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CONTINUING MEDICAL EDUCATION
AND THE ACADEMY
By Allen McDaniels, M.D., San Pedro, California
ABSTRACT
From its inception, the foundation
of the American Academy of Medical Acupuncture (AAMA) has been
firmly laid on the cornerstones of highest standards in professional
education, training, teaching, and clinical practice. As acupuncture
becomes integrated into Western medical training with a more comprehensive
approach to health care, the soundness of these cornerstones are
likely to be tested. In order to bear the weight of institutional
growth, specialty authority, and professional accountability into
the 21st century, this foundation must be reinforced by the Academy's
ability to grant continuing medical education credit. This paper
outlines the past, present, and future plans of the Academy in
becoming a CME-sponsoring institution.
KEY
WORDS
Acupuncture Education, Continuing Medical
Education, Certification of Credit, Accreditation, CME-Sponsor
INTRODUCTION
A Brief History of the Academy as an Educational Institution
Part of the Academy's original mission
stated: "To strengthen and maintain standards of practice of medical
acupuncture by establishing, supporting, or influencing the quality
of acupuncture educa-tion of physicians; upgrading the quality
of acupuncture teaching; arranging international teaching exchanges;
identifying appropriate standards of medical acupuncture practice;
and encouraging the study of acupuncture by physicians" (1). This
formal statement grew from the seed idea of the Academy even before
its incorporation.
In A.D. 353, 42 scholars met at the"Orchid
Pavilion," a site with steep cliffs, luxuriant forests, ele-gant
bamboo, and a clear, gushing stream. Here, they vied with each
other in composing poetry; they drew on nature and each other
for inspiration and creative energy. The Orchid Pavilion-gathering
established an ideal for literary meeting that has been heeded
and celebrated in China, Korea, and Japan ever since (2). The
Academy aspired to become a contemporary "Orchid Pavilion in the
Bamboo Forest," where physician-scholars would gather to teach
and be taught.
As the AAMA grew in membership, with
its special needs for continuing medical education (C.M.E.) in
both content and faculty, the requirement to have more control
over its own destiny became apparent by the mid-90s. Continuing
education requirements for initial full or associate membership
and renewal irrevocably linked the Academy with medical education.
CME-sponsorship of the Academy's educational activities by other
medical institutions has effectively worked for several years,
especially for the Annual Symposium. However, future sponsorship
may be subject to changing academic climate, personnel turnover,
or other unforeseen consequences. A far-sighted president and
board of directors resolved to pursue the path of Academy accreditation
as a CME-sponsoring institution.
This decision also grew out of the membership's
priorities for Academy objectives. Overwhelmingly, the highest
priority of a 1998 membership survey was to offer programs for
continuing education (3). The board intuitively pursued this at
the time it determined to pursue accreditation.
CME:
WHAT IS IT?
The American Medical Association (AMA)
defines continuing medical education as "...educational activities
that serve to maintain, develop, or increase the knowledge, skills,
and professional performance and relationships a physician uses
to provide services for patients, the public, or the profession.
The content of C.M.E. is the body of knowledge and skills generally
recognized and accepted by the profession as within the basic
sciences, the discipline of clinical medicine, and the provision
of health care to the public" (4).
The definition of a formal activity for
the Physician's Recognition Award (PRA) category 1 credit is "...a
formally planned activity...that meets all accreditation standards
and covers a specific subject area that is scientifically valid,
and for which the learning activity is appropriate in depth and
scope for the intended physician audience and stated learning
objectives" (5).
It is necessary to distinguish between
accreditation, validating the process of education, and certification
of subject area; different institutions oversee each.
Certification of educational subject
areas is the purview of the American Medical Association. Certification
pertains to the scientific validity of the specific subject area.
By inference, a scientifically valid subject area would be within
the basic sciences, the discipline of clinical medicine, and the
provision of health care to the public, if it were: 1) validated
by basic research, 2) validated by clinical research, 3) taught
in medical schools, 4) practiced by significant numbers of otherwise
qualified physicians (6).
This contention was made to the AMA,
which agreed that acupuncture is a suitable subject for category
1 credit. The AMA, thereby, certified the subject area by stating:
"In summary, the [CME Advisory] committee
and the AMA believe that acupuncture is a suitable subject for
the designation of AMA PRA Category 1 credit, provided that techniques
taught are supported by recognized and generally-accepted evidence
that the procedures are efficacious and safe for the use intended...
The widely available NIH consensus statement (NIH consensus Development
Conference on Acupuncture, November, 1997) provides useful guidance
as to acceptable subject matter" (7).
Acceptance of acupuncture by the AMA
as a suitable subject for CME credit establishes another milestone
on the Academy's road to incorporate medical acupuncture into
a more comprehensive approach to health care.
The purpose of accreditation is to assure
physicians and the public that CME activities meet accepted standards
of education. Accreditation is thc recognition accorded eligible
institutions and organizations that meet the requirements of the
Essentials, Guidelines and Standards for Accreditation of Sponsors
of Continuing Medical Education (8).
It refers to the educational process;
the sponsor's demonstrated ability to plan and implement CME activities
in an overall program of continuing medical education, the scope
of the Accreditation Council for Continuing Medical Education
(A.C.C.M.E.). A brief discussion follows on the essential requirements
for accreditation as a CME sponsor.
ESSENTIALS
AND STANDARDS
Essential No. 1
The Sponsor shall have a written statement
of its continuing medical education mission formally approved
by its governing body.
