Good morning, everyone. My name is Amanda Weir, and I serve as the Senior Manager of Physician Education and CME at the American Osteopathic Association. I am delighted to be joined today by fellow CME enthusiast, Lindsay Aspis, who is the Professional Development Manager at the American College of Osteopathic Family Physicians. So in today's presentation, you'll get two viewpoints from the accreditor and from the AOA sponsor. Lindsay has also served as an, I almost said incredible role, but that too, accreditor role at a state-based medical society. So she has a lot of extra unique perspectives since she's seen a variety of activities from lots of organizations. Throughout our presentation, we will be in the chat if you have any questions. If you're not viewing this with us on March 22nd, between 1130 and 1230 p.m. Eastern Standard Time, then you can get in touch with us with the email-to-speaker option, and we will also share our email addresses at the end. For our disclosures, Lindsay and I have no relationships to disclose, but to jump right into CME, Lindsay, did we have to sign a disclosure for this presentation about CME? The great question, Amanda. And for this topic, talking about continuing medical education, no, we were not required to sign a disclosure. Especially if the content does not have anything to do with clinical or patient advice or patient decisions, then a disclosure is not needed. There are some CME sponsors who will decide to obtain disclosure from anyone involved in the activity, regardless of the nature of their content. So it really is up to the practices of each CME sponsor and what they'd like to do. What do you usually do in your activities? It does depend on the activity. If it is, say, a one-hour webinar that is on physician health and wellness, or here's a clinical update on physician health and wellness, then I would not ask those involved in the development of that content to disclose relationships, because it's not related to any type of company that could impact patient care. But if it was one session as part of an overall conference, I would likely ask all the individuals involved in that conference, in order to have a consistent process for the conference, regardless of their content, I would ask them to disclose any relationships they have with companies that are ineligible companies that are not allowed to be part of continuing education. I agree. That's what I do as well, especially at those big conferences, and I feel like a lot of the speakers are expecting you to ask anyway. So they just know to get it, sign it, and send it back. Yes. Although we are presenting on the affiliate track, we wanted to make this presentation applicable to physicians too, because not only are they the target audience, but they often are involved in activities in different capacities, from being the chair to a speaker. So if you are a physician watching this, I encourage you to get involved in CME. CME providers are always looking for great, fresh speakers, and you can also earn credit by being a presenter. AOA awards a one-to-one credit for presenters. So if you have a one-hour presentation, you also earn one CME credit. Our learning objectives are, following this presentation, learners will be able to explain the key requirements and steps for obtaining and maintaining AOA accreditation for CME programs, be able to discuss how AOA-accredited CME benefits osteopathic physicians, and including meeting licensing and certification requirements. They'll be able to identify ways to collaborate, and I'm getting tongue-twisted today, with accredited providers to expand CME offerings while ensuring compliance with accreditation standards. All right, who can be an AOA provider? Institutions must meet the following standards to be considered for accreditation by the Bureau of Osteopathic Education. The institution must have an osteopathic affiliation. Those are osteopathic medical schools that are accredited by COCA, specialty associations, and state societies that are chartered by the AOA's House of Delegates. Osteopathic non-practice affiliates, for example, these would be foundations, alumni groups, philanthropic organizations can participate, but they must be chartered by the AOA House of Delegates. Healthcare facilities with at least one osteopathic physician on staff could also qualify. And then on the screen right here, I just picked some random examples of AOA sponsors. Quality guidelines for CME activities or competencies. The purpose of accreditation is to ensure that all activities presented by AOA-accredited Category 1 CME sponsors are developed and appropriately planned by design and implementation and evaluation standards contained in this document. The purpose of continuing medical education, or CME, is to enhance the physician's ability to care for patients. It is the responsibility of the CME sponsor of the CME activity to ensure that education activity is designed primarily for that purpose, regardless of the support received from outside agencies. It is the responsibility of the CME sponsor to ensure that activities adhere to the AOA accreditation standards. CME activities must meet the following requirements. The first is core competencies. CME activities must address one or more of the AOA's seven core competencies or the osteopathic tenets. So, in order to document this requirement, the AOA requires that at least one learning objective be aligned with osteopathic core competencies and or osteopathic tenet. This can be documented on the practice gap analysis or elsewhere, but it will be requested if the