Guidelines to CME Organizers

Transcription

1 Guidelines to CME Organizers Prepared by Khaled Al-Jarallah, FRCPC, FACP, FACR, FRCP I.G. Premadasa, BDS (Cey.), MA (Mich. State) Published by Kuwait Institute for Medical Specialization, 10 th Floor, Behbehani Complex, Al-Sharq, P.O. Box 1793, Kuwait Kuwait Institute for Medical Specialization No part of this publication may be reprinted or reproduced, or stored in any form, without the prior permission of the copyright owner. Kuwait 2003.

2 Contents Preface Learning objectives Part I CME and its role in professional practice Mission statement of the CME Center. 5 Definition of CME... 6 Definition of CPD... 6 Does CME/CPD work?. 7 Administration of CME Program... 8 Part II Organization of CME activities CME activities and CME authorities. 13 Accreditation 13 CME Provider.. 15 CME organizer Categorization of CME Credit points for CME organizers. 19 Registration of CME activities under the CME Program.. 20 Preliminary registration Registration of ongoing activities.. 23 Renewal of registration of ongoing activities Announcement and publicity Completion of CME activity.. 24 Verification of documentation by CME Center Sponsorship Part III Planning effective CME: educational considerations Needs assessment.. 32 Adult education Educational objectives in planning CME activities 34 Target audience Effective CME strategies e-learning CME models Instructional strategies Assessing effectiveness of CME Summary of important educational issues.. 50 Part IV Participation in CME Registration for participation Exemption from CME requirement Exclusion from credit Credit points granted by external agencies Reciprocity with external agencies Appendix Evaluation of CME Program Bulletin of the Kuwait Institute for Medical Specialization Information on CME Program Communication with CME Center

3 Preface The Kuwait Institute for Medical Specialization (KIMS) of the Ministry of Health launched the CME Program in September 2000, and the majority of the medical and dental practitioners in Kuwait are now registered in it. Steps have already been taken to expand the program so that other categories of health professionals would benefit from it. To ensure that the CME program runs smoothly and that practitioners receive optimum opportunities for participating in CME activities, the CME Center has stipulated some administrative requirements to be met by CME organizers. Furthermore, CME organizers need to consider relevant educational issues when planning and conducting CME activities so that the participants find the activities beneficial. Guidelines to CME Organizers deals specifically with these and other topics that should be of interest to those who wish to plan and conduct CME activities. The short section on how the CME program affects the practitioners illustrates the link between CME organization and CME participation and the obligations of CME organizers as far as the participants are concerned. The past publications of the CME Center have been used by practitioners in Kuwait as well as those in the other GCC countries. We feel that a wide readership of CME organizers in the region would find the Guidelines similarly beneficial. The CME Officers who have been appointed by KIMS to represent the different specialties would be in a position to clarify matters regarding the routine administration of the program. Details supplied by the CME organizers regarding CME activities, and updates of CME program implementation appear in the CME Center website Additional copies of the Guidelines, too, can be downloaded from the site. Khaled Al-Jarallah FRCPC, FACP, FACR, FRCP Secretary General Kuwait Institute for Medical Specialization I.G. Premadasa, BDS (Cey.), MA (Mich. State) Director, CME Center Kuwait Institute for Medical Specialization Kuwait, 2003.

4 Learning Objectives Guidelines to CME Organizers has been prepared so that the reader would: 1. Be able to state the organizational and administrative structure of the CME Program; 2. Be able to describe the roles and responsibilities of CME Providers and the CME organizers; 3. Be aware of the procedure adopted in accrediting CME activities; 4. Be able to outline how the resources offered by private commercial establishments be properly used in the organization of CME activities; 5. Appreciate the importance of clearly-defined learning objectives in selecting target audiences, identifying subject content, and choosing teaching methods for CME activities; 6. Be aware of the methods that could be used for determining the effectiveness of CME activities; 7. Be able to outline the basic aspects of the CME Program that would be of interest to health professionals who wish to participate in CME activities conducted in Kuwait.

5 Part I CME and its role in professional practice Learning objectives 4 Mission statement of the CME Center 5 Definition of CME 6 Definition of CPD 6 Does CME/CPD work? 7 Administration of the CME Program 8 CME Center, CME Officer CME AND PROFESSIONAL PRACTICE

6 CME AND PROFESSIONAL PRACTICE Learning Objectives for Part I - CME and its Role in Professional Practice By the end of this section the reader should: 1. Be able to state the overall aims of implementing CME schemes; 2. Be able to state the general objectives of the CME Program in Kuwait; 3. Be able to define CME and CPD, and outline justifications for the use of the latter term; 4. Be able to state the factors that contribute to the effectiveness of CME, as reported in the literature; 5. Be able to state the essential elements in the administrative structure of the CME Program in Kuwait, and outline their roles and functions. 4

