Effect of COVID-19 on Continuing Education Activities and Learner Interactions: Report from Six Accreditation Systems.

The COVID-19 pandemic has had disruptive effects on all parts of the health-care system, including the continuing education (CE) landscape. This report documents, what has happened in six different CE accreditation systems to CE activities as well as learners. Complete lockdown periods in the first part of the COVID-19 pandemic have inevitably led to reductions in numbers of the then predominant format of education, i.e. onsite in-person meetings. However, with impressive speed CE providers have switched to online educational formats. With regard to learner interactions this has compensated, and in some systems even overcompensated, the loss of in-person educational opportunities. Thus, our data convincingly demonstrate the resilience of CPD in times of a global health crisis and offer important insights in how CPD might become more effective in the future.

Standards for Substantive Equivalency between Continuing Professional Development/Continuing Medical Education (CPD/CME) Accreditation Systems.

The International Academy for Continuing Professional Development Accreditation (IACPDA) is dedicated to advocating for and enhancing the development, implementation and evolution of continuing medical education (CME)/continuing professional development (CPD) accreditation systems throughout the world by providing an opportunity for individuals in leadership positions to (a) learn about the values, principles and metrics of varying CME/CPD accreditation systems; (b) explore the accreditation standards for CME/CPD provider organisations and activities under differing systems; and (c) foster evaluations to measure the impact of CME/CPD accreditation systems on physician learning, competence, performance, and healthcare outcomes. IACPDA has developed a shared set of international standards to guide the accreditation of CME/CPD for medical doctors and healthcare teams globally, which have been adopted in the Cologne Consensus Conference on 10 September 2020. These standards will also be used to determine substantive equivalency between accrediting bodies.

Prescription Rates for Antiplatelet Therapy (APT) in Coronary Artery Disease (CAD) - What Benchmark are We Aiming at in Continuing Medical Education (CME)?

Physicians always aim to improve their patients' health. CME should be designed not only to provide knowledge transfer, but also to influence clinical decision-making and to close performance gaps. In aretrospective study we analysed prescription rates for APT in 254,932 CAD patients (male: 64.4%), treated in atotal of 3,405 practices in 2019 in aDMP in the region of North Rhine, Germany. Analyses were run for the whole study population stratified by sex as well as for subgroups of patients suffering from myocardial infarction/acute coronary syndrome, or who have been treated with percutaneous coronary intervention or bypass surgery. Patients mean age was 72.7 ± 11.2 years (mean ± 1SD), mean duration of DMP participation was 7.2 ± 4.7 years, and mean cumulative number of DMP visits was 27 ± 17. APT prescription rates were 85.0% in male and 78.8% in female CAD patients. In subgroups of male CAD patients APT prescription rates were between 89.7% and 92.8%, in the same subgroups of female CAD patients the corresponding rates were between 87.8% and 92.0%. Rates for amissing APT prescription per practice were between .0044% and .0062% for male and female CAD patients, respectively. Rates for amissing APT prescription per practice and DMP visit were .0002% for both sexes. These results suggest that a DMP can achieve high attainment rates for APT in CAD. To further improve attainment rates, consideration of absolute numbers of eligible patients per practice or physician is probably more appropriate than expression of performance as percentage values. This is especially true if attainment rates show substantial variations between subgroups, if subgroups show substantial variation in size, if attainment rates are already in the magnitude of 80% or higher, and if there are disparities in the evidence base underlying treatment recommendations related to subgroups.

Outcomes in CME/CPD - Special Collection: How to make the "pyramid" a perpetuum mobile.

Continuing medical education (CME) should not be an end in itself, but as expressed in Moore's pyramid, help to improve both individual patient and ultimately community, health. However, there are numerous barriers to translation of physician competence into improvements in community health. To enhance the effect CME may achieve in improving community health the authors suggest a kick-off/keep-on continuum of medical competence, and integration of aspects of public health at all levels from planning to delivery and outcomes measurement in CME.

Regulating for Bias in Medical Education - Reaction to the Pharmaceutical Industry Updated EFPIA Code of Practice.

