50.000 CONTINUING MEDICAL EDUCATION

50.982          Physician Participation in the Planning and Development of Accredited Continuing Education for Physicians

MSSNY will collaborate with other stakeholders including the AMA to petition the ACCME to develop policies which require physician participation in the planning and development of accredited continuing education for physicians.

MSSNY will bring this resolution to the AMA for adoption as policy. (HOD 2024 – 150)

50.983          Disclosure of Compliance issues and Creating a National Database of Joint Leadership

MSSNY will urge ACCME to require organizations that apply for joint providership for accreditation of CME activities be required to disclose on its application if the activity has previously been denied accreditation and the reason for denial.

MSSNY will also urge ACCME to develop a national database for this information (in a manner similar to the PARS) which would allow SMS providers to cross-reference this information.

MSSNY will bring this resolution to the AMA HOD meeting and to the ACCME. (HOD 2023-150)

(See also Education, 85.000)

 

50.984          Increase Credit for CME Preparation for Physicians

The Medical Society of the State of New York will urge the American Medical Association to collaborate with the Accreditation Council on Continuing Medical Education (CME), to allow physicians to claim an amount of Category 1 CME credits that more accurately reflects the hours they spend on preparing and presenting CME programs to a maximum of four (4) Category 1 CME hours. (HOD 2022-151)

50.985          Requiring Participation in the Planning and Development of Accredited Continuing Medical Education for Physicians

MSSNY will collaborate with other stakeholders to petition the Accreditation Council of Continuing Medical Education (ACCME) to require physician participation in the development and execution of accredited continuing medical education for physicians. (HOD 2021-151) 

50.986          Partnership on Continuing Medical Education

When the Medical Society of the State of New York provides continuing medical education programs jointly with county medical societies, MSSNY will offer county medical societies a discounted rate of 50% for joint provider fees and the per-credit fees, with the understanding that the jointly providing county medical society will be responsible for the labor associated with meeting the Accreditation Council for Continuing Medical Education (ACCME) accreditation requirements and policies.  The annual fee for MSSNY-accredited CME providers that are academies shall be the same as the charge that ACCME charges MSSNY per provider accredited. (HOD 2018-169; Council January 24, 2019)

50.987             Increase Free Online CME for Members

The Medical Society of the State of New York, in cooperation with the county medical and specialty societies, will promote MSSNY’s online CME program, and working with the county medical and specialty societies, will identify and develop courses for MSSNY’s CME website for the added value of society membership.  (HDO 2018-168)

50.988          Prevention of Unintended Consequences of the Physician Payments Sunshine Act (PPSA)

The Medical Society of the State of New York reaffirms its support for the current ACCME Standards for CME and Commercial Support.

The Medical Society of the State of New York supports the position of the AMA and Alliance for CME: that regulations implementing the Physician Payment Sunshine Act assure that manufacturers not be required to report payments made for a program where the topic, the speakers, and educational materials are independently chosen and have no relationship with a manufacturer which might be supporting the CME activity. (HOD 2012-64; Reaffirmed HOD 2022)

50.989             Continuing Medical Education for Maintenance of Certification (CME for MOC):

MSSNY is to support:

• the current Continuing Medical Education (CME) accrediting system which provides high quality CME activities, thus ensuring continuous professional development as well as educational and practice improvement tools and resources;
• the position of the Alliance, which opposes the American Board of Medical Specialties (ABMS) plan as stated because it would undermine the existing interdisciplinary approach to education and would also redirect important resources away from existing educational programs;
• the position of the Accreditation Council for Continuing Medical Education (ACCME), which opposes the creation of new systems that would impose unnecessary burdens upon ACCME-accredited providers, Recognized Accreditors, intrastate providers and physician learners. (HOD 2011-168; Reaffirmed HOD 2021)

50.990             CME Accreditation:

Programs offered by the Medical Society of the State of New York are to be considered, when appropriate, for American Medical Association (AMA) Category 1 credit for all physician participants when applicable under AMA Guidelines.  (HOD 2011-167; Reaffirmed HOD 2021)

