AOA Continuing Medical Education

Delores J. Rodgers

doi:10.7556/jaoa.2004.104.11.493

This article provides an update on trends in osteopathic continuing medical education (CME) programs and details several changes to CME requirements for state licensure. Additionally, this article explains changes to several policies of the American Osteopathic Association (AOA) with regard to the Association's awarding and recording of CME credits, additional avenues for members who wish to obtain CME credit hours, and the terminology used to define the Association's key CME requirements and CME sponsor–accreditation process.

CME: Meeting and Exceeding Expectations

The Council on Continuing Medical Education (CCME) believes that there should be a two-tiered system of total CME requirements. The first tier is required to maintain membership in the AOA. The second tier is used to demonstrate to patients and evaluative bodies (ie, hospital and university boards) the commitment of participating physicians to continued learning. Physicians who obtain 150 hours of CME credit in a 3-year CME cycle are recognized and rewarded by the Council and the Association by being granted an AOA Certificate of Excellence in CME (Figure).¹

Figure.

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Currently, the AOA assigns CME credits as being from one of four categories: 1-A, 1-B, 2-A, and 2-B (Table 1). In general, Category 1 is osteopathic (AOA) CME credit; Category 2 credit is nonosteopathic CME credit; A credit is granted for formal, didactic courses; B credit is for less formal CME activities such as hospital committee work and reading the scientific content in JAOA—The Journal of the American Osteopathic Association in conjunction with completing THE JOURNAL's CME quizzes.

Table 1

American Osteopathic Association Categories and Types of Continuing Medical Education Credits Awarded

	Type
Category	A - Formal	B - Less Formal
1 - Osteopathic	1-A	1-B
2 - Nonosteopathic	2-A	2-B

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Table 1

American Osteopathic Association Categories and Types of Continuing Medical Education Credits Awarded

	Type
Category	A - Formal	B - Less Formal
1 - Osteopathic	1-A	1-B
2 - Nonosteopathic	2-A	2-B

As with all general models, there are exceptions to the rules. One exception is that all approved standardized life support courses receive Category 1-A credit, regardless of whether the course is taught by an osteopathic CME sponsor. Another exception is that formal osteopathic CME programs that do not meet the Association's quality guidelines for osteopathic content are awarded Category 2-A credit, not Category 1-A credit. A more extensive description of the categorization of CME can be found in Table 2. More detailed information is available from the Association's Division of CME at http://do-online.osteotech.org/index.cfm?PageID=cme_main.

Table 2

American Osteopathic Association (AOA) Continuing Medical Education (CME) Program, 2004–2006: Categories and Requirements for CME Credits Awarded in Three-Year Cycle *

	Hour Requirement
Category and Content	Mandatory	Optional^†
▪ Category 1
□ Category 1-A	30	90
— Formal education programs sponsored by AOA-accredited CME sponsors
— Osteopathic medical teaching
— AOA-accredited standardized life support courses
— CME on the Internet (maximum: 9 hours)
— Risk management and managed care programs (AOA sponsored, clinical in nature and meet the faculty requirement for AOA Category 1-A CME credit)
— Bioterrorism programs that are AOA accredited (face-to-face)
— Bioterrorism programs that are accredited by the Accreditation Council for Continuing Medical Education (ACCME) or approved by the American Academy of Family Physicians (AAFP) (face-to-face; maximum: 4 hours)
— Standardized Federal aviation courses (aviation medicine and flight surgeon primary course)
— Federal programs (for participants who are on active duty in the US military or are employed by a uniformed service)
— Grand rounds (when submitted as a “series of programs,” as opposed to being submitted on a lecture-by-lecture basis)
□ Category 1-B	90
— Development and publication of scientific papers and electronically communicated programs intended for physician education
— Osteopathic preceptoring (maximum: 60 hours)
— Conducting osteopathic health care facility inspections, college inspections, and osteopathic postdoctoral training institution inspections, and administering certifying board examinations
— Passing an AOA recertification examination or a Certificate of Added Qualifications examination (maximum: 15 hours)
— Attendance at committee and departmental meetings for the review and evaluation of patient care at either an osteopathic or allopathic institution
— CME on the Internet (real-time interactive simultaneous conferencing CME)
— Reading the JAOA and/or its supplements and passing a JAOA CME quiz^‡
— Faculty development programs (AOA sponsored)
— Managed care programs (if the faculty requirement is not met)
— Risk management programs (administrative in nature)
— Federal programs
— Journal reading (scientific journals approved by the AOA Council on CME (CCME) and passing the respective CME quiz with a minimum grade of 70%)
— Test construction committee work (specialty boards)
— Postgraduate in-service examination committee work (specialty boards)
— Other osteopathic CME activities approved by the AOA's CCME
▪ Category 2
□ Category 2-A	90
— Formal educational programs that are designed to enhance clinical competency and improve patient care that are sponsored by entities who meet the quality standards of the AOA, the ACCME, or the AAFP
— CME on the Internet (real-time interactive simultaneous conferencing CME)
— Risk management and managed care programs (clinical in nature, ACCME sponsored and AAFP approved)
— Bioterrorism programs that are ACCME accredited or AAFP approved (face-to-face)
□ Category 2-B	90
— Journal-type CME on the Internet
— Home study
— Scientific exhibit preparation and presentation
— CME on the Internet
— Risk management programs (administrative in nature)
— Other CME activities approved by the AOA's CCME
Total CME requirement	120^§

*Source: Continuing Medical Education Guide: American Osteopathic Association, 2004-2006, and AOA Board of Trustee actions.Material that is new since the publication of this Journal's Osteopathic Medical Education 2003 issue¹ is indicated in boldface.

†Optional requirements listed in this table are interchangeable. One may select 90 additional hours from any of the four CME credit types given and in any combination, as long as the mandatory 30-hour requirement for Category 1 credit hours is met.

‡The JAOA—The Journal of the American Osteopathic Association grants 2 hours of Category 1-B CME credit to osteopathic physicians who complete quizzes on the scientific content in the Journal and its supplements. To apply for CME credit, AOA members who are registered users of DO-Online can take the JAOA CME quizzes online (http://do-online.osteotech.org/index.cfm?PageID-cme_main). Alternatively, readers can place their answers to the quiz on the JAOA CME Quiz Application Form answer sheet that accompanies each issue of the Journal and mail the completed form with their AOA number only to the Division of CME.

§Physicians who obtain 150 hours of CME credit in a 3-year CME cycle are recognized and rewarded by the Council and the Association by being granted an AOA Certificate of Excellence in CME.

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Table 2

American Osteopathic Association (AOA) Continuing Medical Education (CME) Program, 2004–2006: Categories and Requirements for CME Credits Awarded in Three-Year Cycle *

	Hour Requirement
Category and Content	Mandatory	Optional^†
▪ Category 1
□ Category 1-A	30	90
— Formal education programs sponsored by AOA-accredited CME sponsors
— Osteopathic medical teaching
— AOA-accredited standardized life support courses
— CME on the Internet (maximum: 9 hours)
— Risk management and managed care programs (AOA sponsored, clinical in nature and meet the faculty requirement for AOA Category 1-A CME credit)
— Bioterrorism programs that are AOA accredited (face-to-face)
— Bioterrorism programs that are accredited by the Accreditation Council for Continuing Medical Education (ACCME) or approved by the American Academy of Family Physicians (AAFP) (face-to-face; maximum: 4 hours)
— Standardized Federal aviation courses (aviation medicine and flight surgeon primary course)
— Federal programs (for participants who are on active duty in the US military or are employed by a uniformed service)
— Grand rounds (when submitted as a “series of programs,” as opposed to being submitted on a lecture-by-lecture basis)
□ Category 1-B	90
— Development and publication of scientific papers and electronically communicated programs intended for physician education
— Osteopathic preceptoring (maximum: 60 hours)
— Conducting osteopathic health care facility inspections, college inspections, and osteopathic postdoctoral training institution inspections, and administering certifying board examinations
— Passing an AOA recertification examination or a Certificate of Added Qualifications examination (maximum: 15 hours)
— Attendance at committee and departmental meetings for the review and evaluation of patient care at either an osteopathic or allopathic institution
— CME on the Internet (real-time interactive simultaneous conferencing CME)
— Reading the JAOA and/or its supplements and passing a JAOA CME quiz^‡
— Faculty development programs (AOA sponsored)
— Managed care programs (if the faculty requirement is not met)
— Risk management programs (administrative in nature)
— Federal programs
— Journal reading (scientific journals approved by the AOA Council on CME (CCME) and passing the respective CME quiz with a minimum grade of 70%)
— Test construction committee work (specialty boards)
— Postgraduate in-service examination committee work (specialty boards)
— Other osteopathic CME activities approved by the AOA's CCME
▪ Category 2
□ Category 2-A	90
— Formal educational programs that are designed to enhance clinical competency and improve patient care that are sponsored by entities who meet the quality standards of the AOA, the ACCME, or the AAFP
— CME on the Internet (real-time interactive simultaneous conferencing CME)
— Risk management and managed care programs (clinical in nature, ACCME sponsored and AAFP approved)
— Bioterrorism programs that are ACCME accredited or AAFP approved (face-to-face)
□ Category 2-B	90
— Journal-type CME on the Internet
— Home study
— Scientific exhibit preparation and presentation
— CME on the Internet
— Risk management programs (administrative in nature)
— Other CME activities approved by the AOA's CCME
Total CME requirement	120^§

*Source: Continuing Medical Education Guide: American Osteopathic Association, 2004-2006, and AOA Board of Trustee actions.Material that is new since the publication of this Journal's Osteopathic Medical Education 2003 issue¹ is indicated in boldface.