The European Federation of Pharmaceutical Industries and Associations (EFPIA) representing the pharmaceutical industry operating in Europe, introduced three codes of conduct between 2007 and 2013, which had a common goal of self-regulating interactions with healthcare professionals and patient organisations. This former set of rules was appreciated as a first self-regulatory step, although self-regulation itself is still considered by many stakeholders as insufficient to provide thorough transparency. EFPIA agreed to replace the separate codes with a new, consolidated EFPIA Code of Practice. The consolidated Code was broadened to include a new section on medical education that outlines the scope of member companies' engagement in "medical education activities?. This new section is controversial as it explicitly confirms that EFPIA members can be involved in medical education. In our view "independent Medical Education" per se prevents industry from "organising" events, i.e. industry must not influence content, presentation, choice of lecturers or publication of results. What is more, only events respecting this key principle (amongst others) can be recognised for purposes of continuing medical education/continuing professional development (CME/CPD). A substantial portion of the medical education is currently funded by the pharmaceutical and medical device industries. This practice carries a significant risk to public and personal health, especially if it is not adequately safeguarded by a high standard of accreditation. We are most concerned by the fact that EFPIA, representing the pharmaceutical industry, is trying to broaden the approach to medical education, to include activities that are not independently evaluated as free from undue influence and conflicts of interest. We believe that in order to preserve scientific integrity and independence, pharmaceutical companies must not be granted the right to influence the content of medical education.

The future of accreditation of continuing medical education (CME)-continuing professional development (CPD) in Europe: harmonisation through dialogue and consensus.

In Europe, there are currently some 30 different jurisdictions and no overarching legislation regarding CME-CPD accreditation, since legislative competency related to national health-care systems lies with national authorities. Thus, public demonstration of professional agreement regarding the principles, rules and practice of CME-CPD as well as its accreditation is a highly desirable professional and political objective in Europe, where free movement and freedom to offer professional (medical) services is a key feature of the EU vision of the single market. The newly formed association of independent European accreditors, Continuing Medical Education - European Accreditors (CME-EA) is committed to offering a platform for dialogue between individuals and organisations involved in definition of professional codes in general, and accreditation of CME-CPD in particular on the national level. The aim is to reach a European consensus on principles and rules applied in planning and delivery of CME-CPD. This includes consensus on constituent characteristics of accreditors as well as principles and practice of accreditation.

An Analysis of 2.3 Million Participations in the Continuing Medical Education Program of a General Medical Journal: Suitability, User Characteristics, and Evaluation by Readers.

BACKGROUND: Physicians frequently use continuing medical education (CME) in journals. However, little is known of the evaluation of journal CME by readers and also user and participation characteristics. Deutsches Ärzteblatt, the journal of the German Medical Association, is distributed to every physician in Germany and regularly offers its readers CME articles. Therefore, it provides a unique opportunity to analyze a journal CME program directed at an entire population of physicians. OBJECTIVE: The aim is to show key sociodemographic characteristics of participants, frequency and temporal distributions of participations, and to analyze whether the articles are suitable for a general medical audience, how physicians rate the CME articles, how successful they were in answering simple multiple-choice questions, and to detect distinct clusters of participants. METHODS: Using obligatory online evaluation forms and multiple-choice questions, we analyzed all participations of the entire 142 CME articles published between September 2004 and February 2014. We compared demographic characteristics of participants with official figures on those characteristics as provided by the German Medical Association. RESULTS: A total of 128,398 physicians and therapists (male: 54.64%, 70,155/128,393; median age class 40 to 49 years) participated 2,339,802 times (mean 16,478, SD 6436 participations/article). Depending on the year, between 12.33% (44,064/357,252) and 16.15% (50,259/311,230) of all physicians in the country participated at least once. The CME program was disproportionally popular with physicians in private practice, and many participations took place in the early mornings and evenings (4544.53%, 1,041,931/2,339,802) as well as over the weekend (28.70%, 671,563/2,339,802). Participation by specialty (ranked in descending order) was internal medicine (18.25%, 23,434/128,392), general medicine (16.38%, 21,033/128,392), anesthesiology (10.00%, 12,840/128,392), and surgery (7.06%, 9059/128,392). Participants rated the CME articles as intelligible to a wider medical audience and filling clinically relevant knowledge gaps; 78.57% (1,838,358/2,339,781) of the sample gave the CME articles very good or good marks. Cluster analysis revealed three groups, one comprised of only women, with two-thirds working in private practice. CONCLUSIONS: The CME article series of Deutsches Ärzteblatt is used on a regular basis by a considerable proportion of all physicians in Germany; its multidisciplinary articles are suitable to a broad spectrum of medical specialties. The program seems to be particularly attractive for physicians in private practice and those who want to participate from their homes and on weekends. Although many physicians emphasize that the articles address gaps in knowledge, it remains to be investigated how this impacts professional performance and patient outcomes.

