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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.

Documentation and Certification Process

Aims and Goals

The purpose of Learning from Teaching is to describe and document the formal learning activity that occurs as a result of interacting with, teaching of, and assessing the competence of medical students and residents. Faculty credit for teaching medical students and residents is approved as a type of live activity that may be certified for AMA PRA Category 1 Credit™ if it meets the requirements outlined below. “Learning from Teaching" activities are essentially personal learning projects designed and implemented by the learner with facilitation from the accredited provider—where credit is provided as recognition of the new learning the preceptor documents as a result of addressing a knowledge gap (i.e., clinical knowledge, alternative approaches, communication skills, etc.) and then sharing that new knowledge in the format of teaching students/residents.

Prerequisites

To be certified for AMA PRA Category 1 Credit™, this live activity, institutions must:

  • Be certified as an accredited CME provider (or working in joint sponsorship with an accredited CME provider), AND is accredited by the LCME (to certify teaching medical students), AND/OR the ACGME (to certify teaching residents/fellows), or both.
  • Provide clear instructions to the physicians that define the educational process of the activity, including the expressed willingness on the part of faculty members to document their learning associated with teaching, awareness of and keeping timelines, etc.
  • In addition to the institution being ACGME accredited, the residency/fellowship program itself must also be ACGME accredited in order for faculty to be awarded AMA PRA Category 1 Credit™ for teaching residents/fellows in that program.
  • As with any activity certified for AMA PRA Category 1 Credit™, this type of live activity must also meet all of the AMA core requirements (in addition to the format specific requirements listed above).
  • Employ adequate accredited CME staff to support collection of documentation, vetting of the documentation, and coordination and delivery of credit award back to faculty.

The following credit designation statement should be used:

The [name of accredited CME provider] designates this live activity for a maximum of 2 AMA PRA Category 1 Credit™ per 1 hour of interaction with medical students and/or residents/fellows. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Process

How does an academic medical center CME office participate in the Learning for Teaching Program?

  1. CME providers may communicate the new category of credit to UME and GME planners in their academic medical centers in whatever way is best for them—email, newsletters, etc. They may also communicate this more broadly via AMC-wide channels (e.g., through the dean's or CEO's offices). This would include an invitation on the part of faculty and/or UME/GME leaders to participate.
  2. UME or GME program leads may then follow up with the CME office, indicating if there are faculty members who would benefit from applying for the new AMA PRA Category 1 Credit™.
  3. These faculty members can then be contacted by any of the CME, GME, or UME offices and given instructions about how to document their learning in relationship to UME or GME activities. Documentation of faculty learning may employ forms created in a pilot phase of this initiative or forms created in a similar fashion.
  4. When completed, the documentation form and its content can then be forwarded to these offices for verification—for UME/GME, confirming that UME or GME participation had, in fact, taken place; for CME, confirming that the learning appears appropriate to the goals and gaps identified.
  5. The CME office would then award the appropriate credit(s) and issue the credit certificate, as it would for all participants in any educational process.

May a preceptor physician enter after a block or some period of teaching instead of after each occurrence?

Yes

Are there examples of forms/documentation to help with the awarding the credits?

The AMA does not prescribe any official forms for awarding credit but does prescribe the way the credit must be awarded. It leaves it up to the provider to choose a way to implement the AMA guidance within their specific/unique environment.

Since there is no official form, the AAMC offers several templates useful as tools for those that wish to use them.

Credits

Is there a maximum number of teaching credits that can be issued per faculty?

There is no limit to the amount of credits one can earn under the Learning from Teaching program. Each individual activity will determine the number of credits available to claim for that one activity. Faculty may not receive credit more than once for the same time period, even if the audience involves residents and students from more than one program and even if being verified by two or more different LCME/ACGME programs.

What are the credits ‘for’?

A key concept is that the CME credit being discussed is for learning that is then employed in the teaching setting. It is not credit for teaching. CME credit is not a reward or payment, but rather is a recognition/acknowledgement/metric intended to note that the physician has engaged in an educational activity which serves to maintain, develop, or increase the knowledge, skills, and professional performance and relationships that a physician uses to provide services for patients, the public, or the profession.

The credit applies to learning associated with teaching, NOT to the teaching activity itself.

The phrase “preparation and teach­ing” means that the learning is taking place in the preparation stage for the purpose of teaching. Neither preparation nor teaching alone are sufficient in and of themselves for the purpose of claiming this CME credit. In this interpretation, the time spent with the student, utilizing what the faculty member learned, is the metric used for determining credit. If the physician does not prepare to teach, and therefore does not learn anything, spending time with students or residents by itself is not sufficient to receive credit. Thus, if there is no learning that can be identified in the preparation stage, there is no credit for spending time with students or residents. This is similar to the concept of CME credit for faculty at AMA PRA Category 1 Credit™ activities that has been in place for CME providers since 2006.

Does this type of credit apply to learning clinical material as well as learning educational techniques, (i.e., not just learning about teaching itself)?

Clinical material and educational techniques are both included among the topics that a physician could study and learn about. For example, if the physician identifies a need—such as learning more about inflammatory bowel disease, or ethics, or the appropriate way to give feedback—in order to teach students, the physician's learning could be claimed for CME credit.

Can the awarding of AMA PRA Category 1 Credit be extended to any physicianwhether community-based or institution-based, full or part-time, voluntary, salaried, or unsalaried?

The Learning from Teaching project was intended originally to provide community-based physicians who volunteer to teach at the undergraduate and graduate levels. However, the AMA has not restricted this format to any subset of undergraduate or graduate clinical faculty, salaried or not salaried, community based or otherwise. Learning from Teaching is based on the premise that teachers at these levels acquire knowledge through their teaching activities which, those of us who teach know, involves preparation for and the conduct of the actual live teaching.

How is the credit calculated?

Physician faculty may be awarded credit based on a 2-to-1 ratio to teaching time, i.e., the time spent in discussing/teaching the student or trainee—not preparation time. This makes the metric consistent with the metric for faculty at an AMA PRA Category 1 Credit™ activity. Obviously, if there was no time spent preparing by learning, then there is no credit. To put in another way, the credit is to recognize the learning that occurs as physicians prepare to teach but the credit is calculated based on the time spent using what they learned to teach.

For example, faculty may be awarded two AMA PRA Category 1 Credits™ for one hour spent teaching or 1.5 AMA PRA Category 1 Credist™ for 45 minutes spent teaching. Credits should be rounded to the nearest one-quarter credit.

Again, Faculty may not receive credit more than once for the same time period, even if the audience involves residents and students from more than one program and even if being verified by two or more different LCME/ACGME programs. Examples of a mechanism to accomplish this include, but are not limited to, a list of faculty approved for credit from the UME and/or GME office, or a co-signature by a UME/GME authority on credit documentation/claim forms provided by physician participants.

Will Learning from Teaching format be available for DO credits?

We suggest checking directly with the American Osteopathic Association External Link for confirmation, clarification, or corrections.

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.

More Information

More information on Learning from Teaching



Contact Learning from Teaching Staff

Lisa Howley, PhD, MEd
Senior Director
Strategic Initiatives & Partnerships in Medical Education
lhowley@aamc.org