activity is selected for review by the AOA. So, Lindsay, as an AOA sponsor, do you have any advice on how to go about making sure these are incorporated into your activities? So, as a sponsor, as we go through the design process of an activity, we're looking at what the needs of our audience are, what the educational needs are, and then how we can go about making those changes. So, that's where, Amanda, you talked about the practice gap analysis, and that's a really great tool to use to document sort of what the need is, what that gap is. And we use a format of that that has the osteopathic core competencies aligned in that document so that we can look at what the need is of the education, how we're going to go about making a change, and then be able to mark the core competency that it's associated with at that time. So, we're always continuously looking at as we go throughout the build of the education. So, if we're building something, say we were going to have a conversation about how Schwartz rounds can be helpful within a healthcare system, that might be more focused on interpersonal and communication skills, where if you're doing something about diabetes management or something that might be more clinical in nature, that might be more medical knowledge and its application in osteopathic medical practice. So, we really try to look at what the content is and then be able to relate that content to the core competency. That is good advice. Are you okay? The second guideline is the practice gap analysis. Oh, I forgot to advance the slide. And so, okay, CME sponsors should systematically identify the practice gaps for prospective participants and use that information in planning the CME activities. This kind of goes back to the previous slide when we were talking about the practice gap analysis for core competencies. The accreditation manual for CME sponsors, this is all listed out on page five, and the gap analysis must be conducted annually if it's a repeat activity. It needs to be produced for each topic, and it needs to be based on current data and analysis documented with at least one evidence-based source. So, Lindsay, are there any additional tips or tricks you have to add to this? I really think using that tool that's in the accreditation manual, the practice gap analysis, is a great format to be able to outline what is needed. One thing as you're looking to produce this for each topic, you really have to look at what is the gap for that topic, and it is going to be different from something if you're discussing an ethical decision that needs to be made in medicine versus clinical content that might be part of the CME. So, typically, there is going to be some type of current data or analysis, and as Amanda noted, you need that documentation with evidence-based sources. So, being able to look to prior research, look to prior evaluations that you've done as a CME program, that can really give you a clue as to what your audience is looking for as part of the education. That's good. There is a template on our website if anyone wants to use that. I feel like it's, at first, it looks like it's kind of hard to follow. I usually send someone an example just so they can see what the questions are asking. I think y'all can always ask me for an example of something. A lot of people write out a lot more than they should, or much more than they have to. I feel like when I send them examples, they're like, okay, this is all they're asking. So, that is helpful. But there are some activities that are exempt from doing a practice gap analysis. Examples are OMM, OMT, activities that are addressing non-clinical core competencies. So, examples would be professionalism, communication, system-based practices. If the activity is faculty development activities, if it's a state licensure requirement, such as risk management or board preparation would be another one. Topics for which the AOA has a specific policy endorsing or encouraging CME. So, the need would only refer to a specific policy, and an example of that would be inhalation of volatile substances or teen alcohol abuse, for example. Examples of the practice gap analysis tools include a medical audit. So, that would be identifying the needs, developing criteria for excellence, also collecting and summarizing data, analyzing and interpreting data. And the nice thing about being in CME this day and age is you can use AI, and I do that all the time, to analyze my data. It saves me so much time. Also, self-assessments that identify the needs and the physician's perceived needs. And lastly would be a questionnaire of the physician's perceived needs. Oh, you're on mute. Amanda, I just wanted to make note, you noted that there was some comment or content that does not require a practice gap analysis. And that's typically because the community, the entire medical community already knows why there is a need for that education. So, the CME sponsor is not required to re-articulate the why that education is needed. Another example that you had is around opioid prescribing, the risk evaluation and mitigation strategies for opioid analgesics. There is already a full documentation from the FDA that notes the why behind that education is needed. So, that's why in those instances the CME sponsor does not need to re-document those gaps. Sure, yes. But did you have anything else to add to that? I think all of these tools, there's great ways to identify what the gap is of your audience. As I said before, being able to utilize prior evaluations from prior activities, it's similar to a questionnaire. But if you're already