7 CME AND ITS ROLE IN PROFESSIONAL PRACTICE MISSION STATEMENT OF THE CME CENTER The CME Center aims to assist health professionals to keep abreast of the developments in their specialties and in fields that have a bearing on their practices. The competencies that practitioners would gain from the opportunities provided under the CME Program would improve their performances, and ultimately raise the quality of health care that patients and the community receive. CME AND PROFESSIONAL PRACTICE The CME Program has the following main objectives: To ensure that health professionals participate in accredited educational programs so that the care provided to the community is of high standard; To demonstrate to patients, the public and peers that health professionals are committed to participating in accredited educational activities throughout their careers; To improve the performances of all health professionals, instead of limiting educational opportunities to those who may be identified as under-performing; To provide a standardized and easily-accessible mechanism to health professionals for documenting their participation in accredited continuing medical education and continuing professional development activities. 5

8 CME AND PROFESSIONAL PRACTICE Definition of CME Continuing Medical Education (CME) represents the education of medical and dental practitioners after they complete formal training. It comprises all education related directly to professional responsibilities and is aimed at assisting them to carry out their professional duties more effectively. Three phases can be identified in the education of health professionals: undergraduate, postgraduate and continuing. CME comprises all educational activities that practitioners undertake after they complete the training that qualifies them to engage in practice in the fields of their choice. In the case of many practitioners, the pre-cme training would be an undergraduate course of studies, followed by an internship. A small proportion would go for additional, postgraduate training after this phase. There is an increasing emphasis today, however, on the need to start CME during the undergraduate phase itself, and for medical schools to play a greater role than in the past in providing CME opportunities to the practitioners. CME therefore consists of any educational activity that helps to maintain, develop or increase knowledge, problemsolving, technical skills or professional performance standards so that physicians and other health professionals are in a position to provide better health care. CME includes formal courses, conferences and workshops, as well as self-directed activities such as preceptorship and directed reading. Definition of CPD Continuing professional development (CPD) is a term that often comes up when discussing CME. It is generally understood to cover the development of a wider range of professional skills than learning in medical subjects. Both terms CME and CPD are in use today, often synonymously. The broad aim of CME as well as CPD, however, is to equip the practitioner to perform more effectively so that the patient and the community receive optimum care. It is important that patient care improves as a result of the CME activities undertaken by the health professionals. Therefore, when assessing the effectiveness of CME, the emphasis should be on the outcome of participation, rather than on whether the participants were satisfied with how the individual activities were organized and presented. 6

9 DOES CME/CPD WORK? Today, a number of institutions use CME as evidence of competence for medical practice when granting re-licensure, hospital privileges, specialty recertification, professional society membership and recognition for other professional activities. 1 An extensive review of the literature, coupled with opinions of recognized experts in the field of CME, by Davis et al showed that the majority of the interventions studied were associated with an improvement in physician performance or health care outcome. 2,3 Three aspects that contribute to the effectiveness of CME activities have been described: 4,5,6 Predisposing features, which influence individuals to change. One way in which this may be achieved is by providing relevant information; Enabling features help practitioners to apply the new competencies in the practice setting. Equipment and other resources required may be made available to the practitioner to introduce new procedures; Reinforcing features would confirm the positive outcomes of any changes implemented. This may be undertaken by providing appropriate feedback and with reminders. E.g. Compliance with guideline recommendations by hypertension patients may be improved with reminders to practitioners. 7 Predisposing features alone are moderately successful in improving performance. When either enabling or reinforcing features were combined with predisposing factors, the effectiveness of the activities is markedly increased. When CME/ CPD activities are planned after an adequate needs assessment and are directly related to practice they tend to be more effective. The effectiveness is further enhanced if the predisposing, enabling and reinforcing strategies are incorporated. CME AND PROFESSIONAL PRACTICE 7

10 CME AND PROFESSIONAL PRACTICE ADMINISTRATION OF CME PROGRAM The Kuwait Institute for Medical Specialization (KIMS) is designated by the Ministry of Health of the State of Kuwait as the authority that is responsible for planning and implementing the CME program. The scheme was introduced in September 2000, and at present covers medical and dental practitioners attached to government institutions as well as those serving in the private sector. Steps have already been taken to expand the program to include other categories of health professionals. CME CENTER KIMS oversees the organization of formal CME activities through the CME Program, which is administered by its CME Center. Institutions and organizations that have the necessary resources are accredited as CME Providers for presenting individual events. The CME activities may take the form of courses, symposia, conferences, workshops etc. The CME Providers accredited at present are the Faculties and Scientific Committees of KIMS, the specialty divisions of the Ministry of Health, the Faculties of the Health Sciences Centre of Kuwait University, and professional organizations and specialist societies in the health care disciplines. The Director of the CME Center is responsible for the dayto-day running of the CME Program, under the overall supervision of the Secretary General of KIMS. The CME Center functions in consultation with the CME Council and the Accreditation Committee of KIMS. The CME Council is constituted by the CME Officers appointed by KIMS to represent the different medical and dental specialties. 8