50.991             CME Credits for Attending MSSNY House of Delegates: SUNSET HOD 2019

50.992             Continuing Medical Education Application Forms:

MSSNY approved revised Continuing Medical Education application forms to be consistent with new standards and accreditation criteria mandated by the Accreditation Council for Continuing Medical Education (ACCME).  (Forms are available from MSSNY’s Office of Continuing Medical Education.)  (Council 12/13/07; Reaffirmed HOD 2017, Update and revised forms approved by Council 4/15/21)

50.993             Continuing Medical Education Mission Statement:

The Office of Continuing Education of the Society of the Medical Society of New York (MSSNY) is committed to support a statewide system of effective continuing medical education which provides all physicians with broad learning opportunities to increase their skills.  The goal of this system is to upgrade medical care by maintaining, augmenting, and updating physicians’ medical knowledge, skills and attitudes in order to facilitate delivery of optimal medical care to their patients.  The CME program will address the professional practice gaps of physician learners as identified in their scope of practice and professional requirements. This is done by providing educational programming and accreditation of providers of Continuing Medical Education (CME) throughout the state.

Content Areas:

The Continuing Medical Education Program of MSSNY strives to provide educational activities relevant to the practice of all recognized medical disciplines and include forums for public health, socio-economic, ethical and legal issues, quality improvement, liability risk reduction, enhancement of the practice environment; impaired physician awareness and treatment; and legislative and regulatory issues related to the provision of quality healthcare.  To implement this most effectively, MSSNY, in addition to the education it provides directly, shall also serve as an accredited joint provider with non-accredited providers of continuing medical education to promote public health goals and an awareness of the public health resources available to physicians and their patients throughout New York State.

Target Audience:

Target audiences include physicians residing or practicing in New York State. Although MSSNY’s CME program primarily will serve New York physicians, some activities may be extended to a national audience when justified by need.

Type of Activities:

MSSNY”s CME offerings will promote high quality educational programs delivered in a cost effective and accessible manner.  These events take the form of didactic presentations, seminars, symposia, workshops, and grand rounds; enduring print, audio, and video material; interactive, live internet and web casting activities. The educational design, instructional method and learning format for each event is chosen to best serve the educational needs and learning objectives of the planned educational activity.

Expected Outcomes of the Program:

Improvements to MSSNY’s CME Program shall be made by evaluation of CME activities and self-assessment of the overall program.  Following an educational activity, MSSNY expects learners to report enhanced or reinforced knowledge upon evaluation.  MSSNY expects that learners will report an increased confidence in approaching clinical challenges or commit to changing behavior by applying newly acquired strategies in their practice.  MSSNY expects that learners will be able to demonstrate competence and an effective use of specific and specialized skills.  MSSNY expects performance parameters within the setting of clinical practice to show improvement or a favorable impact on targeted patient outcomes.  (Council 1/25/07; Reaffirmed HOD 2017; Amended and adopted Council 6/22/17)

50.994              MSSNY’s Task Force on Quality Medical Care:

The Medical Society of the State of New York supports regulatory or legislative efforts to require physicians to complete a certain number of continuing medical education credits periodically as evidence of competence and diligence in medical practice.  (Council 11/17/05; Reaffirmed HOD 2015)

50.995             Standards for Integrity and Independence in Accredited Continuing Education

The health professions are not only defined by expertise, but also by a dedication to put service of others above self-interest. When individuals enter the healthcare professions, they commit to upholding professional and ethical standards including acting in a patient’s best interests, protecting the patient from harm, respecting the patient, fostering informed choices, and promoting equity in healthcare.

While the interests of healthcare and business sometimes diverge, both are legitimate, and collaboration between healthcare professionals and industry can advance patient care. Since healthcare professionals serve as the legally mandated gatekeepers of medications and devices, and trusted authorities when advising patients, they must protect their learning environment from industry influence to ensure they remain true to their ethical commitments.

As the stewards of the learning environment for healthcare professionals, the accredited continuing education community plays a critical role in navigating the complex interface between industry and the health professions. Organizations accredited to provide continuing education, known as accredited providers, are responsible for ensuring that healthcare professionals have access to learning and skill development activities that are trustworthy and are based on best practices and high-quality evidence. These activities must serve the needs of patients and not the interests of industry.

This independence is the cornerstone of accredited continuing education. Accredited continuing education must provide healthcare professionals, as individuals and teams, with a protected space to learn, teach, and engage in scientific discourse free from influence from organizations that may have an incentive to insert commercial bias into education.

