Many state licensing boards believe that CME is an important component in ensuring statewide quality in medical care. A total of 42 states have established CME requirements for physicians who wish to qualify for relicensure (Figure 4). Readers are encouraged to review US Osteopathic Licensure Summary on DO-Online.³ Physician-members who are interested in additional information about state licensing requirements are strongly encouraged to contact their individual state licensing boards (see appendix, pages 78-81). 

The AOA's online CME center gives physician-members ready access to hundreds of accredited hours of online CME courses. With the help of this new feature, AOA members can search a catalog of online CME activities and quizzes, access and complete those activities and quizzes online, and receive a printable screen certificate immediately after completing the activity. Credits for CME activities completed online are automatically applied to members' online CME activity reports (CARs). However, CARs for the current CME cycle will not be available until credit processing is complete for the 2004-2006 cycle. At publication, the AOA's Division of CME anticipates that CARs will be available for online viewing in April 2007. An announcement will be posted on the AOA's DO-Online Web site when 2004-2006 CARs are available. 

Physician-members can view their current CARs at any time through DO-Online's CME Web site (see http://www.docmeonline.com). In addition, CARs from previous CME cycles are archived online for at least 6 full years after the end of a cycle (eg, reports for the 2004-2006 cycle will be archived on the site through 2012). However, only those physicians who are AOA members and registered DO-Online users can review their CARs online. 

The AOA has always maintained member CARs as private documents. However, a physician-member can download his or her CAR or request that it be sent via e-mail to a third party. The AOA releases a member CAR to outside agencies (eg, state licensing boards, hospitals, attorneys, government agencies) only on written request by the physician-member. 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 electronically at their discretion. 

As of July 2006, the AOA no longer routinely mails CARs to its physician-members. Members who do not have online access are asked to contact the AOA's Division of CME in writing to request an updated CAR, which can be sent by fax, mail, or e-mail. 

The CCME continues to believe that all CME activity should be audited. Therefore, physician-members are not allowed to manually enter or update their CME records online. Physician-members should continue to submit their update requests for CME credit directly to the Association's Division of CME. 

Physician-members are encouraged to send any correspondence regarding their CARs to the following address: American Osteopathic Association, Attn: Division of CME, 142 E Ontario St, Chicago, IL 60611-2864. 

The CCME meets three times annually (ie, January, April, November) to address members' concerns and routine business related to CME programming. In addition, a standing subcommittee of the CCME, the Administrative Committee, meets in July as needed to perform necessary duties of the CCME between the regularly scheduled meetings, including reviewing and taking final action on special consideration requests and reviewing policy items and basic documents prior to submission to the full Committee. 

At its July 2006 meeting, the Administrative Committee appointed William Summers Mayo, DO, as the CCME's new chairman. Dr Mayo practices ophthalmology in Oxford, Miss. 

In November 2006, Dr Mayo appointed two new subcommittees to research topics of current interest to physician-members, specifically with regard to the potential influence of evidence-based medicine on the practice of medicine through point-of-care options and double CME credit hours for documenting performance improvements. Many point-of-care options currently allow physicians to obtain CME credit hours for consulting sources in evidence-based medicine through handheld computers while caring for patients. Double CME credit may be offered to osteopathic physicians who document performance improvement over time within a private or group medical practice. The new subcommittees are expected to report their findings at the Council's upcoming April meeting. 

As noted, osteopathic physicians who wish to maintain specialty board certification through the AOA are required to earn a minimum of 50 credit hours of AOA category 1 or 2 CME credit in their specialty areas during each 3-year CME cycle. In 1999, the Bureau of Professional Education submitted a resolution to establish a mechanism that would allow the AOA to monitor CME activity required for board certification (Resolution 30 [M/1999]—Tracking of CME by Specialty Boards). In April 2002, the Council received and reviewed comments from the AOA specialty colleges regarding how CME hours are applied toward certification requirements. The AOA's Division of CME was then directed to survey the AOA specialty boards regarding their criteria for awarding credit. At the same time, as a result of a lack of formal guidelines from the Bureau of Osteopathic Specialists on how to apply earned CME credits toward these specialty requirements, the CCME directed the AOA's Division of CME to stop recording specialty hours in 2002. 

In February of that year, the AOA's Division of CME began working in conjunction with all 18 AOA specialty boards to survey them for their input regarding this matter. From 2004 through 2005, a follow-up survey was conducted to ascertain if there was a rough consensus among the specialty boards and specialty societies on the number of credit hours that should be granted for physician participation in various activities and events, including: 

The AOA's BOT and the Bureau of Osteopathic Specialists instructed the specialty boards to develop “templates” that would specify the academic and professional activities that would allow specialty-board–certified osteopathic physicians to satisfy the existing CME requirements. Within 2 years, the consortium developed basic guidelines that would meet the needs of each member board. In February 2006, the AOA's BOT approved the group's recommended guidelines, which were designed to provide physician-members with a wide variety of options for earning CME credit while also maintaining overall consistency among the specialties (Figure 5). Figure 6 provides a summary of areas of divergence among specialties. For the activities noted in Figure 6 (ie, AOA specialty college seminars, Accreditation Council for Continuing Medical Education courses, formal teaching, and standardized/basic life support), the maximum number of CME credit hours accepted per 3-year CME cycle must be designated at the beginning of each new CME cycle. The number of credit hours accepted by each member board cannot change within a given cycle. 

