Editorials

Evidence-Based CME

Am Fam Physician. 2002 Jul 15;66(2):200-202.

The American Academy of Family Physicians (AAFP), through its Commission on Continuing Medical Education (COCME), is again taking a leadership role in the area of continuing medical education (CME). Unique among specialties, the AAFP has always accredited specific CME programs using input and reviews by family physicians to guarantee relevance. At the beginning of this year, a new process to grant credit for evidence-based CME was instituted.

Evidence-based medicine (EBM) is defined as the integration of current best research evidence with clinical expertise and patient values.1 Evidence-based CME, referred to as EB CME, will include key practice recommendations (points that are intended to change physician behaviors) that are substantiated from approved evidence-based sources in which all the trials on the topic have been systematically identified, appraised, and summarized according to predetermined criteria. Some sources of EBM, including Web sources approved by the AAFP, were listed in an article published in American Family Physician earlier this year.2

Although physicians are not required to earn a designated number of EB CME credit hours, this type of CME will provide additional value to physician learners because they will be assured that practice recommendations made in an EB CME activity will be the result of a systematic review of all available best evidence.

The other categories of AAFP-accredited CME are changing slightly as well. Prescribed credit will be approved for customary and generally accepted medical practice as long as there is AAFP-member involvement in developing the CME activity. Otherwise, elective credit will be offered. Elective credit will be assigned to topics that are not evidence-based or customary and generally accepted medical practice and that are not dangerous to patients. The majority of CME materials that cover topics in complementary and alternative practices will fall into this category. Dangerous interventions are those in which risks substantially outweigh benefits to patients and are not suitable for CME.

As in the practice of medicine, the integration of EBM into CME poses challenges. Systematic reviews of the evidence may not be available on some topics. These topics will not be eligible for EB CME credit but will not be excluded from CME programming. As always, physician learners must use critical thinking skills to determine what is in the best interests of patients.

While the quality and availability of evidence may raise concerns, CME providers and faculty should have the goal of presenting the highest possible level of clinical information to allow physicians to make informed decisions about patients' care. By using an EBM approach to CME, gaps in clinical research can be identified and will stimulate further research in areas lacking adequate evidence.

The COCME has developed a process of continuous improvement that will evaluate new EBM sources and add to the list of approved sources as appropriate; feedback from providers will be ongoing, and outcome measurements to assess the effectiveness of EB CME will be conducted.

The goal of this ongoing process will be to improve the quality of CME that physicians obtain. The next challenge will be to link quality EB CME to changes in physician behavior in caring for patients and measuring patient care improvement as a result of EB CME.

The changes in the system to grant EB CME will be the first small steps in the long overdue process of linking CME and physician behavior. In the spirit of lifelong learning and continuous professional development, we welcome input from CME providers and physician learners.

Timothy Komoto, M.D., is chair of the Commission on Continuing Medical Education, American Academy of Family Physicians, Leawood, Kan.

Nancy Davis, Ph.D., is director of the Division of Continuing Medical Education, American Academy of Family Physicians, Leawood, Kan.

Address correspondence to Timothy Komoto, M.D., American Academy of Family Physicians, 11400 Tomahawk Creek Pkwy, Leawood, KS 66211-2672.

REFERENCES

1. Sackett DL, Rosenberg MC, Muir Gray JA, et al. Evidence-based medicine: how to practice and teach EBM. 2d edition. London, England: Churchill Livingstone; 2000.

2. Siwek J, Gourlay ML, Slawson DC, Shaughnessy AF. How to write an evidence-based clinical review article. Am Fam Physician. 2001;65:251–8.

editor's note: The editors of American Family Physician applaud the AAFP's launch of the new evidence-based medicine category of continuing medical education (EB CME). In support of this effort, we invite authors to submit clinical review articles designed to qualify for EB CME. If the article is accepted, we will provide a special notation to designate it as qualifying for EB CME (see page 297 for AFP's first EB CME clinical review article). Instructions for such articles appear on the journal's Web site (www.aafp.org/afp/authors) as well as the AAFP COCME's Web site (www.aafp.org/cme/accreditation/CMEAindex.xml). Simply stated, articles will qualify for EB CME if they present practice recommendations supported by evidence that has been systematically reviewed by an AAFP-approved source.

 

Copyright © 2002 by the American Academy of Family Physicians.
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