The Accreditation Council for Continuing Medical Education (ACCME^®) acts as the steward of the Standards for Integrity and Independence in Accredited Continuing Education, which have been drafted to be applicable to accredited continuing education across the health professions. The Standards are designed to:

• Ensure that accredited continuing education serves the needs of patients and the public.
• Present learners with only accurate, balanced, scientifically justified recommendations.
• Assure healthcare professionals and teams that they can trust accredited continuing education to help them deliver safe, effective, cost-effective, compassionate care that is based on best practice and evidence.
• Create a clear, unbridgeable separation between accredited continuing education and marketing and sales.

Terms used for the first time are written in blue italics, followed by the definition for the term.

Eligibility

The ACCME is committed to ensuring that accredited continuing education (1) presents learners with only accurate, balanced, scientifically justified recommendations, and (2) protects learners from promotion, marketing, and commercial bias. To that end, the ACCME has established the following guidance on the types of organizations that may be eligible to be accredited in the ACCME System. The ACCME, in its sole discretion, determines which organizations are awarded ACCME accreditation.Types of Organizations That May Be Accredited in the ACCME System

Organizations eligible to be accredited in the ACCME System (eligible organizations) are those whose mission and function are: (1) providing clinical services directly to patients; or (2) the education of healthcare professionals; or (3) serving as fiduciary to patients, the public, or population health; and other organizations that are not otherwise ineligible. Examples of such organizations include:

• Ambulatory procedure centers
• Blood banks
• Diagnostic labs that do not sell proprietary products
• Electronic health records companies
• Government or military agencies
• Group medical practices
• Health law firms
• Health profession membership organizations
• Hospitals or healthcare delivery systems
• Infusion centers
• Insurance or managed care companies
• Nursing homes
• Pharmacies that do not manufacture proprietary compounds
• Publishing or education companies
• Rehabilitation centers
• Schools of medicine or health science universities
• Software or game developers

Types of Organizations That Cannot Be Accredited in the ACCME System

Companies that are ineligible to be accredited in the ACCME System (ineligible companies) are those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. Examples of such organizations include:

• Advertising, marketing, or communication firms whose clients are ineligible companies• Bio-medical startups that have begun a governmental regulatory approval process
• Compounding pharmacies that manufacture proprietary compounds
• Device manufacturers or distributors
• Diagnostic labs that sell proprietary products
• Growers, distributors, manufacturers or sellers of medical foods and dietary supplements
• Manufacturers of health-related wearable products
• Pharmaceutical companies or distributors
• Pharmacy benefit managers
• Reagent manufacturers or sellers

Owners and Employees of Ineligible Companies

The owners and employees of ineligible companies are considered to have unresolvable financial relationships and must be excluded from participating as planners or faculty and must not be allowed to influence or control any aspect of the planning, delivery, or evaluation of accredited continuing education, except in the limited circumstances outlined in Standard 3.2.

Owners and employees are individuals who have a legal duty to act in the company’s best interests. Owners are defined as individuals who have an ownership interest in a company, except for stockholders of publicly traded companies, or holders of shares through a pension or mutual fund. Employees are defined as individuals hired to work for another person or business (the employer) for compensation and who are subject to the employer’s direction as to the details of how to perform the job.

Ineligible companies are prohibited from engaging in joint providership with accredited providers. Joint providership enables accredited providers to work with nonaccredited eligible organizations to deliver accredited education.

The ACCME determines eligibility for accreditation based on the characteristics of the organization seeking accreditation and, if applicable, any parent company. Subsidiaries of an ineligible parent company cannot be accredited regardless of steps taken to firewall the subsidiaries. If an eligible parent company has an ineligible subsidiary, the owners and employees of the ineligible subsidiary must be excluded from accredited continuing education except in the limited circumstances outlined in Standard 3.2.

Standard 1: Ensure Content is Valid

Standard 1 applies to all accredited continuing education.

Accredited providers are responsible for ensuring that their education is fair and balanced and that any clinical content presented supports safe, effective patient care.

