Q: Can CME credits be awarded to participants who are not physicians?
A: All individuals who have completed an Allopathic (MD), Osteopathic (DO) or an equivalent medical degree from another country can be awarded AMA PRA Category 1 Credit™.
For non-physician health professionals and other professionals the activity is designated for AMA PRA Category 1 Credit™ and they need to consult their accrediting body to see if they accept.
Q: Can a physician earn AMA PRA Category 1 Credit™ for teaching at a CME activity? If so, how much credit?
A: Accredited CME providers may choose to award AMA PRA Category 1 Credit™ to faculty for the learning that occurs in the preparation of an original presentation as part of an AMA PRA Category 1 Credit™ live activity. The formula for granting such credit is 2 AMA PRA Category 1 Credits™ per participant credit (or a 2:1 ratio). Like other AMA PRA Category 1 Credits™ awarded based on time metrics, credit can be designated in 15 minute increments. No credits are given for repeat presentations of the same material, it is the responsibility of the physician to only claim the credit once, and credit may not be simultaneously earned as both a presenter and learner.
Currently, D-H does not have a way to properly document the learning that is done while preparing an original set of educational materials to meet the ACCME requirements. Therefore, at this time the only way to claim "teaching credit" is to apply directly to the AMA by completing the Direct Credit Application.
For serving as faculty for other types of non-promotional educational activities physicians may claim AMA PRA Category 2 Credit™.
Since 2010-11, continuing education leaders have made a number of strategic changes to the academic focus and financial management of the CME and CNE programs at Dartmouth-Hitchcock (D-H)/Geisel School of Medicine at Dartmouth (Geisel). These improvements are designed to help D-H and Geisel provide distinctive education and research in continuing education while also addressing core strategies to improve population health, provide value-based care, and reduce cost. The CME and CNE programs are interdisciplinary and inter-professional. They promote team learning and knowledge creation, best pedagogical and assessment practices, and are offered in a safe social-cultural learning environment. We hope the following information answers questions about strategic changes.
Q: How and why has the focus in the CME/CNE Offices shifted in the past two years to academic and accreditation requirements, including outcomes research, rather than event planning?
A: The “old” continuing education methods and systems do not meet clinicians’ needs for effective professional development to meet contemporary licensure, credentialing and practice expectations. Following the 2011 approval by the D-H Trustee Research and Education Subcommittee of the strategic plan to improve continuing education, the Associate Dean for CME and Director of CME, in collaboration with the Chief Nursing Officer, transitioned the focus and priority of the CME and CNE Offices to clinicians’ academic accreditation needs rather than event planning. They endorsed strategies to support maintenance of licensure (MOL) and certification (MOC) and centralized the tracking of D-H accredited activities’ income and expenses as well as education outcomes assessments. Simultaneously they decentralized the event planning function for those activities. CNE event management was placed under the Center for Nursing Excellence. CME event planning was placed within the department or section where the activity originates. The event management change was not significant for most areas because the majority of event planners were already department-based. These changes were announced in March 2012 and executed during Fiscal Year 2013.
Q: What are some of the strategies to support Clinicians’ MOL and MOC?
A: The CLPD will soon offer clinicians new methods to earn and track credits for approved performance improvement activities that meet the American Board of Medical Specialties’ MOC Part IV requirements. A new, online system, launched in Fall 2013, will facilitate this tracking.
Q: What are the free, central academic and accreditation resources now available through CLPD?
A: A key feature of the new focus is that the CME/CNE Offices now provides all Activity Directors and Nurse Planners with a free central resource for all CME and CNE activities’ online registration, marketing, commercial grant application submission, evaluation, assessment, and academic transcript services.
Q: Why does financial management of continuing education flow through D-H as opposed to Geisel, or are both D-H and Geisel involved, and, if so, how?
A: A mutual decision was made in 2010-11 to transition the financial management of the CME/CNE Offices, which is a shared cost center under long-term subvention agreement between D-H and Geisel, to D-H because the learners/target audience is primarily physicians, nurses and other clinicians who are D-H along with Geisel clinical faculty and preceptors, employees across the D-H health system, as well as regional clinicians critical to D-H’s referral base. Accreditation of new academic activities for these clinicians flows through the D-H system with the Continuing Medical Education associate dean and director serving as members of the D-H Clinic. These individuals have formal academic appointments and a direct relationship with the Dean of the Geisel School of Medicine to satisfy Association of American Medical Colleges’ (AAMC)-mandated and Liaison Committee for Medical Education (LCME) requirements. In this capacity the CME/CNE leaders and staff support the Dean’s academic priorities, for example, implementation of the new medical school curriculum and alignment with the Dean’s faculty development initiatives. The Continuing Nursing Education director is a member of the D-H Center for Nursing Excellence and a Mary Hitchcock Memorial Hospital employee. The D-H Chief Nursing Officer funds the CNE Office. The alignment of the Medicine and Nursing educators in the CME/CNE Office promotes team learning and inter-professional practice.
