ICPD

International Center for Professional Development

• CME Basics
• Joint Providership
• Commendation criteria

 Key points:

1. Accreditation through ACCME is worthwhile, but expensive.  Joint providership with AAMS is cheaper.
2. Collaborating with AAMS is beneficial for AAMS as well, if the CME is planned and documented correctly.  
3. Collaboration is REALLY beneficial for AAMS if ICPD fulfills some Commendation Criteria.

The International Center for Professional Development in Armenia was created with the goal of providing resources to continuously improve knowledge and experience in healthcare sciences for practitioners, health professionals and biomedical technology experts. The Center relies on live conferences, online modules, workshops and simulations to offer the latest advances in healthcare to specialists, not only in Armenia and Artsakh, but also regional countries and beyond.

The center was created by collaborative efforts of Drs. Rafi Avitsian, Ara Babloyan and Gevorg Yaghjyan. They have spent many years promoting the need for quality educational programs for professionals in the region. Joining forces and collectively building on their experience they started the center with a few online lectures. Later Dr. Ara Nazarian joined the trio to lend his support to the activities of the Center. The idea to establish a nonprofit organization to provide high quality, affordable continuous medical education was well received by the Ministry of Health, the National Institute of Health and specialty societies in Armenia. ICPD is growing and continuously increasing the number of educational resources and quality conferences to physicians, nurses and other healthcare providers.

  ICPD has been sponsoring continuing medical education activities through  accreditation in Armenia, Europe or both.

https://www.icpdusa.org/  works with NIH and European accrediting bodies.

ICPD intends to start offering CME credit for US physicians.  Fees charged from those attendees can help to support the program.   Direct accreditation through ACCME is an investment of  $11k followed by annual fees of ~$7k per year.

Joint providership through an accredited CME provider is also possible, and fees for that could range from nominal to reasonable.  The Armenian American Medical Society (based in Southern Calif) has offered CME credits for AMIC and IMCA activities dating back to 2009.  

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CME Basics / ACCME Core Criteria (see https://accme.org/rules/criteria/)

Core requirements for the program are that you have a mission, that you perform periodic program analysis to decide how well you are meeting that mission, and that you are making appropriate program improvements to improve on your ability to meet that mission.

Let's start with the Mission Statement.  The wording is up to you, but it must at least include what it seeks to change in terms of learners’ competence, performance and/or patient outcomes. Improved knowledge is not enough.

Educational Planning

Here is the checklist of what a surveyor will review for each CME activity that is submitted in an accreditation or reaccreditation application.  

1. Educational Needs (a.k.a. professional practice gap)

 Why are you offering a given conference or presentation?  What's the problem you are trying to fix?  The given answers range from mealy-mouthed (we are required to offer cancer CME) to excellent (our hypertension control rates are 50% and we are trying to increase to 80%).

We further want to define the educational needs underlying the practice gap.  For hypertension control, there may be dozens of underlying educational needs.  Pick one, or a few.  Hypertension is one of those broad topics where trying to lecture from A to Z is unlikely to lead to much change.

2. Designed to change

Here is where we see a lot of innocent screw-ups.  The activity must be designed to change competence, physician performance, or patient outcomes.  Changing knowledge is not enough.

Innocent screw-ups occur when the learning objectives include increased awareness, understanding, knowing etc.

Evaluation forms often ask the learners whether they feel their ability to do certain tasks (identify a prediabetic patient, counsel a patient regarding breast exam) is improved after the lecture.  This is an example of self-rated improvement in competence and is very commonly done to satisfy this Designed to Change requirement.

A more advanced, and often more meaningful approach is to link CME to performance or outcomes measures.  Performance measures might include use of a bundled pathway, screening for fall risk, administering a vaccine.  Outcomes measures might include A1c control in diabetics, new diagnoses of prediabetes, improved sepsis numbers.  The key word in these cases is "measures".  A CME activity designed to improve screening for diabetic nephropathy is not going to improve performance if you don't measure the screening rates.

 see also the "poop" example

3. Appropriate Formats

Suffice it to say that there are often better (or much better) learning formats than lecturing.  

https://accme.org/rule/appropriate-formats/

4. Competencies (a.k.a. desirable physician attributes)

 CME may address other competencies besides patient care.  Sometimes it's communication, or ethics, or sewing skills, or how to use a computer.  Competencies are different than competence.