Position paper on current aspects of sponsoring in accredited CME.

This position paper is the result of a collaborative approach of several European Specialty Accreditation Boards (ESABs) and, has been stimulated by their current experience in accreditation regarding roles and responsibilities assumed by sponsors of accredited continuing medical education (CME). The suggestions made in this paper aim to preserve the fundamental principle in CME accreditation that the physician in charge of the programme has sole responsibility for the selection of topics, speakers, content and format, as well as mode of presentation, and that sponsors will under no circumstances interfere with this principle. This is considered as a responsibility of an individual physician (or physicians), which cannot be delegated, even in part, to third parties. This responsibility has been extended to include all communication before and after the event. The paper also identifies undecided issues, about which ESABs are committed to elaborate proposals in the future.

Roles and Responsibilities in the Provision of Accredited Continuing Medical Education/Continuing Professional Development.

The Cologne Consensus Conference 2015 has focused on "Providers in accredited CME[continuing medical education]/CPD [continuing professional development]". As an outcome of the CCC 2015, the authors of this paper, who were part of the faculty, propose a contemporary definition of the roles and responsibilities of stakeholders involved in the different stages of planning, delivery and evaluation of CME/CPD.

European Board for Accreditation in Cardiology (EBAC) 2015 CME/CPD Survey Summary.

In the spring of 2015, the European Board for Accreditation in Cardiology (EBAC) collaborated with International CME/CPD Consulting to design and administer a survey to approximately 1,171 professionals active in the field of European CME/CPD, with a focus on cardiology. With a nearly 5% response rate, the results herewith are non-representative, but do express current behaviours and attitudes of those active in European accredited CME/CPD.

Case management program for patients with chronic heart failure: effectiveness in terms of mortality, hospital admissions and costs.

BACKGROUND: At 360 000 cases annually, heart failure is the most common main diagnosis in adults in German hospitals. Treating heart failure is expensive. This study tested whether patients in the case management program (CMP) "CorBene--Better Care for Patients With Heart Failure" have a lower mortality rate and lower hospital admission and readmission rates than patients receiving regular management. METHOD: Routine data from a large German statutory health insurance company were analyzed. After propensity score matching, a total of 1202 patients (intervention group versus control group) were studied in relation to the endpoint "hospital admission and readmission rate" and the variables "annual physician contact rate," "mortality," and "inpatient treatment costs." RESULTS: The intervention group showed a lower rate of hospital admission/readmission (6.2%/18.9% versus 16.6%/36.0%; p<0.0001 / p = 0.041). Mortality rates did not differ significantly (5.0% versus 6.7%; p = 0.217). Analysis of hospital admission data showed no significant differences between the groups in terms of length of hospital stay or costs for heart failure-related treatment per hospital stay. However, the average annual costs for inpatient treatment in the CMP group, at €222.22 per patient, were 67.5% lower than the equivalent costs in the control group (€683.88) (p<0.0001). CONCLUSION: Fewer patients in the intervention group were admitted and readmitted to hospital, and lower inpatient treatment costs were identified. The physician contact rate was higher than in the control group.

Association of long-term adherence to evidence-based combination drug therapy after acute myocardial infarction with all-cause mortality. A prospective cohort study based on claims data.

PURPOSE: To determine long-term adherence to evidence-based secondary preventive combination pharmacotherapy in survivors of acute myocardial infarction (AMI) and to investigate the association between adherence to recommended therapy and all-cause mortality in claims data. METHODS: Prospective cohort study based on claims data of an 18.75 % random sample of all persons insured with the local statutory health insurance fund AOK Hesse. Study population included patients with hospital discharge diagnoses of AMI between 2001 and 2005 excluding those who died within the first 30 days after AMI or who had been hospitalised with an AMI in the previous 2 years. A total of 3,008 patients were followed up until death, cancellation of insurance, or the end of the study period on 31 December 2007, whichever came first (median follow-up: 4.2 years). RESULTS: Drug adherence to single drug groups as determined by proportion of days covered ≥80 % was 21.8 % for antiplatelet drugs, 9.4 % for beta-blockers, 45.6 % for ACE inhibitors or angiotensin II receptor blockers and 45.1 % for lipid-lowering drugs. A total of 924 (39.7 %) patients met our definition of guideline adherence: Drugs available from three of four relevant drug groups on the same day for at least 50 % of the observation time. Of the patients adhering to the guidelines, 17.3 % died and of the non-adherents, 32.4 % died. All-cause mortality was 28 % lower for guideline-adherent patients than for the non-adherent group (adjusted HR 0.72, 95 % CI 0.60-0.86). CONCLUSIONS: In everyday practice, post AMI patients benefit from guideline-oriented treatment, but the percentage of adherent patients should be improved.