Q: What is the difference between the D-H and Geisel accounting systems and why can’t “residual funds” be rolled forward at the end of the fiscal year?
A: There is a critical difference between the D-H and Geisel accounting systems because the organizations are distinct financial entities. D-H is a not-for-profit hospital on an accrual system in which each account, including continuing education, closes at the end of every fiscal year and residual funds must flow into the general ledger. Geisel is a not-for-profit, private medical school and part of a university on a fund accounting system that must close its accounts each year but allows the rollover of certain accounts’ funds.
Q: How will tuition be handled in the future?
A: Tuition fees will be a minimal fee of not less than $25 for a one day activity for D-H employees and Geisel clinicians-employees and emeriti faculty. The tuition fees ultimately depend on the pedagogical design of the activity to meet learners’ needs and the justifiable budget for the activity. Tuition fees must be paid online by credit card. Accounts Payable will no longer process internal transfers of registration fees. Individuals must pay online with a credit card and then seek reimbursement, if appropriate.
Q: Does the reduced tuition apply to all accredited CME and CNE activities and when do the new tuition fees become effective?
A: The reduced tuition fee for D-H and Geisel clinician-employees and emeriti faculty applies to D-H accredited, solely D-H-sponsored activities that are held on-site only. If the activity will take place off-site, then the registration fee should be increased appropriately to cover additional expenses associated with outside venues (hotels, conference centers, etc.). These tuition changes will be phased in during Fiscal Year ‘14 and will be required for any activity with a start date after December 31, 2013. These tuition changes will help clinicians meet growing licensure and certification demands while reducing administrative staff time to transfer internal funds.
Q: What is different if a CME Activity Director or CNE Nurse Planner wants an outside non-accredited organization/institution to be a “Joint Provider” of an activity rather than D-H or Geisel being sole provider of the activity?
A: Activity Directors and Nurse Planners who wish to offer CME credit or CNE contact hours in collaboration with outside (non-Dartmouth) groups must use a D-H contract from D-H Legal Counsel and obtain signatures from outside parties to codify the relationship including financing, accreditation, and indemnification. The protocols for Joint Providers are as follows:
- A standard D-H contract needs to be created and signed by all parties.
- A Joint Providership fee will be charged for CME accreditation (as we do not “give away” Dartmouth Academic credit at no cost).
- A $20 per attendee fee will be charged to cover the CME/CNE Office services (online registration, marketing, commercial grant application submission, evaluation, assessment and academic transcript services) to the non-Dartmouth organization.
- Postage will be charged to the conference as an expense and not absorbed as an institutional expense.
- The Joint Provider may keep a percentage of a positive net balance and will be responsible for paying a percentage of a negative net balance.
Q: Are there any additional costs or guidelines for a CME/CNE activity if an outside conference meeting management company is used.
A: Activity Directors and Nurse Planners who wish to use an outside conference meeting management company to run the logistics of their activity must adhere to the following:
- A standard D-H contract needs to be created and signed by all parties.
- All income and expenses must be processed through the D-H Finance Department.
Q: What must an Activity Director or Nurse Planner do when budgeting for an activity so as to have the activity covered financially by D-H in the event of a negative net balance?
A: In a progressive collaboration between D-H Finance, the CNO, the Associate Dean for CME, the CME and CNE directors, D-H will underwrite all important, properly planned, formally approved, and solely D-H sponsored continuing education activities. Such activities must have robust needs assessments, address clinical practice gaps, use effective teaching and assessment methods, and show reasonable budgets.
- A budget template is available for event coordinators to use when submitting budgets. The template includes appropriate income and expense items. Its use is strongly encouraged.
- Activity Directors, Nurse Planners and their event coordinators should present a budget that: (1) demonstrates modest meals and modest other expenses, and (2) estimates income from tuitions, Exhibitors and Grantors (with itemized details). Budgets should not include line items for internal event coordinators (and their regular or overtime hours). If inappropriate expenses are included in the Final Accounting submitted to the CME/CNE Offices after the activity, the Finance Department will reclassify these expenses back to departmental accounts.
- Only expenses directly related to the educational activity should be included in the activity budget.
- Budgets should be monitored throughout the planning and execution process and adjustments made, if possible, if it appears that expenses are going over budget because of low enrollments, reduced Commercial Grant Support or reduced Exhibit Fees. Please notify the CME or CNE Accreditation Manager if there are concerns about problems such as these.
