CME Accreditation of, by, and for the profession of medicine. The ACCME was founded in 1981 in order to create a national accreditation system. It is the successor to the Liaison Committee on Continuing Medical Education and the American Medical Association’s Committee on Accreditation of Continuing Medical Education. The ACCME’s purpose is to oversee a voluntary, self-regulatory process for the accreditation of institutions that provide continuing medical education (CME) and develop rigorous standards to ensure that CME activities across the country are independent, free from commercial bias, based on valid content, and effective in meeting physicians’ learning and practice needs. The ACCME accreditation process is of, by, and for the profession of medicine.
The ACCME’s founding and current member organizations are the American Board of Medical Specialties, the American Hospital Association, the American Medical Association, the Association of American Medical Colleges, the Association for Hospital Medical Education, the Council of Medical Specialty Societies, and the Federation of State Medical Boards of the United States.
Throughout its history, the ACCME has been dedicated to maintaining a relevant and responsive accreditation system that supports CME as a strategic asset to US health care quality and safety initiatives.
Setting National Accreditation Standards
The ACCME established the first set of accreditation requirements, the Seven Essentials, in 1982. Based on a curriculum planning model, the Essentials required providers to create CME mission statements, use a needs assessment process to plan educational activities, develop educational objectives for each activity, and evaluate the effectiveness of their overall CME programs.
In the early 1990s, the ACCME decided it was no longer enough for CME providers to demonstrate that their programs transmitted important knowledge to physicians. Accredited providers needed to demonstrate the link between their activities and changes in physician performance. In 1998, the ACCME elevated the accreditation requirements, releasing the Essential Areas and Their Elements, or System98. The revised model encouraged accredited providers to focus on CME that linked educational needs with desired results, and to evaluate the effectiveness of their CME activities in meeting those educational needs. The ACCME continued to expect accredited providers to implement processes for reviewing and improving their overall CME programs.
Moving into the 21st century, the government, the public, and organized medicine called on the CME system to be even more accountable in facilitating and demonstrating physician practice improvement. The ACCME was asked by its member organizations and others to assist in repositioning the CME enterprise as a strategic asset to the quality improvement and patient safety imperatives of the US health care system, such as addressing health care disparities, reducing medical errors, and preventing and treating chronic disease. Building on the foundation of the first two sets of requirements, the ACCME released the Accreditation Criteria in 2006 in response to the changes in the health care environment.
With the implementation of the Accreditation Criteria, CME is now strongly positioned to support US health care quality improvement efforts and to align with emerging continuing professional development systems such as the American Board of Medical Specialties Maintenance of Certification® (MOC) and the Federation of State Medical Boards Maintenance of Licensure (MOL) initiatives, and hospital accreditation requirements such as The Joint Commission standards.
Safeguarding CME’s Independence and Integrity
In the 1980s, the ACCME developed guidelines to set boundaries between accredited providers and pharmaceutical and medical device companies. Increasingly, CME programs were being subsidized by industry grants. While pharmaceutical and medical device companies are regulated by the Food and Drug Administration and other government agencies, there were no specific guidelines regarding CME funding. In 1987, the ACCME issued its eight-point Guidelines for Commercial Support of Continuing Medical Education. The 1987 guidelines were formally adopted in 1992 as the Standards for Commercial Support. Just as the Seven Essentials created the framework for developing high quality education, the commercial support guidelines laid the foundation for managing conflicts of interest in accredited CME programs.
As the health care environment evolved, the US Food and Drug Administration (FDA) looked to the ACCME to manage conflicts of interest between FDA-regulated companies and accredited CME providers. National leadership organizations in the field of medicine in the United States asked ACCME to update the Standards. The ACCME believed it was essential to respond by broadening the scope of the Standards for Commercial Support. It was time to “brighten the line” between the educational and promotional activities produced by industry and ACCME providers’ independent CME.
The 2004 ACCME Standards for Commercial SupportSM: Standards to Ensure Independence in CME Activities are designed to ensure that CME activities are independent and free of commercial bias. The Standards impose stringent restrictions on CME providers’ interactions with drug /device companies and other companies the ACCME defines as commercial interests. The ACCME allows providers to accept company funding for CME activities, but prohibits any commercial influence, direct or indirect, over CME content. The ACCME Standards for Commercial Support comprise six standards: independence, resolution of personal conflicts of interest, appropriate use of commercial support, appropriate management of associated commercial promotion, content and format without commercial bias, and disclosures relevant to potential commercial bias.
Supporting the Intrastate Accreditation System
Since 1983, the ACCME has implemented a process for recognizing state and territory medical societies as accreditors. The recognition process is a partnership between the ACCME and the state/territory medical societies that empowers the state system to serve as accreditors for intrastate providers. These providers offer CME primarily to learners from their state or contiguous states as opposed to ACCME-accredited providers, which offer CME primarily to national or international audiences. In response to a 2006 call from Recognized Accreditors (state medical societies), the ACCME revised its recognition system and created the Markers of Equivalency, an updated set of requirements designed to ensure the consistency of accreditation decision-making across the national and state system.
Promoting Education and Collaboration
The ACCME is committed to supporting accredited CME providers and other stakeholders in their efforts to close health care quality gaps, address emerging public health concerns, and produce CME that matters to patient care. In recent years, the ACCME has greatly expanded its education, professional development, outreach, and communications efforts in order to advance its mission and foster the development of quality CME.
The ACCME builds collaboration with a range of stakeholders in the continuing health care education field on a national and international level. The ACCME has long-standing collaborative relationships with the other institutions that oversee national CME accreditation and credit systems, including the American Academy of Family Physicians, the American Medical Association, and the American Osteopathic Association. In 2009, the ACCME partnered with the Accreditation Council for Pharmacy Education and the American Nurses Credentialing Center to develop a joint accreditation initiative that rewards organizations for offering team-based education that improves patient care.
Supporting International CME
Throughout the years, the ACCME has supported CME initiatives with the European Accreditation Council for Continuing Medical Education in Brussels, and with government, health system, and CME representatives from a wide range of countries, including China, France, India, Ireland, Italy, Japan, Jordan, Korea, New Zealand, Singapore, South Africa, Spain, the Sudan, and the United Arab Emirates.
The ACCME recognizes five CME organizations outside the US as substantially equivalent to the ACCME’s accreditation system: the Royal College of Physicians and Surgeons of Canada, the Committee on Accreditation of Continuing Medical Education (Canada), the European Board for Accreditation in Cardiology, the Oman Medical Specialty Board as part of the Ministry of Health of the Sultanate of Oman, and the Qatar Council for Health Practitioners.
By advancing equivalency of CME systems on a global level, the ACCME builds toward a future where patients—regardless of where they are treated or the nationality of their physician—will be assured that their doctors maintain their competence by participating in CME that meets consistent and high standards.