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It depends on the criterion. 

Frequency: Some of the criteria standards require that providers attest to meeting the criterion in a number or percentage of their activities, depending on the program size. For these criteria, we expect providers to demonstrate the frequency of activities that have met the critical elements. For these criteria, if the same content is repeated for different audiences, at different times or places, those count as separate instances. This measure is used for criteria 23–27, 29, 30, 32, and 36. (For C31, evidence is demonstrated through a number of learners based on program size.) 

Diversity and breadth: Other criteria standards require that providers demonstrate compliance through a specified number of examples of activities or initiatives. With these examples, we expect providers to demonstrate the diversity and breadth of approaches they used to meet the critical elements. For these criteria, providers need to submit examples that are completely different from each other. Different iterations of the same activity content repeated for different audiences at different times and places, would not count as separate examples. This measure is used for criteria 28, 33–35, and 37 –38.  

The standard describes the ways providers will be expected to demonstrate compliance with the menu of new criteria:

  • Attestations: For criteria requiring attestations, providers will need to attest  to meeting the criterion in 10% of activities during the accreditation term—this percentage is the same for all providers. We will provide a simple mechanism for attestation during the accreditation process.
  • Submitting evidence at review: Providers will need to submit evidence to show how they met the criterion. The number of activities for which you will submit evidence is based on the number of activities reported during the accreditation term. It may be possible to meet the requirements of multiple criteria with one activity.
  • Examples and descriptions: For the program-based criteria, the standards state that providers will need to demonstrate compliance with examples or descriptions. This will involve submitting brief explanations as part of the self-study report.

No. Achieving compliance with the menu of commendation criteria is optional for CME providers and is not required to achieve Accreditation. Providers will continue to achieve and retain Accreditation by demonstrating compliance with Accreditation Criteria 1-13.

Yes, the total number of activities you've provided across the term of accreditation (four or six years) includes both directly provided and jointly provided activities. It may be helpful to consider how some of your collaborations with joint providers could help you achieve some of the goals of the commendation criteria.

Yes. There are no limitations on the provider using data/information from their CME activities to support compliance with appropriate Critical Elements and Standards for criteria in the menu approach.

The ACCME considers a peer-reviewed forum to be a mechanism for the dissemination of research related to the effectiveness of CME, in which there is a vetting process that assures that the material being presented is evaluated for its scientific merit by peers in educational research. Examples include peer-reviewed journals or research-focused conferences. Examples of forums we do not consider to be peer-reviewed are newsletters, social media posts, and discussion boards.

Yes. Accredited providers can use individual sessions or tracks within larger activities to count as examples of compliance with the Menu of Criteria for Accreditation with Commendation. We expect the demonstration of compliance to meet the critical elements of the criterion/criteria. We have not set a specific threshold for what proportion of an activity needs to be compliant; however, we expect that if part of an activity is used to demonstrate compliance, that part is meaningful to the overall activity. We will review and analyze the examples that providers submit and offer additional guidance if needed.

Yes. In the context of your organization and the learners you serve, patients who elect to have surgery could be the collective "population" referenced in Criterion 27.

No. Providers can meet the Critical Elements and Standard for Criterion 36 without measuring performance change in every learner.


No. Criterion 24 requires that patients and/or public representatives are involved as planners and faculty of CME activities. The same people do not need to be involved as both planners and faculty.

No. For Criterion 28, the provider must demonstrate how collaborations augment its ability to address population health issues, but does not have to demonstrate these approaches with examples of CME activities.

Yes. Criterion 28 requires that the accredited provider work with outside organizations to more effectively address population health issues.

Implementing a new format or a series of new formats of activities into your CME program could be considered one innovation. To meet the expectations for Criterion 35 you would need to describe and demonstrate three additional innovations, as well as how each of the innovations contributes to your ability to meet your CME mission.  

The spirit/intent of C31 is for the provider to develop—with the learner—a learning plan with individualized feedback that will help the learner to address their own personal practice gaps—those areas of knowledge, skill, or performance that need improvement. To that end, a tracking system related to credit or MOC requirements, while useful, would not meet the intent of this criterion. The provider should be able to demonstrate that the learning plan differs meaningfully between learners. 

