Criterion 2 requires that the educational needs that underlie the professional practice gaps of learners be incorporated into the CME activities. However, the CME provider does not have to collect that needs data. There are many, many sources of needs data that relate to professional practice gaps. Determining if that data is relevant to the actual learners is a task for the CME provider. The ACCME's announcement of the Updated Criteria included some references that might be a place for the CME provider to start.
No. The ACCME does not require post-tests for any type of CME activity.
Accredited providers are required to understand the issues with knowledge or competence or performance that underlie a professional practice gap.
The first definition that’s important for the ACCME to share is that our use of competence is in the educational measurement term. Competence is about ability. Competence is what you would do if you could do it. It’s descriptive of strategy. Competence is knowledge put into action; put into action by the learner.
You put competence into action. You put it into practice — that’s performance. Performance implies in practice.
Outcome, patient outcome, research outcome, executive outcome, administrative outcome — those are the consequences in the system, in your stakeholder, in the place of application of your performance. You measure those to determine the impact of the educational intervention.
Does it matter if you call it performance and we call it competence or vice-versa? No. It doesn’t matter. What we want you to do is to understand those differences so that you know that measuring in practice is different than asking people what they would do if they could. Those are two different things. We call one performance, we call one competence. What we want you to do is decide what it is you want to measure as a result of the educational activity. Do you want to measure their strategy, what they would do if they could? Do you want to measure them in practice? Do you want to measure the consequences of their actual performance in practice? And you measure that. And you can call it what you want: competence, performance or outcome. That’s not what’s important. It’s that you recognize that there are differences between them.
Criterion 1 says, "expected results articulated in terms of changes in competence, performance, or patient outcomes that will be the result of the program." What definition of "competence" is ACCME using? Does it mean knowledge and skill, or does it mean the application of knowledge or skill in practice? If the later is true, how does it differ from performance?
In the ACCME context, we are using Miller's (1990) definition of competence as "knowing how" to do something. Knowledge, in the presence of experience and judgment, is translated into ability (competence) - which has not yet put into practice. It is what a professional would do in practice, if given the opportunity. The skills, abilities and strategies one implements in practice is performance.
See Miller GE. The assessment of clinical skills/competence/performance. Acad Med. 1990; 65(9 Suppl):S63-7.
This is an ACCME adaptation of an Agency for Healthcare Research and Quality (AHRQ) definition of a gap in the quality of patient care where the gap is "the difference between health care processes or outcomes observed in practice, and those potentially achievable on the basis of current professional knowledge."
The ACCME does not want to limit the scope of CME providers' or learners' educational projects. Part or all of some professionals' practices include important non-clinical, non-patient care elements which are still considered relevant to continuing medical education.
When there is a gap between what the professional is doing or accomplishing compared to what is "achievable on the basis of current professional knowledge," there is a professional practice gap.
See Kaveh G. et al, Technical Review, Number 9 , Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies Volume 1- Series Overview and Methodology, Publication No. 04-0051-1 Agency for Healthcare Research and Quality , U.S. Department of Health and Human Services Contract No. 290-02-0017, August 2004.