11 CME OFFICER The CME Officers of KIMS coordinate all CME/CPD activities in the respective specialties. While some subspecialties have a CME Officer who is a specialist in the same subspecialty, others have their CME activities coordinated by a CME Officer appointed for a related specialty. The main functions of the CME Officers are to: 1. Serve as the link between the CME Center of KIMS and the Faculty/specialty concerned, with respect to the implementation of the CME Program; 2. Be a member of the CME Council of KIMS, and collaborate with the Director of the CME Center in developing the overall plan for implementing the CME program in the specialty concerned; 3. Prepare an annual program of CME activities that the Faculty/specialty concerned wishes to undertake during the KIMS Academic Year, and forward it to the CME Center of KIMS in time so that the Scientific Calendar of the following year could be prepared in advance; 4. Participate actively in assisting the CME Center of KIMS to give adequate publicity to CME/CPD programs that are organized by the accredited CME Providers; 5. Assist the CME Center in CME credit validation and validation of documentation maintained by practitioners registered in the CME Program; 6. Assist the CME Center and the CME Council in monitoring the implementation of the CME Program of KIMS. The CME Officer would be familiar with the CME activities in the specialty that comes within his or her purview. Organizers of CME activities as well as practitioners registered in the CME Program are advised to contact the CME Officer for details of accredited CME activities or for clarifications on any aspect of the CME Program. A list of the CME Officers is available at the web site of the CME Center. Health care institutions, and academic and scientific establishments may appoint their own CME Coordinators to facilitate the organization of CME activities within the respective institutions. These CME Coordinators would also be able to liaise with the CME Officers of KIMS, and with the CME Center where necessary, to assist in the smooth running of the CME Program. CME AND PROFESSIONAL PRACTICE 9

12

13 Part II Organization of CME activities Learning objectives 12 CME activities and CME authorities 13 Accreditation 13 Accreditation of CME activities by CME Center CME Provider 15 CME organizer 16 Categorization of CME 17 Category 1 CME, Category 2 CME Credit points for CME organizers 19 Registration of CME activities under the CME Program 20 Application procedure, Drawing up session schedules, Advance notice of application, Application forms Preliminary registration 23 Registration of ongoing activities 23 Renewal of registration of ongoing activities 23 Announcement and publicity 24 Completion of CME activity 24 Evaluation of CME activities Verification of documentation by CME Center 25 Sponsorship 26 Sponsorship of CME programs by private commercial establishments

14 ORGANIZATION OF CME ACTIVITIES Learning Objectives for Part II - Organization of CME Activities By the end of this section the reader should: 1. Be able to state the requirements that need to be satisfied for proposed CME activities to be accredited; 2. Be able to state the basis for accrediting CME Providers and name the CME Providers currently accredited; 3. Be able to state the roles and functions of the CME organizer with regard to planning and conducting CME activities; 4. Be able to describe the system used for categorizing CME activities and the basis of the classification; 5. Be able to state the steps that CME organizers need to follow for getting CME activities accredited; 6. Be able to indicate the administrative obligations of the CME organizer prior to, during, and on completion of accredited CME activities; 7. Be able to outline the professional and ethical issues that need to be taken into account when using the resources supplied by private commercial establishments. 12

15 ORGANIZATION OF CME ACTIVITIES CME ACTIVITIES AND CME AUTHORITIES CME activities would fall into one of two major groups: formal CME activities organized and presented by an accredited CME Provider and its CME organizer, or CME activities in topic areas identified and undertaken by individual practitioners. Part II of the Guidelines deals specifically with activities of the former group, i.e. those organized by an accredited CME Organizer. For many years CME activities of varying degrees of sophistication and academic and scientific standards have been conducted by educational or scientific institutions, professional organizations and commercial establishments. Practitioners attended them depending on their background, expertise, interest and availability. However, until formal CME schemes were started, the strategies used to assess the quality of the activities varied considerably. Often there was no mechanism to monitor the progress of the practitioners in CME. This section of the Guidelines describes the CME Program in Kuwait, and deals with points of special interest to those who wish to organize accredited CME activities. ORGANIZATION OF CME ACTIVITIES ACCREDITATION Accreditation is the system used by the CME Center to ensure that CME activities meet the accepted standards of education and scientific merit. Accreditation constitutes registering the proposed CME activity by the CME Center, based on the information received regarding the aims and objectives, content covered, scheduling of sessions, expertise of the resource persons, target audience, and the intended approach to evaluation. CME authorities, in general, require that the proposed program satisfies the following requirements: 8,9 Presents clear aims to potential participants; Demonstrates the relevance of the aims to educational needs of practitioners; Is structured and includes varied learning approaches; Is able to cater to the varying needs of participants, and provide individual feedback; Gives details of the evaluation of the program. 13