1. All recommendations for patient care in accredited continuing education must be based on current science, evidence, and clinical reasoning, while giving a fair and balanced view of diagnostic and therapeutic options.
2. All scientific research referred to, reported, or used in accredited education in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection, analysis, and interpretation.
3. Although accredited continuing education is an appropriate place to discuss, debate, and explore new and evolving topics, these areas need to be clearly identified as such within the program and individual presentations. It is the responsibility of accredited providers to facilitate engagement with these topics without advocating for, or promoting, practices that are not, or not yet, adequately based on current science, evidence, and clinical reasoning.
4. Organizations cannot be accredited if they advocate for unscientific approaches to diagnosis or therapy, or if their education promotes recommendations, treatment, or manners of practicing healthcare that are determined to have risks or dangers that outweigh the benefits or are known to be ineffective in the treatment of patients.

Standard 2: Prevent Commercial Bias and Marketing in Accredited Continuing Education

Standard 2 applies to all accredited continuing education.

Accredited continuing education must protect learners from commercial bias and marketing.

1. The accredited provider must ensure that all decisions related to the planning, faculty selection, delivery, and evaluation of accredited education are made without any influence or involvement from the owners and employees of an ineligible company.
2. Accredited education must be free of marketing or sales of products or services. Faculty must not actively promote or sell products or services that serve their professional or financial interests during accredited education.
3. The accredited provider must not share the names or contact information of learners with any ineligible company or its agents without the explicit consent of the individual learner.

Standard 3: Identify, Mitigate, and Disclose Relevant Financial Relationships

Standard 3 applies to all accredited continuing education.

Many healthcare professionals have financial relationships with ineligible companies. These relationships must not be allowed to influence accredited continuing education. The accredited provider is responsible for identifying relevant financial relationships between individuals in control of educational content and ineligible companies and managing these to ensure they do not introduce commercial bias into the education. Financial relationships of any dollar amount are defined as relevant if the educational content is related to the business lines or products of the ineligible company.

Accredited providers must take the following steps when developing accredited continuing education. Exceptions are listed at the end of Standard 3.

1. Collect information: Collect information from all planners, faculty, and others in control of educational content about all their financial relationships with ineligible companies within the prior 24 months. There is no minimum financial threshold; individuals must disclose all financial relationships, regardless of the amount, with ineligible companies. Individuals must disclose regardless of their view of the relevance of the relationship to the education.

Disclosure information must include:

1. The name of the ineligible company with which the person has a financial relationship.
2. The nature of the financial relationship. Examples of financial relationships include employee, researcher, consultant, advisor, speaker, independent contractor (including contracted research), royalties or patent beneficiary, executive role, and ownership interest. Individual stocks and stock options should be disclosed; diversified mutual funds do not need to be disclosed. Research funding from ineligible companies should be disclosed by the principal or named investigator even if that individual’s institution receives the research grant and manages the funds.
3. Exclude owners or employees of ineligible companies: Review the information about financial relationships to identify individuals who are owners or employees of ineligible companies. These individuals must be excluded from controlling content or participating as planners or faculty in accredited education. There are three exceptions to this exclusion—employees of ineligible companies can participate as planners or faculty in these specific situations: a. When the content of the activity is not related to the business lines or products of their employer/company.
4. When the content of the accredited activity is limited to basic science research, such as pre-clinical research and drug discovery, or the methodologies of research, and they do not make care recommendations.
5. When they are participating as technicians to teach the safe and proper use of medical devices, and do not recommend whether or when a device is used.
6. Identify relevant financial relationships: Review the information about financial relationships to determine which relationships are relevant. Financial relationships are relevant if the educational content an individual can control is related to the business lines or products of the ineligible company.
7. Mitigate relevant financial relationships: Take steps to prevent all those with relevant financial relationships from inserting commercial bias into content.
8. Mitigate relationships prior to the individuals assuming their roles. Take steps appropriate to the role of the individual. For example, steps for planners will likely be different than for faculty and would occur before planning begins.
9. Document the steps taken to mitigate relevant financial relationships.
10. Disclose all relevant financial relationships to learners: Disclosure to learners must include each of the following:
11. The names of the individuals with relevant financial relationships.
12. The names of the ineligible companies with which they have relationships.
13. The nature of the relationships.
14. A statement that all relevant financial relationships have been mitigated.

Identify ineligible companies by their name only. Disclosure to learners must not include ineligible companies’ corporate or product logos, trade names, or product group messages.

Disclose absence of relevant financial relationships. Inform learners about planners, faculty, and others in control of content (either individually or as a group) with no relevant financial relationships with ineligible companies.