- Registration fees for non-D-H/Geisel employees should be at least $25 per credit hour for CME and at least $15 per contact hour for CNE.
- D-H/Geisel faculty, per the D-H Honorarium Policy, cannot be paid to teach in a Dartmouth accredited activity.
- Non-D-H/Geisel faculty can be paid a modest honorarium at “fair market value” as well as appropriate travel and lodging expenses.
- All institutional policies, including financial and Conflict of Interest COI policies must be followed in execution of the budget and event.
Q: Can a department or section receive a grant (commercial support) for a Regularly Scheduled Series?
A: Yes, however, the department or section should apply for these funds using the department’s annual educational needs assessment and a pre-planned schedule for the series, done in advance, without the commercial supporters’ input, and without speakers who are on a speakers’ bureau. Additionally, the department/section must have an official Letter of Agreement with the Commercial Supporter signed in advance of the activity/series
Q: Where do we deposit a grant from a Commercial Supporter for a Regularly Scheduled Series?
A: The funds must be deposited into the central CLPD department number with an assigned project number for the activity and all expenses must be paid from the same department number and project number by the department/section.
Note: As a reminder, these funds must be completely spent down within the same fiscal year in which they are received.
Q: Can Activity Directors and Nurse Planners apply for Exhibit Fees from a Vendor?
A: Yes, at this time, Exhibit Fees can be sought to underwrite an accredited Live Activity (Conference, Symposium, Workshop etc.). Concerned individuals, both faculty and administrators, have proposed to the Organizational Ethics Committee that D-H prohibit commercial exhibitors on its properties in association with accredited educational activities. If, and when, this topic is discussed in the future, the CME Advisory Committee and other faculty, Activity Directors and Nurse Planners will be given an opportunity to comment.
Q: What is considered a jointly provided activity?
A: A D-H department that works with a non-ACCME accredited provider, non-ANCC accredited/approved provider to produce a learning activity. Please contact the CME Office regarding joint-providership fees.
Q: How do I document Assessment of Learner Needs?
A: Continuing medical education activities are developed in response to, and with consideration for, the unique educational needs of the target audience. Activity files must contain the method and documentation of the needs assessment. A variety of methods may be used to conduct a needs assessment including but not limited to:
- continuing review of changes in quality of care as revealed by medical audit or other patient care reviews
- ongoing census of diagnoses made by physicians on staff
- advice from authorities of the field or relevant medical societies
- formal or informal requests or surveys of the target audience faculty or staff
- discussion in departmental meetings
- data from peer-reviewed journals, government sources, consensus reports
- review of board examinations and/or re-certification requirements
- new technology methods of diagnosis/treatment
- legislative regulatory or organizational changes affecting patient care
- Joint Commission Patient Safety Goal Competency
Q: What are the required disclosures for enduring materials?
A: The following content must be displayed on the CME learning activity prior to the learner engaging in the activity:
- The Accreditation Statement and Credit Designation Statement. The number of credits will be assigned by a CME officer.
If the format of the learning activity is blended, combining online and face-to-face learning, two credit designation statements may be necessary to delineate the enduring material from the live activity.
- Dartmouth-Hitchcock Medical Center (DHMC) logo.
- Learning objectives
- Faculty, their full names with degrees, and academic and professional titles.
- Disclosure of conflicts of interest by faculty and planning committee members, if any, or lack thereof.
- Type of media or combination of media used for learners to successfully complete the learning activity (ex: Internet, CD-ROM, text, Windows Media Player, video).
- Method of physician-learner participation in the learning process (ex: watching video, reading web pages, keeping journal entries, completing post-tests).
- Estimated time to complete the educational activity (same as number of designated credits).
- Dates (month and year) of original release and most recent review or update, if applicable. This is essential.
- Termination date (date after which enduring material is no longer certified for credit). CME accredited Internet learning activities are accredited for three years only and must be updated during the third year in order to be reaccredited for another three year period.
- Hardware/systems requirements for learner to participate in activity.
- Provider contact information for questions regarding accreditation of the activity:
Center for Learning and Professional Development
Dartmouth-Hitchcock Medical Center
- Evaluation of Internet learning activity.
- Policy on privacy and confidentiality - inform the learner about the policy on privacy and confidentiality that relates to the CME activity on the Internet.
Confidentiality of Records
Q: At our conference, we would like to distribute a list of participant names and contact info to all who attend. Is this permitted?
A: Since the names of participants and their contact info is confidential information, it is permitted only if you secure approval before the conference from the individuals whose names are on the list. The registration form might include a question asking for this approval and providing an "opt out" checkbox for those who wish to deny permission.