In August 2006, the AOA entered all approved guidelines into its database. However, some questions remained about the recommendations for “formal teaching,” specifically, if student preceptoring would be considered eligible for specialty-board–mandated CME credit hours. The AOA specialty boards were surveyed on this topic in December 2006. In addition, the specialty boards were asked to work alongside their respective colleges to assist in formulating an answer. In January 2007, the CCME discussed this topic in depth, eventually approving up to 25 credit hours of preceptoring per CME cycle as applied to physician-members' specialty board requirements. The hours will not be applied to member records for those physicians in specialties whose boards or colleges indicated objections to granting members CME credit for this activity (ie, American Osteopathic Board of Obstetrics and Gynecology, American Osteopathic Board of Ophthalmology and Otolaryngology – Head and Neck Surgery, American Osteopathic Board of Surgery, and American College of Osteopathic Emergency Physicians). This change has been implemented for the current 2007-2009 CME cycle. 

Approved guidelines will receive further review in April 2007 by the CCME, which plans to refer them back to the specialty boards and colleges for additional refinement and clarification. 

There are currently 162 AOA-accredited category 1 CME sponsors (Table 1). A list of AOA-accredited category 1 CME sponsors is maintained on DO-Online (see http://do-online.osteotech.org/pdf/cme_sponscat1alist.pdf). 

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 (“spot monitoring”) with AOA policies and the CCME-approved Uniform Guidelines for Accrediting Agencies of Continuing Medical Education, which are found in AOA Accreditation Requirements for Category 1A CME Sponsors.^4,5 In addition, AOA staff and the CCME investigate all written complaints or deviations from AOA policy using standard compliance-review procedures.^4,5 

Since the publication of The Journal's 2006 Osteopathic Medical Education issue,⁶ there have been no significant changes made to AOA Accreditation Requirements for Category 1A CME Sponsors.^4,5 However, the Council is planning to make some minor modifications to these guidelines to better align the document with current industry standards. 

In February, the Council approved a resolution that would allow physician-members to receive category 1A credit for outcomes measured through programs offered by AOA-accredited category 1 CME sponsors. The resolution (Resolution 19 [M/2007]—AOA Category 1-A CME Credit for Outcomes Measurement for AOA Category 1-A CME Programs) was reviewed and approved by the AOA's BOT at the 2007 Midyear Meeting, which took place February 15 through February 18 in Chicago, Ill: 

 

This activity will become a part of the standard document survey for AOA category 1 CME sponsors. 

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 (https://www.do-online.org/?PageID=cme_sponsmain). 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 13th Annual National CME Sponsors Conference was held Thursday, January 11, 2007, through Saturday, January 13, 2007, at the Capital Hilton in Washington, DC, in conjunction with the 17th Annual Osteopathic Medical Education Leadership Conference. In an effort to align the 2007 conference with the “AOA Greatness Campaign” launched by 2006-2007 AOA President John A. Strosnider, DO, the conference theme was “From Good to Great.” 

Seventy-six of the 105 participants in attendance were AOA-accredited category 1 CME sponsors. The keynote address was delivered by Earl J. Reisdorff, MD. Dr Reisdorff is a practicing emergency physician, an associate professor of internal and osteopathic medicine at Michigan State University in Lansing, a published author, and serves as director of medical education at the Ingham Regional Medical Center, also in Lansing. 

Conference topics and guest speakers included the following: 

Concerns addressed in networking sessions included: 

The AOA's 14th Annual National CME Sponsors Conference will be held in Phoenix, Ariz, from Thursday, January 10, 2008, through Sunday, January 12, 2008. 

The Association's CME program continues to develop annually, as does the proportion of physician-members with a CME requirement from their state or specialty boards (Table 2). As of January 29, 2007, the number of members with a state- or specialty-board–mandated CME requirement was 25,964. As of September 2005, the AOA reports its membership numbers at 59,000; therefore, approximately 44% of AOA members now have a state-mandated CME requirement. 

The type of CME credit recorded by the AOA has changed over time (Table 3). Earned category 1A credit in formal, osteopathic CME programs increased steadily but incrementally from 2.5 million CME hours in the 1995-1997 CME cycle to 2.9 million hours in the 2001-2003 CME cycle. However, earned category 1B credit, which is less formal, non-osteopathic CME credit, has experienced more dramatic growth, increasing from 5.7 million hours in the 1995-1997 CME cycle to 8.6 million hours in the 2001-2003 CME cycle. 

The number of osteopathic physicians whose AOA membership was dropped for failure to complete the CME requirement has fluctuated between a high of 298 members in the 1983-1985 CME cycle and a low of 43 members in the 1986-1988 CME cycle (Table 2). Association members are given an 18-month grace period to fulfill requirements from the previous CME cycle. A total of 259 members were dropped from membership on May 31, 2005, for not meeting the 2001-2003 CME requirement. Statistics for the 2004-2006 CME cycle will not be available until May 31, 2008. 

Similarly, the total number of CME credits recorded by the AOA has increased considerably during each successive 3-year CME cycle (Table 3). 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. 

Funding issues remain a central concern for the survival of osteopathic CME programming. Although pharmaceutical companies are ineligible to become AOA-accredited category 1 CME sponsors (ie, the AOA has never accredited CME programs developed by them), extensive grant-based financial support for CME programming from pharmaceutical and device companies remains a key source of funding for osteopathic CME. It is anticipated that the number of independent for-profit CME programs will continue to grow, further increasing financial pressures for existing AOA-accredited category 1 CME sponsors. In the future, funding sources for ongoing educational support may derive from a variety of other sources, such as conference sponsors or exhibitors and investment companies or banks. 

The CME landscape is constantly in flux. Faced with an increasing amount of regulatory scrutiny, financial pressure, and technological change, the industry remains dynamic. Because not all grant requests can be funded, commercial supporters are beginning to insist on the use of sophisticated metrics from program administrators—especially as the grant process moves out of the realm of sales and marketing and into the hands of CME specialists. 

The CCME continues to be 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 continues to study the changing environment of osteopathic medicine, adjusting the Association's CME program to respond to the needs of the public, physician-members, and the AOA. 

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