle are recognized and awarded an AOA Certificate of Excellence in CME.4 Source: Continuing Medical Education Guide, 2007-2009: Guide for Osteopathic Physicians, December 2006.7

Physician-members have opportunities to earn CME credit from many osteopathic medical organizations. Programs sponsored or cosponsored by AOA-accredited CME sponsors are listed monthly in the The DO magazine's "Coming Events" department at the back of each issue. Additional opportunities are listed on the DO-Online calendar, accessed through the Calendar link on the navigation bar at the top of the Web page (http://www.do-online.org).

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. In the past year, the majority of changes to the AOA's CME program relate to this component of member requirements, as further detailed on page 73 of the present article.

Continuing medical education requirements are reduced according to a proration schedule based on the date when an osteopathic physician joins the AOA after the beginning of a new 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.

As noted, the current CME cycle began on January 1, 2007, and ends on December 31, 2009. 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 2007-2009 CME cycle. More detailed information regarding CME guidelines for the current cycle is available at the AOA's DO-Online Web site (see http://do-online.osteotech.org/index.cfm?PageID=cme_main).

View larger version (169K): [in this window] [in a new window]   Figure 4 Osteopathic physicians should verify the material reported here with their state licensing boards (see appendix, pages 78-81). The information provided in this figure is reported annually to the AOA directly from each state licensing board and is compiled here for the convenience of AOA members. The exact wording provided by the state licensing boards is preserved in this figure where possible. The AOA takes no responsibility for changes to state guidelines made immediately prior to publication or errors in reporting from state licensing boards. Material that is new since the publication of THE JOURNAL'S 2006 Osteopathic Medical Education issue6 is indicated in boldface. ABMS indicates American Board of Medical Specialties; ACCME, Accreditation Council for Continuing Medical Education; AMA, American Medical Association; AOA, American Osteopathic Association; CCME, Council on Continuing Medical Education; CME, continuing medical education; HIV/AIDS, human immunodeficiency virus/acquired immunodeficiency syndrome; OSHA, US Department of Labor Occupational Safety and Health Organization. *The District of Columbia has no CME requirements for physicians in continuous practice. Florida limits the number of CME credit hours osteopathic physicians can obtain from AMA-approved sources to 13. Wyoming added CME requirements for its licensed physicians as of the current 2007-2009 CME cycle. Previously, there were no state CME requirements in Wyoming. Source: US Osteopathic Licensure Summary, August 2006.3

	State CME Requirements

Top State CME Requirements DO-Online's CME Center Recent Activities at the... AOA-Accredited Category 1 CME... CME Program Trends and... Comment References

	DO-Online's CME Center

Top State CME Requirements DO-Online's CME Center Recent Activities at the... AOA-Accredited Category 1 CME... CME Program Trends and... Comment References

 
The AOA's online CME center gives physician-members ready access to hundreds of accredited hours of online CME courses. With the help of this new feature, AOA members can search a catalog of online CME activities and quizzes, access and complete those activities and quizzes online, and receive a printable screen certificate immediately after completing the activity. Credits for CME activities completed online are automatically applied to members' online CME activity reports (CARs). However, CARs for the current CME cycle will not be available until credit processing is complete for the 2004-2006 cycle. At publication, the AOA's Division of CME anticipates that CARs will be available for online viewing in April 2007. An announcement will be posted on the AOA's DO-Online Web site when 2004-2006 CARs are available.

Physician-members can view their current CARs at any time through DO-Online's CME Web site (see http://www.docmeonline.com). In addition, CARs from previous CME cycles are archived online for at least 6 full years after the end of a cycle (eg, reports for the 2004-2006 cycle will be archived on the site through 2012). However, only those physicians who are AOA members and registered DO-Online users can review their CARs online.

The AOA has always maintained member CARs as private documents. However, a physician-member can download his or her CAR or request that it be sent via e-mail to a third party. The AOA releases a member CAR to outside agencies (eg, state licensing boards, hospitals, attorneys, government agencies) only on written request by the physician-member. 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 electronically at their discretion.

As of July 2006, the AOA no longer routinely mails CARs to its physician-members. Members who do not have online access are asked to contact the AOA's Division of CME in writing to request an updated CAR, which can be sent by fax, mail, or e-mail.