†Optional requirements listed in this table are interchangeable. One may select 90 additional hours from any of the four CME credit types given and in any combination, as long as the mandatory 30-hour requirement for Category 1 credit hours is met.

‡The JAOA—The Journal of the American Osteopathic Association grants 2 hours of Category 1-B CME credit to osteopathic physicians who complete quizzes on the scientific content in the Journal and its supplements. To apply for CME credit, AOA members who are registered users of DO-Online can take the JAOA CME quizzes online (http://do-online.osteotech.org/index.cfm?PageID-cme_main). Alternatively, readers can place their answers to the quiz on the JAOA CME Quiz Application Form answer sheet that accompanies each issue of the Journal and mail the completed form with their AOA number only to the Division of CME.

§Physicians who obtain 150 hours of CME credit in a 3-year CME cycle are recognized and rewarded by the Council and the Association by being granted an AOA Certificate of Excellence in CME.

Current Requirements: CME Program Cycle, 2004–2006

As announced in THE JOURNAL's Osteopathic Medical Education 2003 issue,¹ the AOA Board of Trustees (BOT) approved an updated CME requirement for Association membership at its February 2003 meeting. At that time, the BOT set the requirement for AOA membership in the 2004–2006 CME cycle at 120 credit hours with a minimum of 30 hours dedicated to earning AOA Category 1-A credits. No waiver for this 120-hour requirement will be granted unless due cause or inability to obtain hours is demonstrated to the CCME. The remaining 90 hours of the 120-hour requirement may be obtained by completing and/or combining CME credits from any of the four categories (ie, 1-A, 1-B, 2-A, or 2-B). A maximum of 60 hours of Category 1-B preceptoring may be applied to the 120-hour requirement.

For those physicians who have specialty board certification through the AOA, of the total 120-hour requirement for CME credits, 50 hours must be earned in CME activities related to the primary specialty field in either Category 1 or Category 2—though the total CME requirement for physicians certified by the American Osteopathic Board of Family Physicians is higher, at 150 hours per 3-year CME cycle.² Failure to fulfill this CME requirement may result in loss of AOA specialty board certification.

Continuing medical education requirements are reduced according to a proration schedule based on the date when the osteopathic physician joins the AOA after the beginning of the current, 3-year CME cycle. The CCME considers exemptions, reductions, and waivers to its CME requirements on a case-by-case basis. Again, the CCME will grant no waivers without due cause or inability to obtain hours unless policy advises otherwise.

The current CME cycle began on January 1, 2004, and ends on December 31, 2006. All AOA members, other than those exempted, are required to participate in the CME program and to meet specified CME credit hour requirements for the 2004–2006 CME cycle.

State CME Requirements

Many state licensing boards believe that CME is an important component for their physicians to guarantee statewide quality assurance in medical care. A total of 43 states have established CME requirements to qualify for relicensure (Table 3). In fact, since November 2003, two states (Idaho and Nebraska) have joined the majority of state osteopathic licensing boards in establishing CME requirements for physicians practicing in those states during the 2004–2006 CME cycle.

Table 3

Continuing Medical Education (CME) Requirements by State *

State	CME Requirement
Alabama	12 hours of Category 1 credit per year
Alaska	17 hours of Category 1 credit (American Osteopathic Association [AOA] or American Medical Association [AMA]) per year.
	As of January 1, 2005: 25 hours of Category 1 credit (AOA or AMA) per year
Arizona	20 clock-hours of Category 1-A credit annually from attendance at AOA-approved educational programs (must present evidence of attendance)
Arkansas	20 hours of Category 1 or 2 credit (AOA or AMA) annually
California	150 hours of Category 1 or 2 credit (AOA or state board approved) per 3-year period — 60 hours must be Category 1 credit for active license
	Prior to December 31, 2006: 12 hours Category 1 or 2 credit in the following topic areas: pain management and treatment of terminally ill and dying patients. This is a one-time requirement. ^†
Colorado	None
Connecticut	None
Delaware	40 hours of Category 1 credit (AOA or AMA) every 2 years
District of Columbia	None^‡
Florida	40 hours of Category 1 or 2 credit biennially — 20 hours must be Category 1 credit (AOA or AMA^§) relating to the practice of osteopathic medicine or under osteopathic auspices; course credits are mandated in each of the following topic areas^¶ and require “nonlive/participatory” course attendance^//: domestic violence (1 hour), Florida state laws and rules (1 hour), risk management (1 hour), and prevention of medical errors (2 hours). Two alternative topic areas are also available: end-of-life care (1 hour) or palliative care (1 hour).
Georgia	40 hours of Category 1 credit (AOA or AMA) over 2 years
Hawaii	None
Idaho ^¶	As of January 1, 2005: 40 hours practice relevant to Category 1 credit every 2 years
Illinois	150 hours of Category 1 or 2 credit per prerenewal period — 60 hours must be obtained through formal, Type A CME programs; 90 remaining hours may be obtained through informal, Type B CME programs or activities
Indiana	None
Iowa	40 hours of Category 1 credit (AOA or AMA) biennially, which must include training for identifying and reporting abuse.
	For licensees who regularly provide primary health care to children: 2 hours of training in child abuse identification and reporting in the previous 5 years. For licensees who regularly provide primary health care to adults: 2 hours of training in dependent adult abuse identification and reporting in the previous 5 years. For licensees who regularly provide primary health care to adults and children, separate courses of 2 hours each as outlined above or a combined 2-hour course that includes curricula for identifying and reporting child abuse and dependent adult abuse in the previous 5 years.
	Fees and CME credits prorated to facilitate renewal process.
Kansas	150 hours of Category 1 or 2 credit per 3-year period
Kentucky	60 hours of Category 1 or 2 credit over 3 years — 30 hours must be Category 1 credit (AOA or AMA); 2 hours must be in the area of HIV/AIDS
Louisiana	20 hours of Category 1 credit (AOA or AMA) per year
Maine	100 hours of state board—approved CME credit per 2-year period — 40 hours must be AOA Category 1-A credit (AOA) for the following practice areas: family practice, family medicine, general practice, and internal medicine; 40 hours of Category 1 CME credit in designated specialty area for specialists
Maryland	50 hours of Category 1 or 2 credit (AOA or AMA) every 2 years for unlimited license renewal
Massachusetts	100 hours of credit per 2-year period — 40 hours must be Category 1 credit (AOA or AMA) and should include 10 hours of risk management; remaining 60 hours can be Category 2 credit
Michigan	150 hours of credit over 3 years — 60 hours must be AOA Category 1 credit; 90 hours must be Category 2 credit
Minnesota	75 hours of Category 1 credit (AOA or AMA) per 3-year period
Mississippi	40 hours of AOA Category 1-A credit or AMA Category 1 credit biennially
Missouri	50 hours of Type A credit (AOA or AMA) every 2 years
Montana	None
Nebraska ^¶	50 hours Category 1 credit (AOA or Accreditation Council on Continuing Medical Education [ACCME]) every 2 years
Nevada	35 hours of AOA Category 1-A credit per year OR 35 hours of ACCME Category 1 credit per year — 10 hours minimum of Category 1 credit
New Hampshire	150 hours of Category 1 or 2 credit per 3-year period — 60 hours must be Category 1 credit (AOA or AMA)
New Jersey	100 hours of Category 1 or 2 credit (AOA or AMA) every 2 years
New Mexico	Active membership in AOA OR 75 hours of Category 1 credit (AOA or AMA) per 3-year period
New York	None
North Carolina	150 hours of Category 1 or 2 credit (AOA or AMA) per 3-year cycle — 60 hours must be Category 1 credit
North Dakota	60 hours of Category 1 credit (AOA or AMA) per 3-year period
Ohio	100 hours of Category 1 or 2 credit over a 2-year period — 40 hours must be AOA Category 1 credit
Oklahoma	16 hours of AOA Category 1-A credit per year — 1 hour must be in the area of proper prescribing of controlled dangerous substances
Oregon	None
Pennsylvania	100 hours of Category 1 or 2 credit (AOA or ACCME) every 2 years — 20 hours must be AOA Category 1 credit; 10 hours must be in the area of patient safety and/or risk management
Rhode Island	60 hours of Category 1 credit per 3-year period — 2 hours must be in the area of blood-borne infections
South Carolina	40 hours of Category 1 credit (AOA or AMA) every 2 years
South Dakota	None
Tennessee	50 hours of Category 1 credit (AOA or AMA) per 2-year period
Texas	24 hours of Category 1 credit (AOA or AMA) per 1-year period — 1 hour must be in the area of ethics and/or professional responsibility
Utah	40 hours of Category 1 credit (AOA or ACCME) every 2 years
Vermont	30 hours of Category 1 or 2 credit per 2-year period — 12 hours must be Category 1 credit
Virginia	60 hours of Category 1 or 2 credit within the 2 years immediately preceding renewal — 30 hours must be Category 1 credit, 15 hours of which must be earned in a face-to-face, interactive setting
Washington	150 hours of Category 1 or 2 credit every 3 years — 60 hours must be Category 1 credit
West Virginia	32 hours of Category 1 or 2 credit (AOA or state society—approved) — 16 hours must be AOA Category 1 credit; 2 hours must be in the area of end-of-life care, including pain management (must present evidence of attendance)
Wisconsin	30 hours of Category 1 credit (AOA or AMA) every 2 years prior to registration
Wyoming	None

*Source: AOA Division of State and Socioeconomic Affairs: AOA US Osteopathic Licensure Summary, August 2004.Material that is new since the publication of this Journal's Osteopathic Medical Education 2003 issue¹ is indicated in boldface.Osteopathic physicians should verify the material reported here with their state licensing boards. The information provided in this table is reported annually to the American Osteopathic Association (AOA) directly from each state licensing board and is compiled here for the convenience of AOA members. The exact wording provided by the state licensing boards is preserved in this table where possible. The AOA takes no responsibility for changes to state guidelines made immediately prior to publication or errors in reporting from state licensing boards.

