Continuing Physician Professional Development

Quality improvement and continuing medical education

Product quality and continuous improvement have been a part of manufacturing since the 1920s. These same concepts have also been accepted by the health care industry and have led to many improvements in patient care. The AMA's Division of Continuing Physician Professional Development (CPPD) also employs quality improvement (QI) modeling in its approach to changes to the AMA Physician Recognition Award (AMA PRA) system.

This approach for improvement is grounded in QI and, more specifically, the process of PDSA (plan, do, study, act) cycles. The AMA PRA system, established in 1968, has undergone change throughout the past 44 years in an attempt to remain a valued metric for physician continuous learning. Starting in the 1990s, CPPD began to use a pilot project and PDSA approach with many of the requirements that are part of the AMA PRA system. All improvements to the AMA PRA system are authorized by the AMA Council on Medical Education, which uses data from pilot projects and quality cycles to guide its decision-making.

Currently CPPD has three pilot projects under way:

• In 2011, the Association of American Medical Colleges (AAMC) approached the AMA with a proposal to recognize as AMA PRA Category 1 Credit™ the learning that occurs when faculty teach medical students and residents, since such credit is more generally accepted than AMA PRA Category 2 Credit™. In 2013, the AMA expects to receive data from an AAMC pilot project involving 20 medical schools nationwide—data that may indicate that the proposed change is warranted.

• A second pilot project aims to study learning that occurs during clinical guideline development and deployment at the local clinical level. Do these activities involve new learning for physicians? Should this type of learning be recognized as having value to the development of the individual physician learner? The PDSA cycle for this pilot will help determine the value of learning and identify opportunities to emphasize evidence-based medicine.

• Finally, the AMA is concerned with the transparency of the sources of clinical treatment recommendations taught during certified live CME activities. In 2010, a task force was convened to consider whether disclosure of these sources should be required at certified live activities. The PDSA approach in this case will consist of multiple pilot cycles, each building on one another, so that any recommendations that emerge will have been tested on a range of accredited provider programs with a range of clinical topics.

The PDSA and QI framework in these examples serves a valuable purpose. Changes to the AMA PRA system should occur with thoughtfulness, thoroughness, and rigor. The QI philosophy works to focus attention on the specific acts of planning changes, trying changes, studying the results, and acting upon those results in ways that promote lifelong learning and keep the AMA PRA credit system authentic and valuable.

AMA weighs in on the "Sunshine Act" before Senate committee

Earlier this year, AMA President Jeremy Lazarus, MD, participated in a roundtable discussion on implementation of the "Physician Payments Sunshine Act" held by the Senate Special Committee on Aging. The legislation, enacted as part of the Affordable Care Act, requires pharmaceutical and device companies to report payments and transfers of value they make to health care providers.

The AMA supports efforts to increase transparency and approved of the final Sunshine Act language after important modifications were made. At the same time, Dr. Lazarus expressed some of the AMA's concerns with the proposed implementing regulations, urging that CMS take action in the final rule to:

• Restructure the dispute resolution process and require industry to provide physicians with ongoing access to reports and establish a neutral arbiter to resolve disputes.
• Make clear that certified continuing medical education is not subject to the Sunshine Act and is excluded from reporting.
• Ensure accurate and fair reporting.
• Allocate adequate time—six months—to conduct outreach and education on the final rule to physicians.

Dr. Lazarus' statement for the record, as well as statements of the other roundtable participants, are available online.