The CCME continues to believe that all CME activity should be audited. Therefore, physician-members are not allowed to manually enter or update their CME records online. Physician-members should continue to submit their update requests for CME credit directly to the Association's Division of CME.

Physician-members are encouraged to send any correspondence regarding their CARs to the following address: American Osteopathic Association, Attn: Division of CME, 142 E Ontario St, Chicago, IL 60611-2864.

	Recent Activities at the AOA

Top State CME Requirements DO-Online's CME Center Recent Activities at the... AOA-Accredited Category 1 CME... CME Program Trends and... Comment References

 
The CCME meets three times annually (ie, January, April, November) to address members' concerns and routine business related to CME programming. In addition, a standing subcommittee of the CCME, the Administrative Committee, meets in July as needed to perform necessary duties of the CCME between the regularly scheduled meetings, including reviewing and taking final action on special consideration requests and reviewing policy items and basic documents prior to submission to the full Committee.

At its July 2006 meeting, the Administrative Committee appointed William Summers Mayo, DO, as the CCME's new chairman. Dr Mayo practices ophthalmology in Oxford, Miss.

In November 2006, Dr Mayo appointed two new subcommittees to research topics of current interest to physician-members, specifically with regard to the potential influence of evidence-based medicine on the practice of medicine through point-of-care options and double CME credit hours for documenting performance improvements. Many point-of-care options currently allow physicians to obtain CME credit hours for consulting sources in evidence-based medicine through handheld computers while caring for patients. Double CME credit may be offered to osteopathic physicians who document performance improvement over time within a private or group medical practice. The new subcommittees are expected to report their findings at the Council's upcoming April meeting.

Osteopathic Specialty Board Certification Guidelines
As noted, osteopathic physicians who wish to maintain specialty board certification through the AOA are required to earn a minimum of 50 credit hours of AOA category 1 or 2 CME credit in their specialty areas during each 3-year CME cycle. In 1999, the Bureau of Professional Education submitted a resolution to establish a mechanism that would allow the AOA to monitor CME activity required for board certification (Resolution 30 [M/1999]—Tracking of CME by Specialty Boards). In April 2002, the Council received and reviewed comments from the AOA specialty colleges regarding how CME hours are applied toward certification requirements. The AOA's Division of CME was then directed to survey the AOA specialty boards regarding their criteria for awarding credit. At the same time, as a result of a lack of formal guidelines from the Bureau of Osteopathic Specialists on how to apply earned CME credits toward these specialty requirements, the CCME directed the AOA's Division of CME to stop recording specialty hours in 2002.

In February of that year, the AOA's Division of CME began working in conjunction with all 18 AOA specialty boards to survey them for their input regarding this matter. From 2004 through 2005, a follow-up survey was conducted to ascertain if there was a rough consensus among the specialty boards and specialty societies on the number of credit hours that should be granted for physician participation in various activities and events, including:

• Accreditation Council for Continuing Medical Education courses
  
• AOA Annual Scientific Seminar and Convention
  
• AOA specialty college seminars
  
• AOA state society seminars
  
• commercial and scientific exhibits
  
• medical journal reading (home-study course)
  
• seminars on the following specialized topic areas: acquired immunodeficiency syndrome, medical education (teaching), medical ethics, risk management, standardized (or basic) life support
  

The AOA's BOT and the Bureau of Osteopathic Specialists instructed the specialty boards to develop "templates" that would specify the academic and professional activities that would allow specialty-board–certified osteopathic physicians to satisfy the existing CME requirements. Within 2 years, the consortium developed basic guidelines that would meet the needs of each member board. In February 2006, the AOA's BOT approved the group's recommended guidelines, which were designed to provide physician-members with a wide variety of options for earning CME credit while also maintaining overall consistency among the specialties (Figure 5). Figure 6 provides a summary of areas of divergence among specialties. For the activities noted in Figure 6 (ie, AOA specialty college seminars, Accreditation Council for Continuing Medical Education courses, formal teaching, and standardized/basic life support), the maximum number of CME credit hours accepted per 3-year CME cycle must be designated at the beginning of each new CME cycle. The number of credit hours accepted by each member board cannot change within a given cycle.