In Criterion 36, change in performance refers to measured changes in a learner’s or learners' behavior (e.g., higher patient communication ratings, fewer coding errors, greater participation in team meetings, more appropriate prescribing, etc.). Providers can set their own specific goals and targets for the performance improvement objective. The provider can also choose the most appropriate mechanisms to measure performance change, and how much change in learners is acceptable. The standard, target, and performance improvement that is measured or reported should be consequential in relation to the objectives. The improvement data may emerge from self-reported changes, from practice-level data, or other sources. Improvements in knowledge and plans to change performance would not meet the expectation of this criterion. 

For example, your CME Unit includes staff who are not involved in planning/implementation, but are involved in the meeting planning aspect of CME. These staff are members of professional organizations for meeting planners (not specific to CME) and are all in the process of achieving certification in meeting planning. Would this be sufficient?

If meeting planning staff are part of your CME team, then education/training for them about how to be more effective meeting planners would fulfill the expectation of continuous professional development for Criterion 34

Yes. If your goal was to get your learners to decrease or stop a practice, for example, prescribing a certain drug or ordering a test, and they do make those changes – then, that would meet the expectations of "improvement" for Criterion 36.

No. The expectation of Criterion 36 is that the provider measures and demonstrates performance improvement for any learners (physicians or other learners) who participate in the accredited educational activities.

Yes. Providers can demonstrate that CME activities improve the performance of individuals or groups of learners—including teams—to meet the expectations of Criterion 36.

Criterion 37 is an opportunity for ACCME to recognize and reward the contribution of a provider’s CME program to improving care processes and system performance. The provider can use quality measures that are validated by outside sources and/or measures that are appropriate and important to their own setting. 

No. Criterion 23 rewards interprofessional continuing education (IPCE), where representatives from at least two professions— representative of the target audience for the activity—are included as planners and faculty.

Implementing a new format or a series of new formats of activities into your CME program could be considered one innovation. To meet the expectations for this criterion (Criterion 35) you would need to describe and demonstrate three additional innovations, as well as how each of the innovations contributes to your ability to meet your CME mission.

It is up to the provider to determine the most appropriate interval or intervals for assessing the effectiveness of its support strategies. The ACCME expects that this assessment would occur at least once for each strategy during the accreditation term. The provider should additionally demonstrate how the support strategy evolved following the analysis.

No. The accredited provider can define the role of faculty for their CME activities.

Yes. The innovation must be new to the provider’s CME program during the current accreditation term.

If some of your faculty are functioning as members of your CME team, then providing education and support for them on how to be more effective educators or educational leaders would be considered continuous professional development of your team.

The results of the research from at least two distinct projects must be developed into a form that is suitable for sharing with the community, and have each been submitted to a peer reviewed forum. Acceptance for publication/presentation is not necessary to demonstrate compliance.

Each learner in an activity would be expected to have been observed and given feedback to meet the criterion. 

No. Feedback can be provided in person or virtually, in writing or orally – and can be provided to the individual learner or to a group (for example during a team simulation).

Yes - the intent of this criterion is to have the content/format of the activity support the observation of, and feedback to, learners on their communication skills, so that each participant can derive personal value from the activity. 

Individuals or groups of learners can self-report and/or self-assess their communication skills, but the accredited provider must also include external observation with feedback to the learner – for example with a faculty member, a peer observer, or a standardized patient.

You do not need to teach learners how to conduct an analysis or synthesis of data. You do need to show that your activities include teaching about the collection and/or analysis and/or synthesis of health and practice data.

Yes. Patients/families who serve as planners or faculty in CME would be in a position to control content and therefore the requirements for identifying and disclosing relevant financial relationships and resolving conflicts of interest apply.

Yes. By teaching learners how to conduct community health education, you are teaching them a strategy they can use to achieve improvements in population health. 

No. The ACCME does not expect or require providers to use identifiable patient health or practice data. Providers should seek appropriate guidance from institutional policies and practices concerning the protection of confidential and identifiable information when including health or practice data in CME activities.

No. The accredited provider can define the role of planners for their CME activities.

The term “health professions students” refers to students of any of the health professions (e.g, medicine, nursing, pharmacy, physician assistants, and others), across the continuum of healthcare education, including professional schools (e.g., nursing, medical, pharmacy schools) and graduate education (e.g., residency and fellowship programs). 