doing education, looking at all of your activities, asking your learners what else do you want to know about this topic or what else do you want to know about additional topics can really help clue you in where there are gaps to your audience. And then you can be able to design any of your further education to help address and close those gaps. That question is actually my favorite question to read the responses to when we do surveys. I'm just so interested to see what people are interested in. Our next is the educational objectives. So, for CME sponsors, we must develop learning objectives based on identified gaps in knowledge for each CME topic. The objective shall state that a physician's knowledge, skills, attitudes are impacted or mastered by the conclusion of the activity, such as the correction of an outdated knowledge or acquisition of new knowledge in a specific area, the mastering of new skills or the changing of attitudes or habits. Think about what you want your learners to be able to do as a result of completing the education. And something I do that helps is, and I did it in the very beginning of this slide presentation, I asked myself the question, and I literally write it down. At the end of this activity, a learner will be able to and write it out. So, CME sponsors will use these objectives developed for an educational activity to select the content, the design, and the educational methods for that activity. The learning objectives need to be demonstrable or measurable. Learning objectives that start with understand or learn are not measurable. So, I used to always post a link to Bloom's Taxonomy, and it seemed like every time I did, like a year later, the website would change. So, I stopped doing that, but now I'm just going to recommend everyone just Google Bloom's Taxonomy action verbs and make sure each learning objective starts with one of those. And if you do that, your learning objective will be demonstrable. Anything to add to that, Lindsay, do you have any advice? That's great advice. I use Bloom's Taxonomy every single day. I actually have a worksheet that I developed several positions ago when I first started working in CME that I go back to and update if anyone is interested in that worksheet. It's similar to this table that Amanda has on here where the different categories of the taxonomy are color-coded. I'm happy to share it with anyone. If you want to send me an email, I'd be happy to share that along. But it really helps you think about what you want that learner to do with the education. Do you want them to be able to apply certain knowledge to a competency and as you go up that taxonomy it's more it's more advanced than what that skill or ability or you know the attitudes that you want your learners to take away we're creating something it is gonna be much more challenging than simply remembering something so you really want to look at just what is it that you want your learners to take away also what is realistic for your learners to take away from the education well you may want them to create like a new worksheet as a result of the education if you only have 30 minutes to deliver that education is that realistic is it more realistic where they could apply the standards for learning how to develop a new worksheet within from your education session than actually creating that new worksheet so you can start thinking of it from multiple perspectives of what's possible just with that education or what might be possible when they get back to their office and have a little bit more time right next is the outcomes measurement and this was something I had the most trouble with I think getting into CME is asking the right questions and I've developed a like a questionnaire list that people can choose from if y'all are interested I just kept learning the hard way coming up with a measurement and getting the responses and I'm like okay I could see how they misinterpreted you know what I was asking so it's important to come up with questions that are going to give you something measurable like my biggest green moment was the first activity that I was working on this was years ago maybe eight years ago I was putting yes no questions will you change your practice and they would just put yes but that's not measurable so providers must analyze the changes in their learners and changes will fall into categories of competence performance or patient outcomes as the result of them attending your activity so using evaluation strategies or questions that provide you with data or information about the learner changes and or the patient outcomes are important and measuring the change in activities don't forget to reflect on the effectiveness of your educational efforts some ways that you might choose to evaluate is using the evaluation forums I think that's probably the most common ask learners how they will apply or implement the new knowledge or strategies I think probably the second most common would be the testing doing a pre and post test and you need to ensure the questions you ask are about applying the knowledge so they should be case-based questions and not questions that only measure the increase in knowledge and right that's the right questions that will lead to the data or information that you need when you are collecting data on learner change make sure you reflect and describe your conclusions about effectiveness of your program or the learners change after every activity change needs to be measured change for the learners can be demonstrated like if you're taking a BLS course for example or an OMT activity for