† Osteopathic physicians licensed in the state of California are exempt from the new one-time requirement if their primary specialty is either pathology or radiology.

‡ The District of Columbia has no CME requirements for physicians in continuous practice.

§ Florida limits the number of CME credit hours osteopathic physicians can obtain from AMA-approved sources to 13 hours.

¶ Florida dropped the requirement for osteopathic physicians to obtain CME credits in HIV/AIDS and managed care as of the 2004-2006 CME cycle.

// Florida dropped the requirement for osteopathic physicians to attend face-to-face participatory courses in favor of attendance at “nonlive/participatory” courses.

¶ Idaho and Nebraska added CME requirements for its licensed physicians as of the current 2004-2006 CME cycle. Previously, there were no state CME requirements in either Idaho or Nebraska.

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Table 3

Continuing Medical Education (CME) Requirements by State *

State	CME Requirement
Alabama	12 hours of Category 1 credit per year
Alaska	17 hours of Category 1 credit (American Osteopathic Association [AOA] or American Medical Association [AMA]) per year.
	As of January 1, 2005: 25 hours of Category 1 credit (AOA or AMA) per year
Arizona	20 clock-hours of Category 1-A credit annually from attendance at AOA-approved educational programs (must present evidence of attendance)
Arkansas	20 hours of Category 1 or 2 credit (AOA or AMA) annually
California	150 hours of Category 1 or 2 credit (AOA or state board approved) per 3-year period — 60 hours must be Category 1 credit for active license
	Prior to December 31, 2006: 12 hours Category 1 or 2 credit in the following topic areas: pain management and treatment of terminally ill and dying patients. This is a one-time requirement. ^†
Colorado	None
Connecticut	None
Delaware	40 hours of Category 1 credit (AOA or AMA) every 2 years
District of Columbia	None^‡
Florida	40 hours of Category 1 or 2 credit biennially — 20 hours must be Category 1 credit (AOA or AMA^§) relating to the practice of osteopathic medicine or under osteopathic auspices; course credits are mandated in each of the following topic areas^¶ and require “nonlive/participatory” course attendance^//: domestic violence (1 hour), Florida state laws and rules (1 hour), risk management (1 hour), and prevention of medical errors (2 hours). Two alternative topic areas are also available: end-of-life care (1 hour) or palliative care (1 hour).
Georgia	40 hours of Category 1 credit (AOA or AMA) over 2 years
Hawaii	None
Idaho ^¶	As of January 1, 2005: 40 hours practice relevant to Category 1 credit every 2 years
Illinois	150 hours of Category 1 or 2 credit per prerenewal period — 60 hours must be obtained through formal, Type A CME programs; 90 remaining hours may be obtained through informal, Type B CME programs or activities
Indiana	None
Iowa	40 hours of Category 1 credit (AOA or AMA) biennially, which must include training for identifying and reporting abuse.
	For licensees who regularly provide primary health care to children: 2 hours of training in child abuse identification and reporting in the previous 5 years. For licensees who regularly provide primary health care to adults: 2 hours of training in dependent adult abuse identification and reporting in the previous 5 years. For licensees who regularly provide primary health care to adults and children, separate courses of 2 hours each as outlined above or a combined 2-hour course that includes curricula for identifying and reporting child abuse and dependent adult abuse in the previous 5 years.
	Fees and CME credits prorated to facilitate renewal process.
Kansas	150 hours of Category 1 or 2 credit per 3-year period
Kentucky	60 hours of Category 1 or 2 credit over 3 years — 30 hours must be Category 1 credit (AOA or AMA); 2 hours must be in the area of HIV/AIDS
Louisiana	20 hours of Category 1 credit (AOA or AMA) per year
Maine	100 hours of state board—approved CME credit per 2-year period — 40 hours must be AOA Category 1-A credit (AOA) for the following practice areas: family practice, family medicine, general practice, and internal medicine; 40 hours of Category 1 CME credit in designated specialty area for specialists
Maryland	50 hours of Category 1 or 2 credit (AOA or AMA) every 2 years for unlimited license renewal
Massachusetts	100 hours of credit per 2-year period — 40 hours must be Category 1 credit (AOA or AMA) and should include 10 hours of risk management; remaining 60 hours can be Category 2 credit
Michigan	150 hours of credit over 3 years — 60 hours must be AOA Category 1 credit; 90 hours must be Category 2 credit
Minnesota	75 hours of Category 1 credit (AOA or AMA) per 3-year period
Mississippi	40 hours of AOA Category 1-A credit or AMA Category 1 credit biennially
Missouri	50 hours of Type A credit (AOA or AMA) every 2 years
Montana	None
Nebraska ^¶	50 hours Category 1 credit (AOA or Accreditation Council on Continuing Medical Education [ACCME]) every 2 years
Nevada	35 hours of AOA Category 1-A credit per year OR 35 hours of ACCME Category 1 credit per year — 10 hours minimum of Category 1 credit
New Hampshire	150 hours of Category 1 or 2 credit per 3-year period — 60 hours must be Category 1 credit (AOA or AMA)
New Jersey	100 hours of Category 1 or 2 credit (AOA or AMA) every 2 years
New Mexico	Active membership in AOA OR 75 hours of Category 1 credit (AOA or AMA) per 3-year period
New York	None
North Carolina	150 hours of Category 1 or 2 credit (AOA or AMA) per 3-year cycle — 60 hours must be Category 1 credit
North Dakota	60 hours of Category 1 credit (AOA or AMA) per 3-year period
Ohio	100 hours of Category 1 or 2 credit over a 2-year period — 40 hours must be AOA Category 1 credit
Oklahoma	16 hours of AOA Category 1-A credit per year — 1 hour must be in the area of proper prescribing of controlled dangerous substances
Oregon	None
Pennsylvania	100 hours of Category 1 or 2 credit (AOA or ACCME) every 2 years — 20 hours must be AOA Category 1 credit; 10 hours must be in the area of patient safety and/or risk management
Rhode Island	60 hours of Category 1 credit per 3-year period — 2 hours must be in the area of blood-borne infections
South Carolina	40 hours of Category 1 credit (AOA or AMA) every 2 years
South Dakota	None
Tennessee	50 hours of Category 1 credit (AOA or AMA) per 2-year period
Texas	24 hours of Category 1 credit (AOA or AMA) per 1-year period — 1 hour must be in the area of ethics and/or professional responsibility
Utah	40 hours of Category 1 credit (AOA or ACCME) every 2 years
Vermont	30 hours of Category 1 or 2 credit per 2-year period — 12 hours must be Category 1 credit
Virginia	60 hours of Category 1 or 2 credit within the 2 years immediately preceding renewal — 30 hours must be Category 1 credit, 15 hours of which must be earned in a face-to-face, interactive setting
Washington	150 hours of Category 1 or 2 credit every 3 years — 60 hours must be Category 1 credit
West Virginia	32 hours of Category 1 or 2 credit (AOA or state society—approved) — 16 hours must be AOA Category 1 credit; 2 hours must be in the area of end-of-life care, including pain management (must present evidence of attendance)
Wisconsin	30 hours of Category 1 credit (AOA or AMA) every 2 years prior to registration
Wyoming	None

*Source: AOA Division of State and Socioeconomic Affairs: AOA US Osteopathic Licensure Summary, August 2004.Material that is new since the publication of this Journal's Osteopathic Medical Education 2003 issue¹ is indicated in boldface.Osteopathic physicians should verify the material reported here with their state licensing boards. The information provided in this table is reported annually to the American Osteopathic Association (AOA) directly from each state licensing board and is compiled here for the convenience of AOA members. The exact wording provided by the state licensing boards is preserved in this table where possible. The AOA takes no responsibility for changes to state guidelines made immediately prior to publication or errors in reporting from state licensing boards.

† Osteopathic physicians licensed in the state of California are exempt from the new one-time requirement if their primary specialty is either pathology or radiology.

‡ The District of Columbia has no CME requirements for physicians in continuous practice.

§ Florida limits the number of CME credit hours osteopathic physicians can obtain from AMA-approved sources to 13 hours.

¶ Florida dropped the requirement for osteopathic physicians to obtain CME credits in HIV/AIDS and managed care as of the 2004-2006 CME cycle.

// Florida dropped the requirement for osteopathic physicians to attend face-to-face participatory courses in favor of attendance at “nonlive/participatory” courses.

¶ Idaho and Nebraska added CME requirements for its licensed physicians as of the current 2004-2006 CME cycle. Previously, there were no state CME requirements in either Idaho or Nebraska.

Recent CME Activities at the AOA

CME Records Online—The DO-Online Web Site

Osteopathic physicians can view an updated CME activity report (CAR) at any time through the DO-Online Web site (see http://do-online.osteotech.org). Continuing medical education activity reports for the previous cycle will be kept online for at least 1 year after the end of that cycle (eg, reports for the 2004–2006 cycle will be archived on the site through 2007). However, only those physicians who are AOA members and registered DO-Online users will be able to review their CARs online. Access to the DO-Online.org Web site is a free benefit to all AOA members.