16 ACCREDITATION OF CME ACTIVITIES BY CME CENTER The CME Center adopts an approach essentially similar to that listed previously in accrediting CME activities that are conducted locally. The criteria it uses are that: The target audience of the activity is clearly identified; The activity is planned on the basis of identified needs (perceived and/or objective); The objectives of the activity are clearly stated; The educational methods selected allow the objectives listed by the organizer to be achieved; The audience is able to actively participate in the sessions, where relevant; The participants receive an opportunity to evaluate the activity at its conclusion; The activity, if funded by an external body, is organized adhering to an approved code of ethics and responsibilities with regard to sponsorship of CME activities. For a CME activity to be accredited, the organizer of the program has to submit all the relevant documents to the CME Center. On receipt of the information requested, the activity is assigned a Registration Number, and is classified into one of two groups: Category 1 or Category 2. Taking the duration of contact hours of education into consideration, a credit point value, too, is allotted. These details are then conveyed to the organizer, who is expected to indicate the category to which the CME activity belongs and the number of credits assigned to it in all announcements and in the certificates that would be issued to participants. It is essential that formal and structured CME events such as conferences, symposia, seminars and workshops receive prior CME accreditation, if participants are to claim CME credits under the CME Program. 14

17 CME PROVIDER A number of institutions and organizations that possess expertise for conducting CME activities at a national level have been recognized as CME Providers. They are eligible to plan conferences, courses, symposia, seminars and other educational activities for CME. The following have been accredited at present: Faculties and Scientific Committees of KIMS; Health Sciences Faculties of Kuwait University; Specialty divisions of the Ministry of Health; Health professions associations, e.g. Kuwait Medical Association, Kuwait Dental Association and their specialty societies, Kuwait Pharmaceutical Association, and Kuwait Nursing Association. Institutions that possess expertise and adequate resources for conducting activities, but not included under the above may contact the CME Center of KIMS to inquire whether they qualify for accreditation, and if so, to obtain details of the procedure adopted. 15

18 CME ORGANIZER Depending on the subject area of a given CME/CPD activity, an appropriate content specialist would function as the CME organizer on behalf of the CME Provider. He or she takes immediate responsibility for the different aspects of the CME activity, which include: Initiating, planning, and developing the program; Identifying overall goals and specific objectives, subject content, target group, resource persons, financial resources and logistical support, plan of program evaluation, venue, scheduling etc. Applying to the CME Center to get the activity registered and, after registration, announcing it among the prospective participants; Coordinating the presentation of the activity, carrying out an evaluation, maintaining the participant list, and providing certificates of attendance. Scientific or educational events that CME Providers organize for enhancing professional competencies qualify to be registered under the CME Program. Activities that are primarily for patient care, or promotional displays of medical or dental equipment and materials, therefore, may not be included as CME. Pharmaceutical firms and other private establishments could, however, contribute to the CME Program by way of providing resources for conducting activities. The scientific and educational content included in those events, though, comes within the purview of the accredited CME Provider and its CME organizer. 16

19 CATEGORIZATION OF CME The primary aim of CME is improving the health professionals competencies by assisting them to keep abreast of the developments that would affect professional practice. Some form of yardstick is needed for use in keeping track of CME involvement, and quantifying it. The CME program relies on a relatively imprecise measuring tool CME credit points for this task. All CME activities that come under the CME Program have been categorized into two groups, Category 1 and Category 2. Some CME schemes outside Kuwait have a higher number of categories: the KIMS program has opted for two, to allow it to be easily understood by the practitioners while covering both structured as well as self-learning educational opportunities. The category under which a given CME event gets classified and the amount of credit allotted to it are related to a number of factors which include: Type of CME Provider; Extent to which the activity is structured; Organizational resources required for planning and conducting the program; Degree of involvement of the participants in the learning opportunities; Choice of scheduling and the venue. An important consideration in the categorization is whether all those in the appropriate target group have the opportunity to participate. On an average, Category 1 activities allow the participants to claim 1 credit point for every hour of participation, while Category 2 events give 0.5 point for the same period. Some events in either group receive different credit ratings. CATEGORY 1 CME Category 1 CME activities comprise formal and structured learning opportunities provided by recognized educational or scientific institutions or professional bodies. They are usually scheduled and held at venues that would allow all concerned practitioners to participate. Symposia, conferences, workshops, seminars and lecture series would normally receive registration under Category 1. While lectures and formal presen- 17