View larger version (42K): [in this window] [in a new window]   Figure 5. The recommendations outlined were made by AOA staff and general counsel. ACCME indicates Accreditation Council for Continuing Medical Education; AIDS, acquired immunodeficiency syndrome; AOA, American Osteopathic Association; NA, not applicable (ie, no credit granted). *All activities must be related to the specialty for CME credit. For some activities, an AOA CME form is required from the specialty board or state society, as applicable, to identify eligible credit hours by specialty. Maximum number of credit hours (ie, 25 or 50) is determined by the individual specialty boards. See Figure 4 and Figure 6 for more information. No specialty CME credit hours are granted for administering clinical examinations. ACCME courses do not meet the mandatory 30-hour requirement for category 1A CME credit.¶ Continuing medical education credit is awarded for either AOA- or AMA-sponsored activities.

View larger version (43K): [in this window] [in a new window]   Figure 6. The maximum number of credit hours granted for each continuing medical education activity noted were specified in the Bureau of Osteopathic Specialists' "template" responses, approved by the American Osteopathic Association (AOA) Board of Trustees in February 2006. Each specialty board determined these limits in advance of the 2007-2009 CME cycle. ACCME indicates Accreditation Council for Continuing Medical Education; CME, continuing medical education. *All activities must be related to the specialty for CME credit. All of the specialty boards noted have set a maximum number of 50 credit hours for AOA specialty college seminars for the 2007-2009 CME cycle, except for the American Osteopathic Board of Nuclear Medicine, which has limited member credit hours for this activity to 25.

Approved guidelines will receive further review in April 2007 by the CCME, which plans to refer them back to the specialty boards and colleges for additional refinement and clarification.

	AOA-Accredited Category 1 CME Sponsors

Top State CME Requirements DO-Online's CME Center Recent Activities at the... AOA-Accredited Category 1 CME... CME Program Trends and... Comment References

 
There are currently 162 AOA-accredited category 1 CME sponsors (Table 1). A list of AOA-accredited category 1 CME sponsors is maintained on DO-Online (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 ("spot monitoring") with AOA policies and the CCME-approved Uniform Guidelines for Accrediting Agencies of Continuing Medical Education, which are found in AOA Accreditation Requirements for Category 1A CME Sponsors.^4,5 In addition, AOA staff and the CCME investigate all written complaints or deviations from AOA policy using standard compliance-review procedures.^4,5

Since the publication of THE JOURNAL's 2006 Osteopathic Medical Education issue,⁶ there have been no significant changes made to AOA Accreditation Requirements for Category 1A CME Sponsors.^4,5 However, the Council is planning to make some minor modifications to these guidelines to better align the document with current industry standards.

Category 1A CME Credit for Outcomes Measures
In February, the Council approved a resolution that would allow physician-members to receive category 1A credit for outcomes measured through programs offered by AOA-accredited category 1 CME sponsors. The resolution (Resolution 19 [M/2007]—AOA Category 1-A CME Credit for Outcomes Measurement for AOA Category 1-A CME Programs) was reviewed and approved by the AOA's BOT at the 2007 Midyear Meeting, which took place February 15 through February 18 in Chicago, Ill:

RESOLVED, that each Category 1-A sponsor may offer up to 3 additional 1-A credits at a ratio of 1-10 for each Category 1-A program in excess of 10 hours in which the participant satisfactorily completes an outcomes questionnaire which has been submitted no earlier than 30 days and no later than 90 days after the final day of CME activity...

This activity will become a part of the standard document survey for AOA category 1 CME sponsors.

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 (https://www.do-online.org/?PageID=cme_sponsmain). 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 13th Annual National CME Sponsors Conference was held Thursday, January 11, 2007, through Saturday, January 13, 2007, at the Capital Hilton in Washington, DC, in conjunction with the 17th Annual Osteopathic Medical Education Leadership Conference. In an effort to align the 2007 conference with the "AOA Greatness Campaign" launched by 2006-2007 AOA President John A. Strosnider, DO, the conference theme was "From Good to Great."