The AAMA's Board of Directors, in 1997,
adopted the follow-ing mission for its continuing medical education
program:
"The American Academy of Medical Acupuncture,
a physician-only professional society, commits itself to a program
of continuing medical education of physicians and other appropriate
professionals in the field of medical acupuncture and related
disciplines. Goals: To encourage physicians to enhance their skills
and knowledge by participating in an active program of continuing
education in medical acupuncture and related disciplines; To assure
that the subject matter, level, and type of instruction, and the
educational objectives of medical acupuncture activities, are
suitable for physicians; To assure that high quality, appropriate
credentials, and teaching methods of faculty of continuing education
activities in medical acupuncture are available to physicians;
To promote to its members those activities reviewed and approved
by the Academy as meeting its requirements for continuing education
credit for membership; To educate physicians and appropriate professionals
in the integration of acupuncture with Western medical training,
and thereby, synthesize a more comprehensive approach to health
care" (9).
Essential No. 2
The sponsor shall have established procedures
for identifying and analyzing continuing medical educational needs
and interests of prospective participants.
In recent months, the CME Committee has
pursued methods that would identify the continuing educational
needs of the Academy's membership. Expert opinions were sought
from nationally-recognized educators, literature reviewers, and
examiners. What did they consider the educational needs of medical
acupuncture practitioners?
The Academy also sent members a survey
questionnaire that included many questions about CME (3). Although
results are pre-liminary and perhaps, only suggestive of thc membership's
true educational needs, a methodology for identifying them has
been established.
Essential No. 5
The sponsor shall evaluate the effectiveness
of its overall continuing medical education program and its component
activities, and use this information in its CME planning.
The CME Committee has recommended to
the Academy's Board of Directors that the planning for educational
activities be systematic and clearly documented (through minutes,
memoranda, letters to faculty, etc.), and that it be linked to
needs assessment, development of objectives, educational design,
evaluation, and improvement of future educational activities.
Committee members believe the implementation of these particulars
are mandatory for the Academy to obtain or maintain CME-granting
privileges. Other ACCME essentials address: explicit objectives
for each CME activity; design and implementation of activities
consistent with the stated objectives; the availability of management
procedures and other necessary resources in order to fulfill the
CME mission; and, the acceptance of responsibility for essentials
being met by CME activities which are jointly sponsored with non-accredited
organizations. Additionally, standards fi)r commercial support
of CME, and for enduring materials (printed, recorded, or computer-assisted
instructional materials) must be adhered to. Essentials and Standards
is the skeleton upon which the flesh of instructional content
and faculty qualifications must be attached.
CURRENT
STATUS OF CME-SPONSORSHIP
In order to reach the goal of CME-sponsorship,
two milestones must be crossed. First is an assurance that medical
acupuncture is a suitable subject for CME Category I credit. As
described above, the American Medical Association thusly recognizes,
with qualifications of scientific validity and faculty credentials;
i.e., medical acupuncture meets criteria of certification of credit.
The second milestone is accreditation. Satisfying the ACCME's
Essentials and Standards, through a formal application and inspection
procedure, is now in progress; accreditation is anticipated within
several continued on next page... months. It is incumbent upon
individuals, chapters, or other groups seeking approval of their
educational activities to be mindful of these requirements for
certification and accreditation. Their pre-sent and future applications
for Academy-sponsored CME (continuing education units, CEU's)
must comply with them.
SUMMARY
From the Academy's conception, it has
been inexorably linked with the training and education of its
physician-members and others. If it is to continue its healthy
growth and development, the time is here for the Academy to become
a CME-sponsor. The suitability of medical acupuncture for CME
category I credit toward the AMA's Physician's Recognition Award
has been acknowledged and documented. The task ahead is to complete
the application and inspection process for ACCME accreditation
of the Academy's educational policies and procedures. This should
be accomplished within the next several months. Hence, the Orchid
Pavilion is well under construction within the Bamboo Forest...
REFERENCES
- American Academy
of Medical Acupuncture. Bylaws of the American Academy of Medical
Acupuncture: a California non-profit mutual benefit corporation
(with amendments as of April 1991). Los Angeles: The Academy 1991.
- Murck A and Fong
W. A Chinese garden court: the Astor Court at the Metropolitan
Museum of Art. New York: The Museum 1985; 22-3.
- American Academy
of Medical Acupuncture. 1998 AAMA membership survey (interim survey
results). Los Angeles: The Academy 1998; 1.
- American Medical
Association. The Physician's Recognition Award: information booklet.
Chicago: The Association May 1, 1996; 7.
- Wentz D. Certification
of credit and the AMA's Physician Recognition Award, understanding
the CME accreditation process, Dec 1996; New Orleans. Chicago:
Accreditation Council for Continuing Medical Education, 1996;
F.
- McDaniels A. Personal
correspondence to Dennis K. Wentz, M.D., Director, Division of
Continuing Medical Education, American Medical Association, March
13, 1998.
- Wentz D. Personal
correspondence to Allen McDaniels, M.D., Chairman, CME Committee,
American Academy of Medical Acupuncture, May 7, 1998.
- Accreditation Council
for Continuing Medical Education. Understanding the CME accreditation
process Dec 1996; New Orleans. Chicago: The Council 1996; C.
- American Academy
of Medical Acupuncture. Mission for con-tinuing medical education
program. Los Angeles: The Academy 1997.
AUTHOR
INFORMATION
Dr. Allen McDaniels is in the private
practice of medical acupuncture in San Pedro, California. He is
the Chairman of the Academy's Continuing Medical Education Committee.
Allen McDaniels,
M.D.
603 W. Sixth Street
San Pedro, California 90731-2325
Phone: 310-548-5935 · Fax: 310-548-8455
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