20 tations in this category entitle the participants to claim 1 credit point of CME per hour of educational activity, practical/ clinical training sessions are valued at 0.5 credit point per contact hour. For participants to claim CME credit points, all CME activities under Category 1 need to be registered in advance with the CME Center. The responsibility for taking steps to register them lies with the respective CME organizers. CATEGORY 2 CME Category 2 activities are those that are essentially of a selflearning nature, or are planned and conducted with a local participant group in mind. Many self-instructional formats, reading scientific papers in journals, and research and professional publications would be included under this category. Category 2 also includes a wide variety of activities that are ongoing at health care, educational or scientific institutions. Examples of activities falling under Category 2 are: i. Participation in patient care review activities ii. Teaching of medical and other health professionals iii. Writing questions for use in examinations iv. Journal clubs Case conferences Morbidity/mortality meetings v. Use of self-assessment examinations and reviews vi. Use of approved self-instructional material, including computer assisted instruction vii. Use of distance learning programs viii. Reading scientific papers in journals and other related professional publications ix. Conducting research in health-related disciplines x. Publication of medical/dental books or articles, books and exhibits in medicine/dentistry, which target health professionals xi. Self-directed study undertaken as preparation for examinations Some conferences, symposia, group learning sessions, seminars etc., too, may be classified under Category 2, based on the information that is available to the CME Center. Participants qualify for 0.5 credit point of CME for every hour of education for involvement in activities such as scientific meetings in Category 2. Publication of scientific papers or 18

21 review articles in the area of specialization in refereed journals qualify the authors for variable amounts of CME credit: 1 st (or single) author 5 credits, 2 nd author 3 credits, 3 rd author (and beyond) 2 credits. Writing a chapter in a book in the area of specialization would also enable the authors to claim credit in a similar fashion, while writing a book or monograph in the area of specialization gives the author 10 credits. Calculating the credit values for some of the Category 2 activities could be difficult. The organizer responsible for the activity, where applicable, should estimate the time that the average practitioner would require to complete it. This estimate is used in arriving at the maximum amount of credit that could be claimed. For self-directed education such as reading scientific papers, the amount of credit claimed should match the hours that an average practitioner would spend on comparable tasks. CREDIT POINTS FOR CME ORGANIZERS The resource persons who play a major role in the planning and organization of CME activities are entitled to claim CME credit for their contribution. Purely administrative functions such as attending to correspondence needed for communication with speakers or funding agencies, or secretarial duties are not classified as CME. In addition to the speakers or demonstrators in CME activities, chairpersons, moderators and rapporteurs who make an important academic or scientific contribution are included under resource persons. The organizer of the CME activity and the resource persons responsible for the individual sessions would decide on who is eligible to claim CME credit. The quantum of CME credit that could be claimed depends on the category under which the activity was registered by the CME Center. The resource person may claim twice the amount of credit that the session participants are entitled to claim. If a session has been allocated 1 credit point, giving the participants the opportunity of claiming 1 credit point, the resource person responsible for it, therefore, may claim 2 points. 19

22 REGISTRATION OF CME ACTIVITIES UNDER THE CME PROGRAM All CME activities such as symposia, conferences, workshops and other similar events conducted within Kuwait need to be registered with the CME Center, if the participants who would attend them are to claim CME credits. APPLICATION PROCEDURE Organizers of CME programs and CME Providers who wish to obtain accreditation of the proposed activities are required to apply to the CME Center, well in advance of the scheduled events, for them to be registered. Two forms (Form I Application for Accreditation, and Form II Information on Proposed Program) need to be completed and submitted. It is essential that the organizer indicates the duration (in hours) of each session, as this information is used in calculating credit points. A quarter of an hour is used as the unit in the calculation. When sessions last for periods of time that cannot be converted to credit points on this basis, a rough approximation is used by the CME Center. One of the requirements in the CME scheme is that practitioners registered in the CME Program should send their CME credit details to the CME Center. At the stage when this is undertaken, the CME Center would accept credits only from CME activities that have received prior registration under the CME Program. If a conference or a seminar had not been registered for whatever reason, practitioners who attended it may include the credits under self-instruction or as Category 2 symposia, workshops or seminars. DRAWING UP SESSION SCHEDULES When planning the program, it is important that program organizers bear in mind the needs of the participants and their attention span. Excessively long sessions as well as many presentations coming one after another are not likely to benefit most CME participants. (Details of educational issues that have a bearing on planning of sessions appear in Part III of the Guidelines.) If the schedule submitted to the CME Center does not indicate an appropriate recess or a break within a session, the 20