Seventy-six of the 105 participants in attendance were AOA-accredited category 1 CME sponsors. The keynote address was delivered by Earl J. Reisdorff, MD. Dr Reisdorff is a practicing emergency physician, an associate professor of internal and osteopathic medicine at Michigan State University in Lansing, a published author, and serves as director of medical education at the Ingham Regional Medical Center, also in Lansing.

Conference topics and guest speakers included the following:

• "Specialty CME Reporting – CME Template," William J. Burke, DO, President, Ohio State Society – American College of Osteopathic Family Physicians (Columbus); Program Director, Doctors Hospital – Ohio Health Inc (Columbus); Member, AOA CCME (Chicago, Ill)
  
• "How the Regulatory Environment is Impacting the CME Grant-Making Process," Jason M. Singer, PharmD, Grant Associate, Lilly Grant Office, Eli Lilly and Company (Indianapolis, Ind)
  
• "Perils and Pitfalls of an Online Grant Process," Hong Jin Na, MS, Manager, Hematology/Oncology/Continuous Assessment Professional Education Support, Wyeth (Madison, NJ)
  
• "The Seven AOA Core Competencies," Gary L. Moorman, DO, Director and Chief Medical Officer, Medical Education, Henry Ford Bi-County Hospital (Warren, Mich)
  
• "Educational Outcomes Measurement: What's Ahead," Nancy L. Davis, PhD, Director, Division of Continuing Medical Education, American Academy of Family Physicians (Leawood, Kan)
  
• "Healthcare and Higher Education Issues of the 110th Congress," Congressman Phil English, Member, United States House of Representatives (3rd District of Pennsylvania) (Washington, DC)
  
• "AOA CME Policy Update," Delores J. Rodgers, BS, Director of CME, American Osteopathic Association (Chicago, Ill)
  
• "CME on the Internet – Category 1A," Michael J. Zarski, JD, Executive Director, American Osteopathic Information Association (Chicago, Ill)
  
• "The Role of CME in Maintenance of Certification (MOC)," Janice A. Wachtler, BA, Executive Director, American College of Osteopathic Emergency Physicians (Chicago, Ill)
  
• "Integrating OPP and OMT Into Your CME Programs," Kenneth H. Johnson, DO, President, American Academy of Osteopathy (Indianapolis, Ind); Staff Physician and Interim Associate Dean for Clinical Affairs, University of New England College of Osteopathic Medicine (Biddeford, Me)
  
• "Taking the AOA from Good to Great!" Carlo J. DiMarco, DO, Member, AOA BOT (Chicago, Ill); Chairman, AOA Department of Education (Chicago, Ill); and Robert S. Juhasz, DO, Member, AOA BOT (Chicago, Ill); Vice-Chair, AOA Department of Education (Chicago, Ill)
  

Concerns addressed in networking sessions included:

• proposal for the AOA to develop a Web site or Web log (blog) as a communication tool for use by category 1 CME sponsors
  
• additional sources of commercial support for CME programming (eg, management groups and banks)
  
• ways to increase CME program income
  
• advantages of virtual versus live CME activities and events
  
• possible penalties for delinquent physicians (eg, revocation of certification and suspension of AOA membership)
  
• proposal for future meeting between the CCME and all 18 AOA specialty boards
  
• CME "attendance-getters"—examples were shared of successful joint ventures, handouts, and workshops; topics on coding and billing were also discussed
  

The AOA's 14th Annual National CME Sponsors Conference will be held in Phoenix, Ariz, from Thursday, January 10, 2008, through Sunday, January 12, 2008.

	CME Program Trends and Statistics

Top State CME Requirements DO-Online's CME Center Recent Activities at the... AOA-Accredited Category 1 CME... CME Program Trends and... Comment References

 
The Association's CME program continues to develop annually, as does the proportion of physician-members with a CME requirement from their state or specialty boards (Table 2). As of January 29, 2007, the number of members with a state- or specialty-board–mandated CME requirement was 25,964. As of September 2005, the AOA reports its membership numbers at 59,000; therefore, approximately 44% of AOA members now have a state-mandated CME requirement.