The AOA has always maintained the CAR as a private document. However, physician-members can download the CAR as a hard copy or attach it to an e-mail sent by the AOA to a third party as specified by the physician-member. The AOA only releases the CAR to outside agencies on written request by the physicianmember. Through DO-Online, the AOA will continue to maintain the confidentiality of this information, but individual physician-members have the added convenience of forwarding this information at their discretion.

The CCME continues to believe that all CME activity should be audited. Therefore, physician-members will not be allowed to enter or update their CME records online and should continue to submit their update requests for CME credit directly to the Association's Division of CME. Physician-members are still encouraged to address such correspondence and requests to the following address: American Osteopathic Association, Attn: Division of CME, 142 E Ontario St, Chicago, IL 60611-2864.

AOA Publications

▪ JAOA

In February 2004, the BOT approved granting CME credit to osteopathic physicians who take part in the peer review process for articles submitted to THE JOURNAL.

The BOT also adjusted the number of credit hours granted to osteopathic physicians who author papers submitted to and accepted by THE JOURNAL for publication. The distribution of credit hours for each type of submission accepted by THE JOURNAL (eg, original contribution, clinical practice article, letter to the editor) were reevaluated by the CCME and adjusted either upward or downward to better coordinate with the goals of the JAOA and the osteopathic profession. For example, while credit hours granted to authors of original contributions were raised to the highest level offered, credit hours for other types of submissions were lowered to better reflect the relative value of that type of contribution to THE JOURNAL and the effort required of the author(s) in the creation of it.

▪ The Whole Patient

The BOT approved granting osteopathic physicians 1 hour of AOA Category 1-B credit when osteopathic physicians read The Whole Patient, complete the accompanying CME quiz, and send it to the AOA's Division of CME.

Further, osteopathic physicians who write and review articles for The Whole Patient will be granted AOA Category 1-B credit in accordance with AOA CME policy.

▪ The DO

The BOT approved a resolution for clinically related CME programs that are published in The DO and its supplements and that include a CME quiz. Physician-members will be granted 1 hour of AOA Category 1-B credit if they read the publication, complete the accompanying CME quiz, and send it to the AOA's Division of CME.

Processing Fees for Nonmembers

The AOA grants Category 1-B credit for Accreditation Council for Continuing Medical Education (ACCME)–accredited or American Academy of Family Physicians (AAFP)–approved CME programs provided that no equivalent osteopathic CME courses are available.

To request AOA Category 1-B credit for ACCME-accredited or AAFP-approved CME programs, physicians must submit the Formal Request for AOA Category 1-B Credit (Non-osteopathic Programs) form (see http://do-online.osteotech.org/pdf/cme_formsnonosteopathiccat1b.pdf) to the AOA's Division of CME. This form allows physicians to request AOA Category 1-B CME credit for allopathic-sponsored CME programs that would usually be granted AOA Category 2-A CME credit. The form must be completed and submitted to the AOA Division of CME along with a copy of the printed program for review by the AOA's CCME, which then submits requests to the appropriate specialty college for review and recommendation. Osteopathic physicians who are active AOA members are not charged for processing and credit conversion. This service is a free AOA member benefit.

As of the February 2004 BOT meeting, however, nonmembers who request this type of CME credit conversion must now pay a $25.00 application fee for each request in addition to a $10.00 processing fee for each program for which they are requesting AOA CCME credit conversion. The Council requests that checks be made payable to the AOA in care of the Division of CME.

Recent CME Quality Enhancements

AOA-Accredited Category 1 CME Sponsors

As previously noted,¹ the Council had an ongoing struggle with the term affiliate organizations and who may apply as an AOA-accredited Category 1 CME sponsor. Because a primary objective of the AOA CME program is to ensure that osteopathic physicians earn at least 30 hours of CME credit based on osteopathic principles and practice—a goal formalized in the new 2004–2006 requirements for Category 1-A credit hours—sponsorship for Category 1-A is limited to recognized osteopathic medical organizations—such as the divisional societies, specialty colleges, acute healthcare facilities, AOA-chartered foundations, and colleges of osteopathic medicine.

Although osteopathic hospitals can no longer apply to be recognized as AOA-accredited Category 1 CME sponsors,¹ hospitals and other organizations currently granted sponsor status will be able to retain this status until either hospital closure or failure to adhere to the accreditation requirements as specified in AOA Accreditation Requirements for Category 1-A CME Sponsors.³ Accredited sponsors have the discretion of allowing other non–AOA-accredited organizations, termed providers, to conduct CME programs under their accreditation status.

There are currently 164 AOA-accredited Category 1 CME sponsors (Table 4). A list of AOA-accredited Category 1 CME sponsors is maintained on the AOA's members'-only Web site in PDF format (see http://do-online.osteotech.org/pdf/cme_sponscat1alist.pdf).

Table 4

American Osteopathic Association (AOA) Accredited Category 1 CME Sponsors (N = 164)

Organization	No. (%) ^*
▪ Affiliates
□ Nonpractice (AOA)^†	...
□ Practice (AOA)	3 (2)
▪ Colleges
□ Colleges of osteopathic medicine (AOA-accredited)	18 (11)
- Alumni groups^†	...
□ Specialty (AOA-affiliated)^†	...
▪ Foundations (AOA-affiliated)^†	6 (4)
▪ Hospitals	54 (33)
▪ Military	2 (1)
▪ Philanthropic organizations (AOA-affiliated)^†	...
▪ Professional associations	1 (< 1)
▪ Societies
□ Divisional (AOA-affiliated)^†	...
□ Specialty	28 (17)
□ State	52 (32)^‡

*Percentages reported were rounded for each type of organization. Therefore, the sum of these percentages may not equal 100%.

†In 2003, the AOA's Board of Trustees approved a resolution regarding who may apply for recognition as an AOA-accredited Category 1 CME sponsor. Applications for sponsorship are currently limited to the organizations indicated.¹

‡The 52 state societies noted include all state societies, county societies, and state district societies (eg, Florida has a state osteopathic medical association, a county association, and two separate district societies: Broward county, District 6; District 7; and Southwest, District 11).

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Table 4

American Osteopathic Association (AOA) Accredited Category 1 CME Sponsors (N = 164)

Organization	No. (%) ^*
▪ Affiliates
□ Nonpractice (AOA)^†	...
□ Practice (AOA)	3 (2)
▪ Colleges
□ Colleges of osteopathic medicine (AOA-accredited)	18 (11)
- Alumni groups^†	...
□ Specialty (AOA-affiliated)^†	...
▪ Foundations (AOA-affiliated)^†	6 (4)
▪ Hospitals	54 (33)
▪ Military	2 (1)
▪ Philanthropic organizations (AOA-affiliated)^†	...
▪ Professional associations	1 (< 1)
▪ Societies
□ Divisional (AOA-affiliated)^†	...
□ Specialty	28 (17)
□ State	52 (32)^‡

*Percentages reported were rounded for each type of organization. Therefore, the sum of these percentages may not equal 100%.

†In 2003, the AOA's Board of Trustees approved a resolution regarding who may apply for recognition as an AOA-accredited Category 1 CME sponsor. Applications for sponsorship are currently limited to the organizations indicated.¹

‡The 52 state societies noted include all state societies, county societies, and state district societies (eg, Florida has a state osteopathic medical association, a county association, and two separate district societies: Broward county, District 6; District 7; and Southwest, District 11).

All AOA-accredited Category 1 CME sponsors are obligated to meet certain requirements to maintain their accreditation status. On an ongoing schedule, the CCME and AOA staff monitor sponsor compliance with the AOA's accreditation requirements³ by spot monitoring CME programs for compliance with AOA policies and the CCME-approved Uniform Guidelines for Accrediting Agencies of Continuing Medical Education.³ Additionally, AOA staff and the CCME investigate all written complaints or deviations from AOA policy using standard complaint review procedures.³

▪ National CME Sponsors Conference

The AOA holds an annual conference, the National CME Sponsors Conference, to provide sponsors with up-to-date information regarding the latest requirements for maintaining their CME accreditation status. The National CME Sponsors Conference is also intended to help sponsors understand the rationale of CCME directives, clarify those directives as necessary, and explain the trends and evolution of the CME environment.

The AOA's 11th Annual National CME Sponsors Conference is scheduled for Thursday, January 6, 2005 through Saturday, January 8, 2005, at the Renaissance Vinoy Resort and Golf Club in St Petersburg, Fla (see http://do-online.osteotech.org/index.cfm?PageID=cme_sponsmain). The theme of the 2005 conference is “CME in a Changing Environment.” The conference agenda will be posted online at the aforementioned site by the end of November.

Revision of the Definition of “Faculty”—Category 1-A CME Faculty Requirement

In February 2004, the AOA's BOT amended the 2003 resolution that a CME conference will be deemed to have met the 50% requirement under the following circumstances (the word paid has been added, as shown in caps):

[If] at least 50% of the total education hours are presented by osteopathic physicians, [allopathic physicians], PhDs, or other professionals with graduate degrees who hold a full-time PAID faculty appointment at a college of osteopathic medicine, or
at least 50% of the presenters are osteopathic physicians, [allopathic physicians], PhDs, or other professionals with graduate degrees who hold a full-time PAID faculty appointment at a college of osteopathic medicine.