23 credit points allotted would be adjusted. For a two-hour session presented by the same resource person, credit points would be calculated with 15 minutes deducted from the total duration. An option the organizer may use is to include a 15- minute break within the session, unless there is a strong practical reason that prevents it. For a three-hour session, or for three one-hour sessions scheduled one after another, the duration of a break is taken as 30 minutes, the academic activity being taken as running for 2 hours and 30 minutes. ADVANCE NOTICE OF APPLICATION The application for registration of proposed activities needs to reach the CME Center at least three weeks before the scheduled starting date. This period of advance notice has been decided mainly in response to requests made by the practitioners themselves. Additionally, such advance notice is necessary for the CME Center to confirm that the relevant information has been submitted, and to attend to the administrative formalities. It also gives the organizer adequate time to prepare the announcements indicating credit point details, and have them circulated for the benefit of the prospective participants. The practitioners would then be able to choose those activities that they wish to attend, and make appropriate arrangements to ensure that their routine duties are carried out without disruption. We hope that the advance notice requirement would prevent the occurrence of situations where interested practitioners were unable to attend CME activities because the notices did not reach them in time. APPLICATION FORMS Two forms, Form I and Form II, are available at the CME Center website for online registration. They can also be printed from the site using MS Word, to be completed and sent to the CME Center by fax or other means. Online registration, though, is the preferred option. Form I of the application deals mainly with the administrative aspects of the activity, while Form II is concerned with academic matters, which are used in reviewing the proposed activities before they can be accredited. Information is called for under the following headings: 21

24 CME/CPD Provider Title of program Frequency of conducting program Aims and objectives Content outline Scheduling of sessions Target audience - number and background Resource persons (lecturers, demonstrators, instructors, tutors etc.) Plans for assessment of outcome and for follow-up Plans for program evaluation For activities classified under Category 1, the above information is needed in nearly all the situations. With respect to ongoing scientific meetings and other frequent activities that come under Category 2, some of this information may not be applicable. The organizer is not expected to calculate the credit points for the CME event. The CME Center would undertake this task based on the information supplied by the organizer and the criteria that have been announced. Once the CME Center receives the application, it classifies the proposed activity under either Category 1 or Category 2. It then assigns a credit value to the program considering the information available on objectives, content covered, educational contact hours of the activity, target audience, resource persons, venue and scheduling of sessions. The maximum number of CME points that would be allotted to a single CME activity (e.g. symposium, workshop, seminar, training program etc.) is 25 CME credits. When the information supplied regarding a prospective activity is incomplete, there is bound to be delay in registration. If the CME Center does not receive all the information requested, it may not register the program as an accredited CME activity. Therefore, it remains the responsibility of the CME organizer to ensure that all relevant information is included when the application is submitted. 22

25 PRELIMINARY REGISTRATION Some CME activities such as major international conferences often involve communication between the organizer and a number of different parties. Therefore the organizers may need a considerable amount of time before complete schedules and programs can be prepared. While the CME Center is unable to allocate credit points to an activity until scheduling details are received, the sponsors or the administrative authority may want to ensure that the program would be an accredited CME activity before an offer of funds etc. is confirmed. To deal with this situation, the CME Center provides a scheme of preliminary registration. The organizer may forward the available information to the CME Center although planning is not complete, and the activity could be considered for registration on a preliminary basis. With details received in due course, registration is confirmed and credit points are assigned. Preliminary registration also enables the organizer to announce CME accreditation applied for even in a First Announcement of a seminar or a conference. REGISTRATION OF ONGOING ACTIVITIES Ongoing educational activities at health care institutions such as patient care review meetings, journal clubs, and morbidity/mortality meetings are accepted for credit under Category 2. For this, the institution has to appoint a suitable practitioner to function as the organizer. He or she would submit an application in advance to the CME Center for registration. The application could cover events that are to be conducted over an extended period (6 months or 1 year). RENEWAL OF REGISTRATION OF ONGOING ACTIVITIES Ongoing educational activities that have already been registered under the CME Program need renewal of registration if they are to be repeated beyond the period of initial registration. A written request by the organizer, before the activities are held, would be sufficient for this unless there is a major change in the format of the activity. 23

26 ANNOUNCEMENT AND PUBLICITY Preparing the announcements and brochures, and taking steps to circulate them among the potential participants remains the responsibility of the organizer. The Illustrations Unit of KIMS could assist in these tasks, provided the organizer submits the text of the material well in advance to the Unit. Additionally, the Office of the Secretary General of KIMS would make some of the resources at its disposal available for distributing the announcements among the various health care facilities and other institutions. It is essential that the Registration Number and the Category of CME and credit points are clearly stated in all announcements. A program should not be announced as a CME activity, with details of CME credits accredited by the CME Center, until the organizer has received a letter of registration from the CME Center. COMPLETION OF CME ACTIVITY When a CME activity is completed, the organizer is expected to maintain relevant documentation, and to issue each participant a certificate of attendance. The documentation required is: i. A list of the participants who completed the activity satisfactorily; ii. An evaluation report. The certificate that the organizer of the CME activity is required to issue is only an official document, which may be printed on office stationery using standard office equipment. Professional artwork and page designs, and printing at a commercial establishment are not needed to satisfy the requirements of the CME Program. The CME Registration Number, the Category of CME and the number of CME credit points the participant may claim should clearly be stated in the document issued. Each physician or dentist is entitled to claim only those hours of credit that he or she actually spent in the educational activity. In the case of some Category 2 activities, a number of events conducted over a specified period may be included in the same certificate. The organizer would decide where such an approach is appropriate after considering the practicality issues. 24