CME in a general medical journal: three-year evaluation of CME in Deutsches Arzteblatt.

PURPOSE: There is a dearth of data regarding journal-based continuing medical education (CME) programs. Deutsches Arzteblatt has been publishing CME articles since 2004. Articles are accompanied by a test on the article's content as well as a readers' evaluation questionnaire. The goal was to find out whether a journal-based CME program can be successfully tailored to a multidisciplinary audience. SUMMARY: This study is an analysis of 706,995 participations (76,486 participants) between September 2004 and August 2007. Main dependent variables were the percentages of correctly answered test questions. Independent variables were subgroups defined by demographic and job-related (e.g., specialty) variables, and characteristics emerging from the participants' evaluations of the articles. On average, 9.55 (SD = 0.82) out of 10 test questions were answered correctly. Significant differences were found between the subgroups, but these were small. Significant intersubgroup differences for difficult questions were larger yet still small in absolute terms. Reader satisfaction was high. CONCLUSIONS: Our results indicate that these articles are suitable for a wide range of physicians. The high percentage of correct answers reflects the understanding in Germany that CME questions should not mimic examinations but rather check whether readers have read the article attentively.

Long-term effects of a multimodal behavioral intervention on myocardial perfusion--a randomized controlled trial.

BACKGROUND: Recent advances in drug therapy question as to the additional impact behavioral interventions may have on the prognosis of patients with clinically stable coronary heart disease (CHD). PURPOSE: The aim of the study was to evaluate the effects of a multimodal, behavioral intervention on myocardial perfusion (MP) and cardiac events, compared to standardized cardiologic care, in patients with stable CHD. METHODS: Seventy-seven CHD patients (age 54.2 +/- 6.9 years, male 87%) were randomly assigned to a behavioral intervention plus standardized cardiologic care (INT, n = 39) or standardized cardiologic care alone (CO, n = 38). MP was assessed by (201)Thallium MP-scintigrams (SPECT) at baseline, after 2, 3, and 7 years, respectively. Subsequent cardiac events (MI, PCI, CABG) were assessed using the cardiologists' charts. RESULTS: Sixty-five patients (84%) completed the study. In all patients, the course of MP was significantly better in INT analysis of variance (ANOVA group x time p = 0.001); this was also true for patients without subsequent PCI/CABG (ANOVA group x time p = 0.002). Incidence of cardiac events was significantly associated with INT (6 vs. 14; log rank test p = .047). CONCLUSION: The study suggests additional long-term benefits of a behavioral intervention on myocardial perfusion and cardiac events in patients with stable CHD compared to standardized cardiologic care only.

[How long do doctors need to read a paper in specialist journals presenting accredited continuing medical education (CME)?]. / Determinanten für die Bearbeitungszeit von zertifizierter Fortbildung in Printmedien.

BACKGROUND AND PURPOSE: In Germany, 45 min of continuing medical education (CME) are awarded 1 credit point. It was the aim of this study to assess the time amount needed to read a CME article in a wide variety of specialist journals. MATERIAL AND METHODS: All CME articles in 18 specialist journals presented in 2004 were analyzed, which had all used the same evaluation form provided by the Chamber of Physicians North Rhine (65,393 evaluation forms of 12,587 participants). RESULTS: There was only a weak linear relationship between the time needed to read an article and the number of characters as a measure of length of the text. Duration of reading was more closely related to the amount of new data presented and was inversely related to duration of professional activity and clinical experience, but, on the other hand, age was positively related to very long reading times. Reading times also increased with the number of articles read, up to the fourth article. Day of the week and hour of the day revealed no influence on reading time. CONCLUSION: The time amount needed to read a CME article is mainly determined by factors which are relevant in terms of clinical experience, while the length of the article is only of minor importance. Thus, the number of credit points awarded for reading CME articles should be based on direct assessment of reading time.