Learners must receive disclosure information, in a format that can be verified at the time of accreditation, before engaging with the accredited education.

Exceptions: Accredited providers do not need to identify, mitigate, or disclose relevant financial relationships for any of the following activities:

1. Accredited education that is non-clinical, such as leadership or communication skills training.
2. Accredited education where the learner group is in control of content, such as a spontaneous case conversation among peers.
3. Accredited self-directed education where the learner controls their educational goals and reports on changes that resulted, such as learning from teaching, remediation, or a personal development plan. When accredited providers serve as a source of information for the self-directed learner, they should direct learners only to resources and methods for learning that are not controlled by ineligible companies.

Standard 4: Manage Commercial Support Appropriately

Standard 4 applies only to accredited continuing education that receives

financial or in-kind support from ineligible companies.

Accredited providers that choose to accept commercial support (defined as financial or in-kind support from ineligible companies) are responsible for ensuring that the education remains independent of the ineligible company and that the support does not result in commercial bias or commercial influence in the education. The support does not establish a financial relationship between the ineligible company and planners, faculty, and others in control of content of the education.

1. Decision-making and disbursement: The accredited provider must make all decisions regarding the receipt and disbursement of the commercial support.
2. Ineligible companies must not pay directly for any of the expenses related to the education or the learners.
3. The accredited provider may use commercial support to fund honoraria or travel expenses of planners, faculty, and others in control of content for those roles only.
4. The accredited provider must not use commercial support to pay for travel, lodging, honoraria, or personal expenses for individual learners or groups of learners in accredited education.
5. The accredited provider may use commercial support to defray or eliminate the cost of the education for all learners.
6. Agreement: The terms, conditions, and purposes of the commercial support must be documented in an agreement between the ineligible company and the accredited provider. The agreement must be executed prior to the start of the accredited education. An accredited provider can sign onto an existing agreement between an accredited provider and a commercial supporter by indicating its acceptance of the terms, conditions, and amount of commercial support it will receive.
7. Accountability: The accredited provider must keep a record of the amount or kind of commercial support received and how it was used, and must produce that accounting, upon request, by the accrediting body or by the ineligible company that provided the commercial support.
8. Disclosure to learners: The accredited provider must disclose to the learners the name(s) of the ineligible company(ies) that gave the commercial support, and the nature of the support if it was in-kind, prior to the learners engaging in the education. Disclosure must not include the ineligible companies’ corporate or product logos, trade names, or product group messages.

Standard 5: Manage Ancillary Activities Offered in Conjunction with Accredited Continuing Education

Standard 5 applies only when there is marketing by ineligible companies or

nonaccredited education associated with the accredited continuing education.

Accredited providers are responsible for ensuring that education is separate from marketing by ineligible companies—including advertising, sales, exhibits, and promotion—and from nonaccredited education offered in conjunction with accredited continuing education.

1. Arrangements to allow ineligible companies to market or exhibit in association with accredited education must not:
2. Influence any decisions related to the planning, delivery, and evaluation of the education.
3. Interfere with the presentation of the education.
4. Be a condition of the provision of financial or in-kind support from ineligible companies for the education.
5. The accredited provider must ensure that learners can easily distinguish between accredited education and other activities.
6. Live continuing education activities: Marketing, exhibits, and nonaccredited education developed by or with influence from an ineligible company or with planners or faculty with unmitigated financial relationships must not occur in the educational space within 30 minutes before or after an accredited education activity. Activities that are part of the event but are not accredited for continuing education must be clearly labeled and communicated as such.
7. Print, online, or digital continuing education activities: Learners must not be presented with marketing while engaged in the accredited education activity. Learners must be able to engage with the accredited education without having to click through, watch, listen to, or be presented with product promotion or product-specific advertisement.
8. Educational materials that are part of accredited education (such as slides, abstracts, handouts, evaluation mechanisms, or disclosure information) must not contain any marketing produced by or for an ineligible company, including corporate or product logos, trade names, or product group messages.
9. Information distributed about accredited education that does not include educational content, such as schedules and logistical information, may include marketing by or for an ineligible company.
10. Ineligible companies may not provide access to, or distribute, accredited education to learners.

(Council 3/14/05; Updated/Adopted Council January 15, 2015; Updates Adopted by Council, April 15, 2021)