27 EVALUATION OF CME ACTIVITIES The main purpose of the evaluation is to give feedback to the course organizer and the instructors on the strengths and weaknesses of the activity. This would help to introduce appropriate modifications if similar programs are to be conducted in the future. When preparing an Evaluation Report a series of comparable events that are held routinely and frequently may be grouped. Thus journal clubs, morbidity/mortality meeting or patient care review meetings conducted over a specified period may be included in a single report. The website of the CME Center ( provides sample forms for documenting participation and for use in evaluation (Form III - Attendance at CME Program; Forms IVa and IVb for evaluation; Form V - Letter of Attendance). These may be modified to meet the specific needs of individual CME events. During the periodic review of the CME Program, the CME Center would ask the organizers of past CME activities to submit copies of relevant documentation pertaining to them. VERIFICATION OF DOCUMENTATION BY CME CENTER The documentation maintained by the organizers of CME activities will be reviewed on a regular basis to ensure that the implementation of the program proceeds satisfactorily. The organizers would be contacted by the CME Center for this purpose. The organizers are then expected to forward copies of the Attendance Lists and of the Evaluation Reports to the CME Center or to the CME Officers of KIMS, as requested. The CME Officers would also assist the CME Center in the verification of the documentation. 25

28 SPONSORSHIP Most major CME activities need financial and other forms of sponsorship. Prior to the commencement of planning activities, the organizer would estimate the expenses likely to be incurred and identify the potential sponsors. When an application for registration of a CME activity is received by the CME Center, it is taken for granted that the organizer had already dealt with the issue of resources, and has received the necessary assurances from the concerned parties, if relevant. The CME Center is not a sponsoring agency in any way, and inquiries regarding budgetary estimates or allocation should be directed to the appropriate authority at KIMS or other institution. Additionally, by the time an application is submitted for registration, substantive planning is expected to be in place to conduct the program so that the organizer could supply details of program objectives, scheduling etc. to the CME Center without difficulty. Organizers of CME activities are welcome to use the resources offered by private commercial establishments in organizing CME activities. Guidelines for making use of these opportunities are listed in detail overleaf. 26

29 SPONSORSHIPS OF CME PROGRAMS BY PRIVATE COMMERCIAL ESTABLISHMENTS The CME Center of KIMS has received many inquiries from CME organizers about how sponsorship by pharmaceutical firms and other private establishments could be used to support CME activities organized under the CME Program. CME Providers and organizers are requested to ensure that CME activities that receive financial or other forms of sponsorship from such institutions meet the following guidelines: Academic and Scientific Content The CME Provider is responsible for the scientific and academic merit of the CME activities approved under the CME Program. Therefore, the course director, course organizer or the planning committee of the activity would take the overall responsibility for the subject content and the choice of speakers for conferences, symposia, workshops and other similar events. Activities that are primarily of a promotional nature such as displays of medical or dental equipment and materials are not considered as CME. Choice of Topics The activities should focus on topics that would assist in the development of expertise in one or more areas of professional competence. Even if a formal needs analysis may not be possible prior to planning, the organizers should consider at least the perceived needs of the participants when defining the objectives and identifying the content for the proposed activity. This would help to ensure relevance to professional practice, promoting interest and involvement of the participants in the sessions. Generic Names of Drugs As a general principle, the use of generic names of drugs is preferred in presentations and discussions. Appropriate Ethical and Professional Standards During planning and implementing the program, issues dealing with ethics and professional standards should receive appropriate consideration. Patients rights and informed consent need to be given their due place by the organizers and the presenters of the sessions. 27

30 Evaluation of Activity An essential component of the activity is its evaluation by the participants. This may be undertaken at conclusion of the sessions, or within a few days/weeks of completion if some post-program action was expected. Many workshop evaluation forms are available for this purpose. The CME Center has supplied its own formats considering the activities that would be conducted under the CME Program. The CME organizer may modify these forms as required for the specific activity. Social Events Social events may be arranged as part of the activity. However, the main emphasis in the program should be on its academic or scientific aspects. Travel and Accommodation Arrangements for travel and accommodation of speakers or participants of the CME activities should be comparable to those that would normally be made if assistance from the sponsor was not available. Acknowledgement of Support Support provided by the sponsor may be acknowledged in the course brochures or other documents as appropriate. Identification or endorsement of the products marketed by the sponsor should not appear in the material circulated by the program organizer. Additionally, promotional displays should not be held in the same room where the educational activity is conducted. 28