This one-word addition to the definition formalized by the Association's CCME at their February 2003 meeting¹ is a refinement of the definition of the term faculty as it appears in the Standards for Osteopathic Category 1-A Programs section of the Accreditation Requirements document, and is intended to further refine the 50% rule established at the 2003 BOT meeting.^1,3

CME Program Trends

The Association's CME program continues to grow annually, as do the number of physician-members with a CME requirement from their state or specialty boards (Table 3). As of October 12, 2004, the number of members with a state- or specialty board–mandated CME requirement is 26,976—a 68% increase from the 1992–1994 CME cycle (Table 5). As of August 2004, the AOA reports its membership numbers at 54,000; therefore, approximately 50% of AOA members now have a state-mandated CME requirement—a 4% increase over last year and the highest percentage reported to date.¹

Table 5

American Osteopathic Association (AOA) Members with a Continuing Medical Education (CME) Requirement

	No. of AOA Members
3-Year Cycle	CME Requirement^*	Dropped from Membership
1973 to 1976^†	...	...
1977 to 1979	10,373	239
1980 to 1982	12,050	159
1983 to 1985	11,881	298
1986 to 1988	12,901	43
1989 to 1991	16,093	159
1992 to 1994	16,040	146
1995 to 1997	19,315	214
1998 to 2000	21,383	219
2001 to 2003^‡	23,770	...
2004 to 2006^§	26,976	...

*The number of AOA physician members who have a CME requirement are those whose state or specialty boards mandate a CME requirement for them to qualify for relicensure.

†Numbers are not reported for the 1973-1976 CME cycle because the program was in its testing phase during those years.

‡Numbers reported for the 2001-2003 CME cycle are current as of September 9, 2003. Data for the number of Association members dropped for a CME deficiency during that cycle will not be available until May 31, 2005.

§Numbers reported for the 2004-2006 CME cycle are current as of September 8, 2004. Data for the number of Association members dropped for a CME deficiency for the 2004-2006 cycle will not be available until May 31, 2008.

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Table 5

American Osteopathic Association (AOA) Members with a Continuing Medical Education (CME) Requirement

	No. of AOA Members
3-Year Cycle	CME Requirement^*	Dropped from Membership
1973 to 1976^†	...	...
1977 to 1979	10,373	239
1980 to 1982	12,050	159
1983 to 1985	11,881	298
1986 to 1988	12,901	43
1989 to 1991	16,093	159
1992 to 1994	16,040	146
1995 to 1997	19,315	214
1998 to 2000	21,383	219
2001 to 2003^‡	23,770	...
2004 to 2006^§	26,976	...

*The number of AOA physician members who have a CME requirement are those whose state or specialty boards mandate a CME requirement for them to qualify for relicensure.

†Numbers are not reported for the 1973-1976 CME cycle because the program was in its testing phase during those years.

‡Numbers reported for the 2001-2003 CME cycle are current as of September 9, 2003. Data for the number of Association members dropped for a CME deficiency during that cycle will not be available until May 31, 2005.

§Numbers reported for the 2004-2006 CME cycle are current as of September 8, 2004. Data for the number of Association members dropped for a CME deficiency for the 2004-2006 cycle will not be available until May 31, 2008.

Interestingly, the type of CME credit recorded by the AOA has also changed over time (Table 6). Earned Category 1-A credit in formal, osteopathic CME programs increased steadily but incrementally from 2.3 million CME hours in the 1992–1994 CME cycle to 2.9 million hours in the 2001–2003 CME cycle. However, earned Category 1-B credit, which is less-formal, nonosteopathic CME credit, has more than doubled from 4.1 million hours in the 1992–1994 CME cycle to 8.6 million hours in the 2001–2003 CME cycle. The CCME is reviewing these data to determine whether they represent a trend or are a matter of definitional changes over time, and the possible causes of such rapid growth in Category 1-B credit.

Table 6

American Osteopathic Association Total Number of Continuing Medical Education (CME) Credits Recorded (in Millions) for Each 3-Year CME Cycle

	CME Credit Category
3-Year Cycle	1-A	1-B	2^*	Total
1973 to 1976	1.3	0.1	1.1	2.5
1977 to 1979	1.4	0.8	0.5	2.7
1980 to 1982	1.5	1.3	0.6	3.4
1983 to 1985	1.5	1.4	0.8	3.7
1986 to 1988	1.8	3.0	1.1	5.9
1989 to 1991	2.2	3.7	1.3	7.2
1992 to 1994	2.3	4.1	1.2	7.6
1995 to 1997	2.5	5.7	1.6	9.8
1998 to 2000	3.0	7.3	1.7	12.0
2001 to 2003	2.9	8.6	1.6	13.0
2004 to 2006^†	...	...	...	1.9

*Numbers reported for CME credit Category 2 includes all Category 2-A and Category 2-B credits recorded.

†The total number reported for the 3-year, 2004-2006 CME cycle is current as of October 21, 2004.

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Table 6

American Osteopathic Association Total Number of Continuing Medical Education (CME) Credits Recorded (in Millions) for Each 3-Year CME Cycle

	CME Credit Category
3-Year Cycle	1-A	1-B	2^*	Total
1973 to 1976	1.3	0.1	1.1	2.5
1977 to 1979	1.4	0.8	0.5	2.7
1980 to 1982	1.5	1.3	0.6	3.4
1983 to 1985	1.5	1.4	0.8	3.7
1986 to 1988	1.8	3.0	1.1	5.9
1989 to 1991	2.2	3.7	1.3	7.2
1992 to 1994	2.3	4.1	1.2	7.6
1995 to 1997	2.5	5.7	1.6	9.8
1998 to 2000	3.0	7.3	1.7	12.0
2001 to 2003	2.9	8.6	1.6	13.0
2004 to 2006^†	...	...	...	1.9

*Numbers reported for CME credit Category 2 includes all Category 2-A and Category 2-B credits recorded.

†The total number reported for the 3-year, 2004-2006 CME cycle is current as of October 21, 2004.

The number of osteopathic physicians whose AOA membership was withdrawn for failure to complete their CME requirement has fluctuated between a low of 43 members in the 1986–1988 CME cycle to a high of 298 members in the 1983–1985 CME cycle. A total of 219 members were dropped from membership on May 31, 2002, for not meeting the 1998–2000 CME requirement. Because Association members are given an 18-month grace period to fulfill requirements from the previous CME cycle, statistics for the 2001–2003 CME cycle will not be available until May 31, 2005.

Similarly, the total number of CME credits recorded by the AOA has increased considerably during each successive 3-year CME cycle (Table 6). This growth is a reflection of the increasing number of AOA members who have a state- or specialty board–mandated CME requirement and the steadily increasing average number of CME credits recorded per member.

Comment

The CCME is committed to an agenda of progress in CME policies, while at the same time maintaining the high standards for which the AOA is known. The Council will continue to study the changing environment of osteopathic medicine and adjust the Association's CME program to respond to the needs of the public, physician-members, and the AOA. The Council encourages members to send suggestions on CME issues to the Council for consideration.

1

Rogers DJ. AOA continuing medical education. J Am Osteopath Assoc. 2003;103:531-538. Available at: http://www.jaoa.org/cgi/reprint/103/11/531 Accessed November 19, 2004.

2

American Osteopathic Board of Family Physicians. Verification and Maintenance of Certification. 2000. Available at: http://www.aobfp.org/verification-cert/index.html. Accessed November 19, 2004.

3

Division of Continuing Medical Education. Accreditation Requirements: Category 1 CME [continuing medical education] Sponsors. Chicago, Ill: American Osteopathic Association; 2004. Available at: http://do-online.osteotech.org/pdf/acc_cmespo.pdf. Accessed November 19, 2004.

Table 1

American Osteopathic Association Categories and Types of Continuing Medical Education Credits Awarded

	Type
Category	A - Formal	B - Less Formal
1 - Osteopathic	1-A	1-B
2 - Nonosteopathic	2-A	2-B

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Table 1

American Osteopathic Association Categories and Types of Continuing Medical Education Credits Awarded

	Type
Category	A - Formal	B - Less Formal
1 - Osteopathic	1-A	1-B
2 - Nonosteopathic	2-A	2-B

Table 2

American Osteopathic Association (AOA) Continuing Medical Education (CME) Program, 2004–2006: Categories and Requirements for CME Credits Awarded in Three-Year Cycle *

	Hour Requirement
Category and Content	Mandatory	Optional^†
▪ Category 1
□ Category 1-A	30	90
— Formal education programs sponsored by AOA-accredited CME sponsors
— Osteopathic medical teaching
— AOA-accredited standardized life support courses
— CME on the Internet (maximum: 9 hours)
— Risk management and managed care programs (AOA sponsored, clinical in nature and meet the faculty requirement for AOA Category 1-A CME credit)
— Bioterrorism programs that are AOA accredited (face-to-face)
— Bioterrorism programs that are accredited by the Accreditation Council for Continuing Medical Education (ACCME) or approved by the American Academy of Family Physicians (AAFP) (face-to-face; maximum: 4 hours)
— Standardized Federal aviation courses (aviation medicine and flight surgeon primary course)
— Federal programs (for participants who are on active duty in the US military or are employed by a uniformed service)
— Grand rounds (when submitted as a “series of programs,” as opposed to being submitted on a lecture-by-lecture basis)
□ Category 1-B	90
— Development and publication of scientific papers and electronically communicated programs intended for physician education
— Osteopathic preceptoring (maximum: 60 hours)
— Conducting osteopathic health care facility inspections, college inspections, and osteopathic postdoctoral training institution inspections, and administering certifying board examinations
— Passing an AOA recertification examination or a Certificate of Added Qualifications examination (maximum: 15 hours)
— Attendance at committee and departmental meetings for the review and evaluation of patient care at either an osteopathic or allopathic institution
— CME on the Internet (real-time interactive simultaneous conferencing CME)
— Reading the JAOA and/or its supplements and passing a JAOA CME quiz^‡
— Faculty development programs (AOA sponsored)
— Managed care programs (if the faculty requirement is not met)
— Risk management programs (administrative in nature)
— Federal programs
— Journal reading (scientific journals approved by the AOA Council on CME (CCME) and passing the respective CME quiz with a minimum grade of 70%)
— Test construction committee work (specialty boards)
— Postgraduate in-service examination committee work (specialty boards)
— Other osteopathic CME activities approved by the AOA's CCME
▪ Category 2
□ Category 2-A	90
— Formal educational programs that are designed to enhance clinical competency and improve patient care that are sponsored by entities who meet the quality standards of the AOA, the ACCME, or the AAFP
— CME on the Internet (real-time interactive simultaneous conferencing CME)
— Risk management and managed care programs (clinical in nature, ACCME sponsored and AAFP approved)
— Bioterrorism programs that are ACCME accredited or AAFP approved (face-to-face)
□ Category 2-B	90
— Journal-type CME on the Internet
— Home study
— Scientific exhibit preparation and presentation
— CME on the Internet
— Risk management programs (administrative in nature)
— Other CME activities approved by the AOA's CCME
Total CME requirement	120^§

*Source: Continuing Medical Education Guide: American Osteopathic Association, 2004-2006, and AOA Board of Trustee actions.Material that is new since the publication of this Journal's Osteopathic Medical Education 2003 issue¹ is indicated in boldface.

