AAFP offers double-credit CME to push evidence-based learning

The move comes as evidence-based medicine continues to gain in popularity.

By Myrle Croasdale — Posted Nov. 14, 2005

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Take one continuing medical education course and get twice the credit. That's the American Academy of Family Physicians' latest pitch promoting its brand of evidence-based CME.

While proponents of the AAFP campaign are confident that evidence-based CME is the wave of the future, skeptics say flaws in the system could slow acceptance. But regardless of whether a course sports the AAFP's evidence-based CME designation, even critics say the move toward evidence-based medicine and higher-quality CME content is gaining momentum.

"It's hard to overstate," said family physician Lee Green, MD, MPH, an associate professor at the University of Michigan Medical School in Ann Arbor who has taught double-credit CME classes. "If the AAFP stays the course and keeps it going, not too terribly far down the road when the generation of physicians trained in evidence-based medicine is practicing, it will make non-evidence-based CME look second class."

The AAFP set specific standards for evidence-based CME in 2002. Now it's upping the ante with the double-credit offer.

"We feel [evidence-based CME] does raise the bar on content, so it should have added credit, too," said Nancy Davis, PhD, director of the AAFP's Division of Continuing Medical Education. "We're trying to give value. It's been kind of a controversial thing to do. How do you know [evidence-based] CME is any more effective than traditional CME? We don't know yet."

Another question is whether physicians will do less CME if they're getting double credit. "I hope that that's just being cynical and that physicians will be doing CME to learn, not just to meet CME requirements," Dr. Davis said.

Making inroads

The double-credit designation is new enough that only a small number of courses are available. In 2004, 1.5% of CME activities the AAFP accredited were evidence-based CME.

While the American Medical Association's Physician's Recognition Award CME credit system is the mostly widely used among CME providers, the AAFP has its own CME credit structure, and the two organizations recognize each other's credits.

The Pennsylvania Academy of Family Physicians is among the CME providers that have ventured into the double-credit area. The group had evidence-based CME courses at the AAFP annual meeting in San Francisco this fall. That meeting was the biggest venue to date for evidence-based CME, with at least half of the courses carrying double credit.

Janine Owen, AAFP's education director, said physicians at the San Francisco meeting clearly appreciated the double credit. At an evidence-based CME course on adult-onset attention-deficit disorder, 220 people packed into a space for 150, Owen said.

Still, there hasn't been a flood of requests for the evidence-based CME designation, in part because of the additional work it requires of CME faculty, Dr. Davis acknowledged.

R. Van Harrison, PhD, CME director for the University of Michigan Medical School, said he had found Michigan's faculty reluctant to take on the additional time required to gain the AAFP's stamp of approval.

"The problem is the speaker has to outline the evidence for the presentation in a way that can be preapproved," Dr. Harrison said. "It adds a third more prep time for the speaker. How many faculty are willing to give that extra time?"

The system rewards the person sitting in the audience, he said, and the speaker doesn't get anything extra for the additional work.

Not only are faculty not eager to take on the extra work, but Dr. Harrison isn't seeing demand from practicing physicians, either. They get plenty of CME credit throughout the year and aren't clamoring for double-credit courses, he said.

While Dr. Green has been an active advocate of evidence-based CME within the AAFP and has worked on guidelines, he's also critical of the system.

"Is it worth the extra trouble? For the 300 people sitting in the audience, it's definitely worth it," Dr. Green said, "But it's a lot of extra work for the one preparing the talk."

If a presenter decides that evidence-based CME is worth supporting, then he or she makes the choice to do the additional work, Dr. Green said. That means sitting down and doing a systematic review of what research has been done on a particular topic using an AAFP-approved source, documenting this research, presenting it for review to the AAFP and outlining it for those attending the CME event.

Dr. Green said his content already included the best evidence. It's the documentation and review process that he finds burdensome. He's even had the AAFP reject a course.

"The material was evidence-based, but it didn't come from a listed source," Dr. Green said. "There are still some bugs in the system."

The evidence-based medicine push

The AAFP is not alone in its pursuit of medicine based on evidence, instead of just accepted medical practices. But the AAFP is the only one to create a designation for evidence-based CME.

"The world is paying more attention to levels of evidence," Dr. Harrison said. "Like the pay-for-quality movement. ... There is enormous pressure in society to do these things."

Though only the AAFP qualifies its CME as evidence-based, physicians outside of family medicine can expect to feel a change, CME experts said.

For example, the American College of Physicians already has created the Physicians' Information and Education Resource, a database of medical information, which is among the AAFP's approved evidence-based sources. Sometime in 2006, the ACP expects to offer CME credit to PIER users.

"It is going to turn into a near revolutionary approach to CME, to give double credit for evidenced-based CME," Dr. Green said. "It will have enormous ripple effects. We're holding the content of CME to some standards, which has never been done before."

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What qualifies

  • Be based on the best available evidence.
  • Deliver specific practice recommendations based on evidence that has been systematically reviewed by an AAFP-approved source.
  • Cite the source of the information and the level of strength of the evidence for each practice recommendation made in the CME content.

Source: American Academy of Family Physicians

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