most of these activities change can be hard to demonstrate but they can also be self-reported self-reported would be a question along the lines of following this activity what changes will you make in your practice so it's important to ask how they will make the changes make it an open-ended question do not do a yes or no and that also helps with helps if you use AI now I was originally doing the yes no questions because that's obviously easy to measure when it's an open-ended question it's harder to measure so luckily now with the AI we can just put in everyone's responses and ask for a summary or to analyze it and give me an outcome so also surveys don't have to be completed immediately after the activity you could send the activity survey out later and ask since attending this activity what changes have you made I personally like this option because you're finding out what changes they have actually made first immediately after the activity and asking them which what changes they basically plan on making and so you know the follow-through but the downside of doing this is it is so much harder to get surveys back when you send them out any that like the farther out after the activities and amount the harder you're gonna have getting them back so since these questions are required for accreditation I say that they're a requirement to get credit so that usually helps people come out and send them back if the purpose of activity is only to change knowledge then you could do a pre or post test and easily measure change so following every activity after the data's been collected it needs to be analyzed for effectiveness if you find very little or no change I've personally never seen this because people plan so well but I'm sure it happens and the next steps for that would be to go back to your committee and come up with an action plan document it for your next activity using what you learned to improve and if this activity is picked for reaccreditation no matter what the outcomes are you will need to have it written out your effectiveness plan to kind of correct maybe what you found in the original activity so do you have any tips tricks on on doing this so I want to bring this from a couple different standpoints one thing when I think of with outcomes measurement is I go back to sort of the whole activity life cycle and again I like to think of developing education as a cycle and that you're taking that information you've learned from what your audience is so you've you've analyzed that you're designing what you want your education to look like you're developing you're delivering that education you're going through an evaluation process of that education and once you go through that evaluation as mana just noted sometimes you might see oh we've just uncovered some other learning opportunities for our audience so then you go through that cycle again with those new learning opportunities that you have as our organization so from another perspective I'll just say we usually do outcomes measurements in multiple ways for standardization on all of our activity evaluations we have an open-ended question that asks what changes will you make as a result of this activity depending on what we need to measure within that activity as you noted Amanda pre and post tests are really helpful in looking at some of the knowledge and competency changes between what the learners know before they go through the education versus what they know then after they completed the education we just did this with one of our programs and we saw a jump in about 60% of competency improvement on one of our learning objectives from what they knew before the education to what they knew after the education and so that seeing numbers like that it really makes you realize this is this is why I do what I do every day because it's really impacting what the clinicians know on this educational content other ways we'll do it as Amanda you noted the follow-up survey we like to get some type of sort of initial gut reaction from the learners of what they thought of the education and that is going to be most accurate if you do get some type of survey immediately after the education we all we know how much people are fatigued of doing surveys but if it could just be one or two questions asked in a way that's quite easy for them to answer once the education is over that might give you some of the data that you need but then you can do a multi-step process and it is as Amanda noted maybe three months later you send a survey okay you completed this education back on this date on this date you told us this is what you were going to do what have you done since this time you could look at that at a six-month time at any type of time interval to evaluate sort of that long-term what changes you're seeing in your learners that could create another activity what barriers are you facing absolutely have not made this change and then that could be for the next year you can uncover a lot yeah by doing that process yes too far sorry so a few years ago the AOA formally adopted the ACCME standards for integrity and independence the ACCME standards have been adopted by accrediting bodies representing multiple health professions these standards are designed to ensure that accredited continuing education serves the needs of patients and the public it's based on valid content and it's free of commercial influence I'm just going to summarize these and if you want more information you can find a plethora of information on each of these on the ACCME.org website or on osteopathic.org so standard one ensure the content