†Optional requirements listed in this table are interchangeable. One may select 90 additional hours from any of the four CME credit types given and in any combination, as long as the mandatory 30-hour requirement for Category 1 credit hours is met.

‡The JAOA—The Journal of the American Osteopathic Association grants 2 hours of Category 1-B CME credit to osteopathic physicians who complete quizzes on the scientific content in the Journal and its supplements. To apply for CME credit, AOA members who are registered users of DO-Online can take the JAOA CME quizzes online (http://do-online.osteotech.org/index.cfm?PageID-cme_main). Alternatively, readers can place their answers to the quiz on the JAOA CME Quiz Application Form answer sheet that accompanies each issue of the Journal and mail the completed form with their AOA number only to the Division of CME.

§Physicians who obtain 150 hours of CME credit in a 3-year CME cycle are recognized and rewarded by the Council and the Association by being granted an AOA Certificate of Excellence in CME.

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Table 2

American Osteopathic Association (AOA) Continuing Medical Education (CME) Program, 2004–2006: Categories and Requirements for CME Credits Awarded in Three-Year Cycle *

	Hour Requirement
Category and Content	Mandatory	Optional^†
▪ Category 1
□ Category 1-A	30	90
— Formal education programs sponsored by AOA-accredited CME sponsors
— Osteopathic medical teaching
— AOA-accredited standardized life support courses
— CME on the Internet (maximum: 9 hours)
— Risk management and managed care programs (AOA sponsored, clinical in nature and meet the faculty requirement for AOA Category 1-A CME credit)
— Bioterrorism programs that are AOA accredited (face-to-face)
— Bioterrorism programs that are accredited by the Accreditation Council for Continuing Medical Education (ACCME) or approved by the American Academy of Family Physicians (AAFP) (face-to-face; maximum: 4 hours)
— Standardized Federal aviation courses (aviation medicine and flight surgeon primary course)
— Federal programs (for participants who are on active duty in the US military or are employed by a uniformed service)
— Grand rounds (when submitted as a “series of programs,” as opposed to being submitted on a lecture-by-lecture basis)
□ Category 1-B	90
— Development and publication of scientific papers and electronically communicated programs intended for physician education
— Osteopathic preceptoring (maximum: 60 hours)
— Conducting osteopathic health care facility inspections, college inspections, and osteopathic postdoctoral training institution inspections, and administering certifying board examinations
— Passing an AOA recertification examination or a Certificate of Added Qualifications examination (maximum: 15 hours)
— Attendance at committee and departmental meetings for the review and evaluation of patient care at either an osteopathic or allopathic institution
— CME on the Internet (real-time interactive simultaneous conferencing CME)
— Reading the JAOA and/or its supplements and passing a JAOA CME quiz^‡
— Faculty development programs (AOA sponsored)
— Managed care programs (if the faculty requirement is not met)
— Risk management programs (administrative in nature)
— Federal programs
— Journal reading (scientific journals approved by the AOA Council on CME (CCME) and passing the respective CME quiz with a minimum grade of 70%)
— Test construction committee work (specialty boards)
— Postgraduate in-service examination committee work (specialty boards)
— Other osteopathic CME activities approved by the AOA's CCME
▪ Category 2
□ Category 2-A	90
— Formal educational programs that are designed to enhance clinical competency and improve patient care that are sponsored by entities who meet the quality standards of the AOA, the ACCME, or the AAFP
— CME on the Internet (real-time interactive simultaneous conferencing CME)
— Risk management and managed care programs (clinical in nature, ACCME sponsored and AAFP approved)
— Bioterrorism programs that are ACCME accredited or AAFP approved (face-to-face)
□ Category 2-B	90
— Journal-type CME on the Internet
— Home study
— Scientific exhibit preparation and presentation
— CME on the Internet
— Risk management programs (administrative in nature)
— Other CME activities approved by the AOA's CCME
Total CME requirement	120^§

*Source: Continuing Medical Education Guide: American Osteopathic Association, 2004-2006, and AOA Board of Trustee actions.Material that is new since the publication of this Journal's Osteopathic Medical Education 2003 issue¹ is indicated in boldface.

†Optional requirements listed in this table are interchangeable. One may select 90 additional hours from any of the four CME credit types given and in any combination, as long as the mandatory 30-hour requirement for Category 1 credit hours is met.

‡The JAOA—The Journal of the American Osteopathic Association grants 2 hours of Category 1-B CME credit to osteopathic physicians who complete quizzes on the scientific content in the Journal and its supplements. To apply for CME credit, AOA members who are registered users of DO-Online can take the JAOA CME quizzes online (http://do-online.osteotech.org/index.cfm?PageID-cme_main). Alternatively, readers can place their answers to the quiz on the JAOA CME Quiz Application Form answer sheet that accompanies each issue of the Journal and mail the completed form with their AOA number only to the Division of CME.

§Physicians who obtain 150 hours of CME credit in a 3-year CME cycle are recognized and rewarded by the Council and the Association by being granted an AOA Certificate of Excellence in CME.

Table 3

Continuing Medical Education (CME) Requirements by State *

State	CME Requirement
Alabama	12 hours of Category 1 credit per year
Alaska	17 hours of Category 1 credit (American Osteopathic Association [AOA] or American Medical Association [AMA]) per year.
	As of January 1, 2005: 25 hours of Category 1 credit (AOA or AMA) per year
Arizona	20 clock-hours of Category 1-A credit annually from attendance at AOA-approved educational programs (must present evidence of attendance)
Arkansas	20 hours of Category 1 or 2 credit (AOA or AMA) annually
California	150 hours of Category 1 or 2 credit (AOA or state board approved) per 3-year period — 60 hours must be Category 1 credit for active license
	Prior to December 31, 2006: 12 hours Category 1 or 2 credit in the following topic areas: pain management and treatment of terminally ill and dying patients. This is a one-time requirement. ^†
Colorado	None
Connecticut	None
Delaware	40 hours of Category 1 credit (AOA or AMA) every 2 years
District of Columbia	None^‡
Florida	40 hours of Category 1 or 2 credit biennially — 20 hours must be Category 1 credit (AOA or AMA^§) relating to the practice of osteopathic medicine or under osteopathic auspices; course credits are mandated in each of the following topic areas^¶ and require “nonlive/participatory” course attendance^//: domestic violence (1 hour), Florida state laws and rules (1 hour), risk management (1 hour), and prevention of medical errors (2 hours). Two alternative topic areas are also available: end-of-life care (1 hour) or palliative care (1 hour).
Georgia	40 hours of Category 1 credit (AOA or AMA) over 2 years
Hawaii	None
Idaho ^¶	As of January 1, 2005: 40 hours practice relevant to Category 1 credit every 2 years
Illinois	150 hours of Category 1 or 2 credit per prerenewal period — 60 hours must be obtained through formal, Type A CME programs; 90 remaining hours may be obtained through informal, Type B CME programs or activities
Indiana	None
Iowa	40 hours of Category 1 credit (AOA or AMA) biennially, which must include training for identifying and reporting abuse.
	For licensees who regularly provide primary health care to children: 2 hours of training in child abuse identification and reporting in the previous 5 years. For licensees who regularly provide primary health care to adults: 2 hours of training in dependent adult abuse identification and reporting in the previous 5 years. For licensees who regularly provide primary health care to adults and children, separate courses of 2 hours each as outlined above or a combined 2-hour course that includes curricula for identifying and reporting child abuse and dependent adult abuse in the previous 5 years.
	Fees and CME credits prorated to facilitate renewal process.
Kansas	150 hours of Category 1 or 2 credit per 3-year period
Kentucky	60 hours of Category 1 or 2 credit over 3 years — 30 hours must be Category 1 credit (AOA or AMA); 2 hours must be in the area of HIV/AIDS
Louisiana	20 hours of Category 1 credit (AOA or AMA) per year
Maine	100 hours of state board—approved CME credit per 2-year period — 40 hours must be AOA Category 1-A credit (AOA) for the following practice areas: family practice, family medicine, general practice, and internal medicine; 40 hours of Category 1 CME credit in designated specialty area for specialists
Maryland	50 hours of Category 1 or 2 credit (AOA or AMA) every 2 years for unlimited license renewal
Massachusetts	100 hours of credit per 2-year period — 40 hours must be Category 1 credit (AOA or AMA) and should include 10 hours of risk management; remaining 60 hours can be Category 2 credit
Michigan	150 hours of credit over 3 years — 60 hours must be AOA Category 1 credit; 90 hours must be Category 2 credit
Minnesota	75 hours of Category 1 credit (AOA or AMA) per 3-year period
Mississippi	40 hours of AOA Category 1-A credit or AMA Category 1 credit biennially
Missouri	50 hours of Type A credit (AOA or AMA) every 2 years
Montana	None
Nebraska ^¶	50 hours Category 1 credit (AOA or Accreditation Council on Continuing Medical Education [ACCME]) every 2 years
Nevada	35 hours of AOA Category 1-A credit per year OR 35 hours of ACCME Category 1 credit per year — 10 hours minimum of Category 1 credit
New Hampshire	150 hours of Category 1 or 2 credit per 3-year period — 60 hours must be Category 1 credit (AOA or AMA)
New Jersey	100 hours of Category 1 or 2 credit (AOA or AMA) every 2 years
New Mexico	Active membership in AOA OR 75 hours of Category 1 credit (AOA or AMA) per 3-year period
New York	None
North Carolina	150 hours of Category 1 or 2 credit (AOA or AMA) per 3-year cycle — 60 hours must be Category 1 credit
North Dakota	60 hours of Category 1 credit (AOA or AMA) per 3-year period
Ohio	100 hours of Category 1 or 2 credit over a 2-year period — 40 hours must be AOA Category 1 credit
Oklahoma	16 hours of AOA Category 1-A credit per year — 1 hour must be in the area of proper prescribing of controlled dangerous substances
Oregon	None
Pennsylvania	100 hours of Category 1 or 2 credit (AOA or ACCME) every 2 years — 20 hours must be AOA Category 1 credit; 10 hours must be in the area of patient safety and/or risk management
Rhode Island	60 hours of Category 1 credit per 3-year period — 2 hours must be in the area of blood-borne infections
South Carolina	40 hours of Category 1 credit (AOA or AMA) every 2 years
South Dakota	None
Tennessee	50 hours of Category 1 credit (AOA or AMA) per 2-year period
Texas	24 hours of Category 1 credit (AOA or AMA) per 1-year period — 1 hour must be in the area of ethics and/or professional responsibility
Utah	40 hours of Category 1 credit (AOA or ACCME) every 2 years
Vermont	30 hours of Category 1 or 2 credit per 2-year period — 12 hours must be Category 1 credit
Virginia	60 hours of Category 1 or 2 credit within the 2 years immediately preceding renewal — 30 hours must be Category 1 credit, 15 hours of which must be earned in a face-to-face, interactive setting
Washington	150 hours of Category 1 or 2 credit every 3 years — 60 hours must be Category 1 credit
West Virginia	32 hours of Category 1 or 2 credit (AOA or state society—approved) — 16 hours must be AOA Category 1 credit; 2 hours must be in the area of end-of-life care, including pain management (must present evidence of attendance)
Wisconsin	30 hours of Category 1 credit (AOA or AMA) every 2 years prior to registration
Wyoming	None