31 Part III Planning effective CME: educational considerations Learning objectives 30 Needs assessment 32 Types of educational needs, Methods of identifying needs Adult education 33 CME and adult learning 33 Educational objectives in planning CME activities 34 What is a learning objective?, Knowledge, Procedural skills, Values and attitudes Target audience 37 Effective CME strategies 38 e-learning 39 CME models 40 Instructional strategies 41 Small group teaching and discussions, Practicals/demonstrations, Clinical teaching, Lecturing Assessing effectiveness of CME activities 48 Assessing short-term effectiveness, Assessing effectiveness on a medium-term basis and a long-term basis Summary of important educational issues 50 CME AND EDUCATIONAL ISSUES

32 Learning Objectives for Part III - Planning Effective CME: Educational Considerations By the end of this section the reader should: 1. Appreciate the importance of needs assessment prior to planning CME, and be able to state the types of educational needs; 2. Be able to define adult education and show its application in planning and organizing CME; 3. Be able to define learning objectives and classify them so that the classification could become useful in planning CME; 4. Appreciate the importance of clearly identifying the target audience, for CME activities to be conducted effectively; 5. Be able to list strategies that would be effective in achieving the learning objectives of CME activities; 6. Be able to describe e-learning and state its current and potential uses in CME; 7. Be able to state the teaching methods that could be used for different types of learning in CME, and indicate measures available to the instructor to facilitate learning by the participants; 8. Be able to indicate the approaches for planning the evaluation of effectiveness of CME, and list strategies of evaluation. 30

33 PLANNING EFFECTIVE CME: EDUCATIONAL CONSIDERATIONS When planning any CME activity, it is important that the CME organizer pays attention to the relevant educational issues. In this section, the following topics are dealt with: i. Needs assessment; ii. Educational objectives in planning CME activities; iii. Target audience; iv. Approaches to CME; v. Assessing the effectiveness of CME. The term effective CME would signify learning activities that enable the participants to reach the educational objectives for which the sessions are being planned. It is more important, however, to assess whether the widely used types of CME such as conferences, seminars or workshops ultimately result in the individual patient and the community receiving an improved level of health care services. Some of the factors that could contribute to the success of CME activities are: Examples of good practice getting established as the norm among colleagues; 10 Ensuring that speakers at formal presentations are experts in their fields; 11 A person of authority taking responsibility for educational programs; Where institutions collaborate, one person at each institution being responsible for the management of the intervention; 12 Promoting good interpersonal relationships between the participants

34 NEEDS ASSESSMENT Before planning CME activities, the CME organizer should consider the educational needs of the prospective participants. Identifying these needs would help in selecting the subject content and the appropriate method of teaching. TYPES OF EDUCATIONAL NEEDS Perceived Needs Perceived needs reflect a gap between the knowledge and skills the practitioner feels that he already possesses and those that he would like to acquire. 8 The practitioner himself identifies these needs through self-reflection. Objective Needs Objective needs reflect a gap that has been shown to exist between a practitioner s current level of skills and knowledge and the level recommended by experts. Informal meetings, questionnaires, peer review, reports of assessment committees, and feedback from peers or patients may be used to gather data on objective needs. Normative Needs Normative needs are a type of objective need. They are related to advances in research and development in the medical sciences. They are defined by experts in training or research institutions or professional societies. Institutional Needs Institutional needs are derived from the goals that a health care facility or any other institution wishes to achieve. They are influenced by the mission of the organization. METHODS OF IDENTIFYING NEEDS Examples of formal methods used for identifying needs are focus groups, the nominal group technique, evaluation of past activities, meetings between colleagues, survey of participants expectations, and analysis of patient records. Some of these methods of needs assessment may be limited in scope, and often are not practically feasible for use by the average CME organizer. Therefore, relatively informal methods, based on professional judgment and organizational development could be used. 14,15 32

35 ADULT EDUCATION A concept that is relevant when dealing with the topic of organizing effective CME is adult education. A related issue that also warrants attention is whether the education of adults differs from adult education? All learning activities created by one agency for another group of people may be referred to as education. Some may view education as consisting of programs having wide rather than narrow goals, thus excluding training and indoctrination from education. 16 The education of adults is often described as all forms of education for those above a specified age that identifies adulthood. This cutoff point may be 16, 18 or 20 years of age. The term adult education is restricted to what can best be learned as adults because they rely on experience or relate to adult roles. These definitions would still leave some subjects such as literacy, sports, art and languages falling under one or the other. The difference between the education of adults and adult education may lie more with the approach to learning than with what is being learned. Therefore adult education could consist of all forms of education that treat the student participants as adults capable, experienced, responsible, mature and balanced people. CME AND ADULT LEARNING CME is likely to be effective when the activities that are being planned are based on the principles of adult education. The main factors that have an influence on planning effective education for health care practitioners are listed below: Adults learn best when actively engaged in the learning process and where the learning builds upon their prior knowledge and experience. 2. The subject content that adults learn must be relevant to the practice or some other aspects of the work. 3. Adults learn best when they feel that the learning is necessary to solve a practical problem related to their professional performance. 4. Adult learners tend to be independent and to maintain responsibility for their learning. 33