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Integrating an Effective CME Presence into the Academic Medical Center

Academic CME Survey

The 2014 update of the Continuing Education and Improvement Section of the Group on Educational Affairs (GEA) and the AAMC Medical Education Cluster.

Q&A Case Study

Case Studies - Q&A

The local community hospital setting

A medical school utilizes a local community hospital as a teaching site for students. That community hospital has its own CME office. If a teaching faculty wants to utilize the new Learning from Teaching to be awarded AMA PRA Category 1 Credit™, should the paperwork be submitted through the school of medicine CME office, or from the CME office within the community hospital?

Since it is your medical school and medical students, the medical school CME office should attest to and award the credit. Further, given that the program is truly a medical school/academic function, and since the faculty belong to the medical school, not—as faculty—to the community hospital, the medical school CME office should in all probability handle this credit. However, if circumstances dictate that the community hospital CME division take this on—that is acceptable as well.

Teaching students and residents

If the faculty member ALSO oversees residents (the local community hospital also has an internal medicine and family medicine residency), should the UME teaching go through the medical school and the GME teaching through the community hospital?  That seems burdensome to the faculty to submit to two places. 

Local circumstances may prevail here. On the other hand if your medical school wants to undertake the vetting of both kinds of teaching, this could be construed as a gesture of cooperation, thus relieving the hospital of the burden. Also, since most of the teaching and prep would be done for both the students and residents together, such as morning rounds, case conferences, etc., it makes sense to assure the credit under one rubric—the medical school.

NOTE: The key here is that the CME office has final sign-off on the validity of the learning.

Teaching residents and students together

If a faculty member teaches medical students and residents together in the same setting (a lecture, for example, or on ward rounds), can he or she claim credit for both?

It should be made very clear that they can only claim credit through one of the programs. Since when students and residents are together it is because the vast majority of the time the students are added to the resident’s activities and not the other way around, it would seem that the CME provider accredited for the GME program should be the one responsible for the CME credit.

The primary care preceptor

Primary Care providers often set time aside for discussion of a topic related to a special interest on the part of the student or to a patient seen at a previous visit. In that example, if I had spent time preparing for that conversation by researching the topic and had learned in the process, then I would have been able to claim credit under this new guidance. I would not be able to claim credit for a student following me around for several hours and observing me or for providing the student with feedback on the way to conduct an interview or perform a part of the physical exam all based on my accumulated experience over the years.

That is correct.

The longitudinal integrated curriculum

At this site, each preceptor spends a half day with a student each week for 20 weeks. If a preceptor indicates ALL of those hours (about 80) for precepting a student during a semester, instead of indicating the prep time only, should that time be worth 160 credits of AMA PRA Category 1 Credit™?

That is possible. Here again, credit is only awarded if the physicians learns something which he/she then applies in the precepting situation. This is probably best calculated on a half-daily basis rather than over the entire 20 week period. Out of that 20 week period, if the preceptor believes he/she has learned and applied that learning in half of those sessions, then he or she would indeed be eligible for 80 credits.

Five hours of prep; one hour of teaching

You are asked to lecture third-year medical students on common infectious diseases in infants. You prepare for your presentation by reviewing six peer-reviewed publications focused on new infectious disorders in infants; culling your related saved publications and abstracts on the topic; reviewing your prior power point presentations, updating where necessary. This preparation takes a total of five hours. Your actual teaching, which provokes a standing ovation, takes one hour. Of the six hours devoted to preparation for and teaching of the topic, how many AMA PRA Category 1 Credits™ would you claim for "learning from teaching"?

2 credits (2 x 1 hour of teaching)

The rusty teacher

You discover that you are a bit rustier than you thought when a question related to the coagulation cascade was raised by a pediatric resident during morning report or other teaching rounds setting. You listened to the discussion, added the little you remembered, and informed the group that the topic should be pursued the following morning. You spend one hour researching the topic that evening, and the following morning, devote 15 minutes during rounds to teach what you felt the "students" should know about the cascade and hope they learned during your 15 minutes presentation. Of the 1.25 hours devoted to preparing for and the actual conduct of the teaching about the coagulation cascade, how many AMA PRA Category 1 Credits™ would you claim for the learning you experienced?

0.5 credits (2 x 15 minutes of teaching)

A community-based member of the voluntary faculty

A community-based member of the voluntary faculty participates as a preceptor for students rotating through his office practice. The assigned student spends two hours thrice weekly: 1) taking, recording, and presenting histories to the preceptor; 2) observing the preceptor perform a physical examination; 3) listening to the preceptor discuss the patient's illness, formulate a diagnosis, and develop a plan of therapy; and 4) writing up one of the cases seen. The preceptor taught by example, learned nothing new about the patients' illnesses, and may have learned something about the art of teaching (self-learned). Of the six hours/week spent in a preceptor role, how many AMA PRA Category 1 Credits™ can the preceptor legitimately apply for or designate?

This vignette demonstrates the unlikely scenario of the faculty member truly learning nothing in preparation for, or as follow-up to, his teaching/precepting experience. If this were indeed the case, he receives NO credit for learning.