The ACCME does not require providers to use a particular definition of public or population health. As one suggestion, a 1988 Institute of Medicine (IOM) report offered a condensed definition of public health as “fulfilling society’s interest in assuring conditions in which people can be healthy.” (Committee for the Study of the Future of Public Health, 1988, p.19) [Institute of Medicine (1988). The Future of Public Health. Washington, D.C.: National Academy Press.] 

Healthcare quality improvement refers to improvements in clinical care processes or systems. The provider would be expected to describe and provide data that demonstrates the healthcare quality improvement achieved with the support of its collaboration.

Yes. Providers can measure patient or community health improvement using a variety of approaches that can include self-reporting by patients and other community members.

Yes. Providers can measure changes in the performance of individuals or groups of learners based on self-reports of changes in practice.

Yes, provided that the simulation includes assessment of the learner’s or learners’ actions, behaviors, and skills.

Patients are often important contributors to educational activities and we encourage providers to engage patients as planners and faculty. Providers should seek appropriate guidance from institutional policies and practices concerning the protection of confidential and private information when including patients in CME activities. The Health Insurance Portability and Accountability Act (HIPAA) does not prohibit the use of patients as faculty, planners, or learners in accredited CME as long as their permission has been received.

Yes. You would need to show that, through your CME activities, you are collaborating in the process of healthcare quality improvement and demonstrate that the activity/activities resulted in healthcare quality improvement at least twice during the accreditation term.

The CME team does not have to take the lead on the management of the research project. However, the research must be related to the effectiveness of and/or best practices in CME.  

Healthcare quality improvement refers to improvements in clinical care processes or systems.

An interprofessional team is comprised of team members from two or more different professions (e.g., nurses and physicians, physicians and community health workers, social workers and psychologists, pharmacists and respiratory therapists) who learn with, from, and about each other to enable effective collaboration and improve health outcomes.

Patient or community health are the health characteristics or outcomes related to individuals or to groups of individuals within a geographic location, service area, or other grouping. Health and health outcomes can include incidence and/or prevalence of disease, mortality, vaccinations, nutrition, and social determinants (for example, healthy behaviors, safe environment). 

The provider can set its own goals and offer evidence for how achieving those goals has contributed to the improvement in health outcomes for the individuals and/or communities they serve.

The provider might evaluate how many learners are accessing support strategies, how many learners are using the reminders and/or patient education materials, or how many learners are logging into networking opportunities post-activity to engage with faculty or other learners. The provider might survey the learners to find out if the support strategies were helpful in reinforcing change, and if not, what might be more effective/helpful.

No, collaboration is not limited to a single institution. Collaboration can occur within, or in connection with, a healthcare institution such as a hospital or health system, but it can also occur more broadly across systems of care. The ACCME interprets "system performance" broadly and the CME provider can choose how, and with whom, it collaborates in the processes of healthcare quality improvement.

No. The provider can involve students from any health profession as planners and faculty of CME activities for Criterion 25.

Yes. The use of clinical registry data in your CME activities would be an example of compliance with Criterion 26, if the data in the registry are used to teach about healthcare improvement.  

No. Criterion 28 requires that the accredited provider work with outside organizations to more effectively address population health issues. Such internal collaborations, however, could support the provider’s compliance with other commendation criteria.

Not necessarily. Strategies to meet the expectations of Criterion 37 do not necessarily include the demonstration of improved learner performance (Criterion 36). 

For Criterion 36, the majority of learners whose performance has improved would be calculated based on those learners who respond to the follow-up survey. The provider should ensure there are appropriate mechanisms in place to optimize the response rate. Note that providers can use follow-up surveys or a variety of methods to obtain this data.

The ACCME gives the provider broad latitude to design activities that optimally meet learners’ needs while engaging health professions students as planners and faculty for CME activities.

Criterion 24 encourages the accredited provider to utilize patients, their families, and other members of the public as planners and faculty members in accredited CME. Providers have broad latitude in how they define the roles of planners and faculty – as appropriate to their CME program and activities. For example, a patient or public representative could serve on a planning committee to advise the provider, could be a speaker, or could be a participant in a case-based discussion during an accredited CME activity.