The type of CME credit recorded by the AOA has changed over time (Table 3). Earned category 1A credit in formal, osteopathic CME programs increased steadily but incrementally from 2.5 million CME hours in the 1995-1997 CME cycle to 2.9 million hours in the 2001-2003 CME cycle. However, earned category 1B credit, which is less formal, non-osteopathic CME credit, has experienced more dramatic growth, increasing from 5.7 million hours in the 1995-1997 CME cycle to 8.6 million hours in the 2001-2003 CME cycle.

The number of osteopathic physicians whose AOA membership was dropped for failure to complete the CME requirement has fluctuated between a high of 298 members in the 1983-1985 CME cycle and a low of 43 members in the 1986-1988 CME cycle (Table 2). Association members are given an 18-month grace period to fulfill requirements from the previous CME cycle. A total of 259 members were dropped from membership on May 31, 2005, for not meeting the 2001-2003 CME requirement. Statistics for the 2004-2006 CME cycle will not be available until May 31, 2008.

Similarly, the total number of CME credits recorded by the AOA has increased considerably during each successive 3-year CME cycle (Table 3). 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.

Funding issues remain a central concern for the survival of osteopathic CME programming. Although pharmaceutical companies are ineligible to become AOA-accredited category 1 CME sponsors (ie, the AOA has never accredited CME programs developed by them), extensive grant-based financial support for CME programming from pharmaceutical and device companies remains a key source of funding for osteopathic CME. It is anticipated that the number of independent for-profit CME programs will continue to grow, further increasing financial pressures for existing AOA-accredited category 1 CME sponsors. In the future, funding sources for ongoing educational support may derive from a variety of other sources, such as conference sponsors or exhibitors and investment companies or banks.

	Comment

Top State CME Requirements DO-Online's CME Center Recent Activities at the... AOA-Accredited Category 1 CME... CME Program Trends and... Comment References

 
The CME landscape is constantly in flux. Faced with an increasing amount of regulatory scrutiny, financial pressure, and technological change, the industry remains dynamic. Because not all grant requests can be funded, commercial supporters are beginning to insist on the use of sophisticated metrics from program administrators—especially as the grant process moves out of the realm of sales and marketing and into the hands of CME specialists.

The CCME continues to be 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 continues to study the changing environment of osteopathic medicine, adjusting the Association's CME program to respond to the needs of the public, physician-members, and the AOA.

Submitted January 29, 2007; accepted January 29, 2007.

	References

Top State CME Requirements DO-Online's CME Center Recent Activities at the... AOA-Accredited Category 1 CME... CME Program Trends and... Comment References

 
1. Rodgers 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 February 13, 2007.

2. American Osteopathic Board of Family Physicians. Verification and Maintenance of Certification. 2000. Available at: http://www.aobfp.org/verificationcert/index.html. Accessed February 13, 2007.

3. Division of State and Socioeconomic Affairs. US Osteopathic Licensure Summary, August 2006. Chicago, Ill: American Osteopathic Association; 2006.

4. Rodgers DJ. AOA continuing medical education [published correction appears in J Am Osteopath Assoc. 2004;104:514]. J Am Osteopath Assoc. 2004;104:493-502. Available at: http://www.jaoa.org/cgi/content/full/104/11/493. Accessed February 13, 2007.

5. Division of Continuing Medical Education. Accreditation Requirements: Category 1 CME Sponsors. Chicago, Ill: American Osteopathic Association; 2004. Available at: http://do-online.osteotech.org/pdf/acc_cmespo.pdf. Accessed February 13, 2007.

6. Rodgers DJ. Osteopathic continuing medical education [published correction appears in J Am Osteopath Assoc. 2006;106:687]. J Am Osteopath Assoc. 2006;106:85-95. Available at: http://www.jaoa.org/cgi/content/full/106/2/85. Accessed February 13, 2007.

7. Division of Continuing Medical Education. Continuing Medical Education Guide, 2007-2009: Guide for Osteopathic Physicians, December 2006. Chicago, Ill: American Osteopathic Association; 2006. Available at: http://www.do-online.osteotech.org/pdf/cme_guidemain07-09.pdf. Accessed February 7, 2007.

This Article Abstract Full Text (PDF) A correction has been published A correction has been published Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Rodgers, D. J. Search for Related Content PubMed PubMed Citation Articles by Rodgers, D. J.