*Source: AOA Division of State and Socioeconomic Affairs: AOA US Osteopathic Licensure Summary, August 2004.Material that is new since the publication of this Journal's Osteopathic Medical Education 2003 issue¹ is indicated in boldface.Osteopathic physicians should verify the material reported here with their state licensing boards. The information provided in this table is reported annually to the American Osteopathic Association (AOA) directly from each state licensing board and is compiled here for the convenience of AOA members. The exact wording provided by the state licensing boards is preserved in this table where possible. The AOA takes no responsibility for changes to state guidelines made immediately prior to publication or errors in reporting from state licensing boards.

† Osteopathic physicians licensed in the state of California are exempt from the new one-time requirement if their primary specialty is either pathology or radiology.

‡ The District of Columbia has no CME requirements for physicians in continuous practice.

§ Florida limits the number of CME credit hours osteopathic physicians can obtain from AMA-approved sources to 13 hours.

¶ Florida dropped the requirement for osteopathic physicians to obtain CME credits in HIV/AIDS and managed care as of the 2004-2006 CME cycle.

// Florida dropped the requirement for osteopathic physicians to attend face-to-face participatory courses in favor of attendance at “nonlive/participatory” courses.

¶ Idaho and Nebraska added CME requirements for its licensed physicians as of the current 2004-2006 CME cycle. Previously, there were no state CME requirements in either Idaho or Nebraska.

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Table 3

Continuing Medical Education (CME) Requirements by State *

State	CME Requirement
Alabama	12 hours of Category 1 credit per year
Alaska	17 hours of Category 1 credit (American Osteopathic Association [AOA] or American Medical Association [AMA]) per year.
	As of January 1, 2005: 25 hours of Category 1 credit (AOA or AMA) per year
Arizona	20 clock-hours of Category 1-A credit annually from attendance at AOA-approved educational programs (must present evidence of attendance)
Arkansas	20 hours of Category 1 or 2 credit (AOA or AMA) annually
California	150 hours of Category 1 or 2 credit (AOA or state board approved) per 3-year period — 60 hours must be Category 1 credit for active license
	Prior to December 31, 2006: 12 hours Category 1 or 2 credit in the following topic areas: pain management and treatment of terminally ill and dying patients. This is a one-time requirement. ^†
Colorado	None
Connecticut	None
Delaware	40 hours of Category 1 credit (AOA or AMA) every 2 years
District of Columbia	None^‡
Florida	40 hours of Category 1 or 2 credit biennially — 20 hours must be Category 1 credit (AOA or AMA^§) relating to the practice of osteopathic medicine or under osteopathic auspices; course credits are mandated in each of the following topic areas^¶ and require “nonlive/participatory” course attendance^//: domestic violence (1 hour), Florida state laws and rules (1 hour), risk management (1 hour), and prevention of medical errors (2 hours). Two alternative topic areas are also available: end-of-life care (1 hour) or palliative care (1 hour).
Georgia	40 hours of Category 1 credit (AOA or AMA) over 2 years
Hawaii	None
Idaho ^¶	As of January 1, 2005: 40 hours practice relevant to Category 1 credit every 2 years
Illinois	150 hours of Category 1 or 2 credit per prerenewal period — 60 hours must be obtained through formal, Type A CME programs; 90 remaining hours may be obtained through informal, Type B CME programs or activities
Indiana	None
Iowa	40 hours of Category 1 credit (AOA or AMA) biennially, which must include training for identifying and reporting abuse.
	For licensees who regularly provide primary health care to children: 2 hours of training in child abuse identification and reporting in the previous 5 years. For licensees who regularly provide primary health care to adults: 2 hours of training in dependent adult abuse identification and reporting in the previous 5 years. For licensees who regularly provide primary health care to adults and children, separate courses of 2 hours each as outlined above or a combined 2-hour course that includes curricula for identifying and reporting child abuse and dependent adult abuse in the previous 5 years.
	Fees and CME credits prorated to facilitate renewal process.
Kansas	150 hours of Category 1 or 2 credit per 3-year period
Kentucky	60 hours of Category 1 or 2 credit over 3 years — 30 hours must be Category 1 credit (AOA or AMA); 2 hours must be in the area of HIV/AIDS
Louisiana	20 hours of Category 1 credit (AOA or AMA) per year
Maine	100 hours of state board—approved CME credit per 2-year period — 40 hours must be AOA Category 1-A credit (AOA) for the following practice areas: family practice, family medicine, general practice, and internal medicine; 40 hours of Category 1 CME credit in designated specialty area for specialists
Maryland	50 hours of Category 1 or 2 credit (AOA or AMA) every 2 years for unlimited license renewal
Massachusetts	100 hours of credit per 2-year period — 40 hours must be Category 1 credit (AOA or AMA) and should include 10 hours of risk management; remaining 60 hours can be Category 2 credit
Michigan	150 hours of credit over 3 years — 60 hours must be AOA Category 1 credit; 90 hours must be Category 2 credit
Minnesota	75 hours of Category 1 credit (AOA or AMA) per 3-year period
Mississippi	40 hours of AOA Category 1-A credit or AMA Category 1 credit biennially
Missouri	50 hours of Type A credit (AOA or AMA) every 2 years
Montana	None
Nebraska ^¶	50 hours Category 1 credit (AOA or Accreditation Council on Continuing Medical Education [ACCME]) every 2 years
Nevada	35 hours of AOA Category 1-A credit per year OR 35 hours of ACCME Category 1 credit per year — 10 hours minimum of Category 1 credit
New Hampshire	150 hours of Category 1 or 2 credit per 3-year period — 60 hours must be Category 1 credit (AOA or AMA)
New Jersey	100 hours of Category 1 or 2 credit (AOA or AMA) every 2 years
New Mexico	Active membership in AOA OR 75 hours of Category 1 credit (AOA or AMA) per 3-year period
New York	None
North Carolina	150 hours of Category 1 or 2 credit (AOA or AMA) per 3-year cycle — 60 hours must be Category 1 credit
North Dakota	60 hours of Category 1 credit (AOA or AMA) per 3-year period
Ohio	100 hours of Category 1 or 2 credit over a 2-year period — 40 hours must be AOA Category 1 credit
Oklahoma	16 hours of AOA Category 1-A credit per year — 1 hour must be in the area of proper prescribing of controlled dangerous substances
Oregon	None
Pennsylvania	100 hours of Category 1 or 2 credit (AOA or ACCME) every 2 years — 20 hours must be AOA Category 1 credit; 10 hours must be in the area of patient safety and/or risk management
Rhode Island	60 hours of Category 1 credit per 3-year period — 2 hours must be in the area of blood-borne infections
South Carolina	40 hours of Category 1 credit (AOA or AMA) every 2 years
South Dakota	None
Tennessee	50 hours of Category 1 credit (AOA or AMA) per 2-year period
Texas	24 hours of Category 1 credit (AOA or AMA) per 1-year period — 1 hour must be in the area of ethics and/or professional responsibility
Utah	40 hours of Category 1 credit (AOA or ACCME) every 2 years
Vermont	30 hours of Category 1 or 2 credit per 2-year period — 12 hours must be Category 1 credit
Virginia	60 hours of Category 1 or 2 credit within the 2 years immediately preceding renewal — 30 hours must be Category 1 credit, 15 hours of which must be earned in a face-to-face, interactive setting
Washington	150 hours of Category 1 or 2 credit every 3 years — 60 hours must be Category 1 credit
West Virginia	32 hours of Category 1 or 2 credit (AOA or state society—approved) — 16 hours must be AOA Category 1 credit; 2 hours must be in the area of end-of-life care, including pain management (must present evidence of attendance)
Wisconsin	30 hours of Category 1 credit (AOA or AMA) every 2 years prior to registration
Wyoming	None