5. Analyzes Change

This is critical.  Analyze whether your activity made any difference.  Again, it should reflect whether competence, performance or outcomes were improved.  Failing to demonstrate that they were improved is OK.  It just means you'll try a different approach next time.

6. Standards for Integrity and Independence in Accredited Continuing Education

 Here is where we see the most serious errors in a reaccreditation application.  Somebody forgot to include a financial disclosure statement.  A relevant financial relationship was not mitigated.  See https://accme.org/rules/standards/

There are a few requirements, but they all have to do with preventing commercial bias.  Financial disclosures must include a specific definition of ineligible company (formerly called commercial interest).  Click here for an example of a disclosure form.

Financial disclosure is required from all in control of educational content:  planners, faculty, CME committee members.  

7. Proper Accreditation  and Credit Designation statements (see below for jointly provided statement)  https://accme.org/rule/accreditation-statement/

AAMS is accredited through California Medical Association, not ACCME, so the statement substitutes CMA where other providers would use ACCME.

8. For activities originating in California, content relating to cultural & linguistic competence and intrinsic bias should be included where appropriate.

 This is really important.  Armenia has many cultures (urban, rural, refugee, military, South Asian, Yazidi, Russian, Ukranian, different occupations, varying trust of healthcare system, gender, sexual orientation, age, political bent ...) and a few dialects.  There is the (maybe apocryphal) story of the Mexican patient who used up all his pills in only 3 days:  the Rx said to take one tablet once daily.  "Once" is Spanish for eleven.

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  Joint Providership

This is where a non-accredited provider offers a CME activity, and the credit is given by an accredited organization.  For our purposes, that accredited organization could be AAMS.  

ICPD would offer the CME activities and AAMS will grant the credits.  For this to happen, AAMS will want the activities to follow the above rules, and a stellar performance is always welcomed.  AAMS may need to submit one or more of these jointly provided activities in their application for reaccreditation so we don't want screwups.

An example of a jointly provided accreditation statement is:

“This activity has been planned and implemented in accordance with the accreditation requirements and policies of the California Medical Association (CMA) through the joint providership of the Armenian-American Medical Society (AAMS) and International Center for Professional Development (ICPD). AAMS is accredited by the CMA to provide continuing medical education for physicians.”

  Commendation Criteria

These represent a golden opportunity.  Usual accreditation is for 4 years.  If AAMS can demonstrate the inclusion of Commendation Criteria, they may be granted an extra 2 years of accreditation.  More than that, the Commendation Criteria represent qualities that take CME to the next level.  Including these in ICPD's activities could be immensely beneficial to AAMS.  See https://accme.org/rules/criteria/ and scroll to the bottom of the page.

There are a few broad areas of Commendation Criteria:

• Promotes Team-based Education

• Addresses Public Health Priorities

• Enhances Skills

• Demonstrates Educational Leadership

• Achieves Outcomes

 We can and should discuss these at some point.  Imagine if MoH measured some physician performance (like HPV vaccination) and ICPD was to offer some education.  Then MoH measures an increase in vaccination rates.  That would be an "Achieves Outcomes" measure.  Actually it could satisfy all 3 "Achieves Outcomes" measures.  We'll discuss later.

 There is a similar webpage dealing with CME planning for the Madrid Congress that rehashes much of this discussion at https://amicnow.org/253 

AAMS is also providing CME credit for US physicians at the Madrid Congress. 

As it turns out, certain other countries have reciprocity with the ACCME including Spain, Germany, Netherlands and others.  France and Armenia do not, although Armenia does accept credits from the European Accreditaion Council for Continuing Medical Education (EACCME).

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some notes after speaking with Jenia

 https://learnwithopen.org/  works with NIH doing online pediatric education, wants to expand to adult medicine.  Currently 75% of the 900 pediatricians in Armenia are using the platform.  Also hosted on NIH online database.

Education started with ROP/retinopathy of pregnancy with the Armenian Eye Care Project.

No nursing education yet.