*Source: AOA Division of State and Socioeconomic Affairs: AOA US Osteopathic Licensure Summary, August 2004.Material that is new since the publication of this Journal's Osteopathic Medical Education 2003 issue¹ is indicated in boldface.Osteopathic physicians should verify the material reported here with their state licensing boards. The information provided in this table is reported annually to the American Osteopathic Association (AOA) directly from each state licensing board and is compiled here for the convenience of AOA members. The exact wording provided by the state licensing boards is preserved in this table where possible. The AOA takes no responsibility for changes to state guidelines made immediately prior to publication or errors in reporting from state licensing boards.

† Osteopathic physicians licensed in the state of California are exempt from the new one-time requirement if their primary specialty is either pathology or radiology.

‡ The District of Columbia has no CME requirements for physicians in continuous practice.

§ Florida limits the number of CME credit hours osteopathic physicians can obtain from AMA-approved sources to 13 hours.

¶ Florida dropped the requirement for osteopathic physicians to obtain CME credits in HIV/AIDS and managed care as of the 2004-2006 CME cycle.

// Florida dropped the requirement for osteopathic physicians to attend face-to-face participatory courses in favor of attendance at “nonlive/participatory” courses.

¶ Idaho and Nebraska added CME requirements for its licensed physicians as of the current 2004-2006 CME cycle. Previously, there were no state CME requirements in either Idaho or Nebraska.

Table 4

American Osteopathic Association (AOA) Accredited Category 1 CME Sponsors (N = 164)

Organization	No. (%) ^*
▪ Affiliates
□ Nonpractice (AOA)^†	...
□ Practice (AOA)	3 (2)
▪ Colleges
□ Colleges of osteopathic medicine (AOA-accredited)	18 (11)
- Alumni groups^†	...
□ Specialty (AOA-affiliated)^†	...
▪ Foundations (AOA-affiliated)^†	6 (4)
▪ Hospitals	54 (33)
▪ Military	2 (1)
▪ Philanthropic organizations (AOA-affiliated)^†	...
▪ Professional associations	1 (< 1)
▪ Societies
□ Divisional (AOA-affiliated)^†	...
□ Specialty	28 (17)
□ State	52 (32)^‡

*Percentages reported were rounded for each type of organization. Therefore, the sum of these percentages may not equal 100%.

†In 2003, the AOA's Board of Trustees approved a resolution regarding who may apply for recognition as an AOA-accredited Category 1 CME sponsor. Applications for sponsorship are currently limited to the organizations indicated.¹

‡The 52 state societies noted include all state societies, county societies, and state district societies (eg, Florida has a state osteopathic medical association, a county association, and two separate district societies: Broward county, District 6; District 7; and Southwest, District 11).

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Table 4

American Osteopathic Association (AOA) Accredited Category 1 CME Sponsors (N = 164)

Organization	No. (%) ^*
▪ Affiliates
□ Nonpractice (AOA)^†	...
□ Practice (AOA)	3 (2)
▪ Colleges
□ Colleges of osteopathic medicine (AOA-accredited)	18 (11)
- Alumni groups^†	...
□ Specialty (AOA-affiliated)^†	...
▪ Foundations (AOA-affiliated)^†	6 (4)
▪ Hospitals	54 (33)
▪ Military	2 (1)
▪ Philanthropic organizations (AOA-affiliated)^†	...
▪ Professional associations	1 (< 1)
▪ Societies
□ Divisional (AOA-affiliated)^†	...
□ Specialty	28 (17)
□ State	52 (32)^‡

*Percentages reported were rounded for each type of organization. Therefore, the sum of these percentages may not equal 100%.

†In 2003, the AOA's Board of Trustees approved a resolution regarding who may apply for recognition as an AOA-accredited Category 1 CME sponsor. Applications for sponsorship are currently limited to the organizations indicated.¹

‡The 52 state societies noted include all state societies, county societies, and state district societies (eg, Florida has a state osteopathic medical association, a county association, and two separate district societies: Broward county, District 6; District 7; and Southwest, District 11).

Table 5

American Osteopathic Association (AOA) Members with a Continuing Medical Education (CME) Requirement

	No. of AOA Members
3-Year Cycle	CME Requirement^*	Dropped from Membership
1973 to 1976^†	...	...
1977 to 1979	10,373	239
1980 to 1982	12,050	159
1983 to 1985	11,881	298
1986 to 1988	12,901	43
1989 to 1991	16,093	159
1992 to 1994	16,040	146
1995 to 1997	19,315	214
1998 to 2000	21,383	219
2001 to 2003^‡	23,770	...
2004 to 2006^§	26,976	...

*The number of AOA physician members who have a CME requirement are those whose state or specialty boards mandate a CME requirement for them to qualify for relicensure.

†Numbers are not reported for the 1973-1976 CME cycle because the program was in its testing phase during those years.

‡Numbers reported for the 2001-2003 CME cycle are current as of September 9, 2003. Data for the number of Association members dropped for a CME deficiency during that cycle will not be available until May 31, 2005.

§Numbers reported for the 2004-2006 CME cycle are current as of September 8, 2004. Data for the number of Association members dropped for a CME deficiency for the 2004-2006 cycle will not be available until May 31, 2008.

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Table 5

American Osteopathic Association (AOA) Members with a Continuing Medical Education (CME) Requirement

	No. of AOA Members
3-Year Cycle	CME Requirement^*	Dropped from Membership
1973 to 1976^†	...	...
1977 to 1979	10,373	239
1980 to 1982	12,050	159
1983 to 1985	11,881	298
1986 to 1988	12,901	43
1989 to 1991	16,093	159
1992 to 1994	16,040	146
1995 to 1997	19,315	214
1998 to 2000	21,383	219
2001 to 2003^‡	23,770	...
2004 to 2006^§	26,976	...

*The number of AOA physician members who have a CME requirement are those whose state or specialty boards mandate a CME requirement for them to qualify for relicensure.

†Numbers are not reported for the 1973-1976 CME cycle because the program was in its testing phase during those years.

‡Numbers reported for the 2001-2003 CME cycle are current as of September 9, 2003. Data for the number of Association members dropped for a CME deficiency during that cycle will not be available until May 31, 2005.

§Numbers reported for the 2004-2006 CME cycle are current as of September 8, 2004. Data for the number of Association members dropped for a CME deficiency for the 2004-2006 cycle will not be available until May 31, 2008.

Table 6

American Osteopathic Association Total Number of Continuing Medical Education (CME) Credits Recorded (in Millions) for Each 3-Year CME Cycle

	CME Credit Category
3-Year Cycle	1-A	1-B	2^*	Total
1973 to 1976	1.3	0.1	1.1	2.5
1977 to 1979	1.4	0.8	0.5	2.7
1980 to 1982	1.5	1.3	0.6	3.4
1983 to 1985	1.5	1.4	0.8	3.7
1986 to 1988	1.8	3.0	1.1	5.9
1989 to 1991	2.2	3.7	1.3	7.2
1992 to 1994	2.3	4.1	1.2	7.6
1995 to 1997	2.5	5.7	1.6	9.8
1998 to 2000	3.0	7.3	1.7	12.0
2001 to 2003	2.9	8.6	1.6	13.0
2004 to 2006^†	...	...	...	1.9

*Numbers reported for CME credit Category 2 includes all Category 2-A and Category 2-B credits recorded.

†The total number reported for the 3-year, 2004-2006 CME cycle is current as of October 21, 2004.

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Table 6

American Osteopathic Association Total Number of Continuing Medical Education (CME) Credits Recorded (in Millions) for Each 3-Year CME Cycle

	CME Credit Category
3-Year Cycle	1-A	1-B	2^*	Total
1973 to 1976	1.3	0.1	1.1	2.5
1977 to 1979	1.4	0.8	0.5	2.7
1980 to 1982	1.5	1.3	0.6	3.4
1983 to 1985	1.5	1.4	0.8	3.7
1986 to 1988	1.8	3.0	1.1	5.9
1989 to 1991	2.2	3.7	1.3	7.2
1992 to 1994	2.3	4.1	1.2	7.6
1995 to 1997	2.5	5.7	1.6	9.8
1998 to 2000	3.0	7.3	1.7	12.0
2001 to 2003	2.9	8.6	1.6	13.0
2004 to 2006^†	...	...	...	1.9

*Numbers reported for CME credit Category 2 includes all Category 2-A and Category 2-B credits recorded.

†The total number reported for the 3-year, 2004-2006 CME cycle is current as of October 21, 2004.

AOA Continuing Medical Education

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