it's valid accredited continuing education must be based on valid scientific evidence and clinical reasoning it should be providing a balanced view of diagnostic and therapeutic options any referenced research must adhere to accepted standards of experimental design and analysis while emerging topics may be explored they must be clearly identified and education should not promote unscientific or harmful practices standard two is prevent commercial bias and marketing in accredited continuing education accredited education must remain free of commercial influence ensuring that planning faculty education I'm sorry faculty selection and delivery are independent of ineligible companies faculty cannot promote their own products or services during the education and the learner contact information cannot be shared without their written consent CME providers must implement processes to prevent marketing within the educational content Amanda I want to make a note on this standard too because we have run into this a couple times as a CME sponsor where we've had faculty ask us if they could promote a book that they've written as part of their education and we've had to tell them as much as we appreciate that they are a subject matter expert on that topic they are not allowed to promote the book within their education session if they want to talk about their book and promote their book they can do that once the education session is over and they're in the hallways they're outside of that education room but we really make sure as we talk to those faculty that we keep any type of promotion whether it have to do with an ineligible company or not in an eligible company but any type of promotion separate from education yeah that's a good one good thing to note so standard three is identifying mitigating and disclosing relevant financial information providers are required to collect and disclose financial relationships with ineligible companies and it needs to be within the last 24 months and you're required to take steps to mitigate any conflicts so owners or employees of ineligible companies cannot control educational content all relevant financial relationships must be disclosed to learners and a clear process for managing potential conflicts must be in place so Lindsey how do you usually mitigate your potential conflicts well I was gonna first say this references back to Amanda what you and I did at the very beginning of our session talking about disclosure and that we did disclose that we don't have any relationships with ineligible companies but there are some exceptions to this standard so you can read more about those on osteopathic.org but when it comes to mitigating relationships we we look at a few different methods first of all we found since the standards have changed and now we've moved to the standards of independence and integrity and faculty anyone involved in developing education they are required to disclose all of their relationships with ineligible companies not just relevant relationships which is what the standards used to say what we found is that we have individuals disclosing all relationships that they have with any organization that exists so for example I will have a faculty say that they have been or they are an employee at Phoenix Children's you know one of those organizations that you noted earlier is accredited as an AOA sponsor or they receive they've submitted a paper to a specific journal those are not relationships with ineligible companies so our mitigation process will review those realize that the entity that the relationship is with is not an ineligible company and then be able to take that off of our list that we need to do any further steps our mitigation process is complete for those and we have a form that we use to go through this step-by-step for any relationship that one of our faculty might have if it is someone who says well I'm on the Speakers Bureau for this pharmaceutical companies that typically requires further investigation we'll look at what is the what is the content that that individual is presenting on and what are the products and services that are offered by that pharmaceutical company typically we'll go back to the individual to ask them some further questions because we are not scientific experts as we're going through some of these processes sometimes even the physician that we have reviewing the content is not as clued in on some very focused clinical topics as the presenter or one of the faculty might be so we'll use the advisors on our reference committees and we'll look through all of the you know Google the organization or the company look through pretty much everything we possibly can find to help us mitigate that relationship when in doubt we have gone to inquiring with ACCME if there is a very unique type of organization that we can't tell if they're an ineligible company or not we have gone back to ACCME and asked are there any other questions that we can use to help differentiate whether or not this is an ineligible company and I think they do have a tool list on their website that can help you look at that. The hard part that we find is when we have someone who says I am an owner of this small pharmaceutical company. Owners and employees those fall into one of those categories of for the most part those individuals cannot be involved in developing accredited continuing education. So we try to understand more about what the education is versus what that organization does. Again if that person might be talking about leadership and developing leadership qualities that has nothing to do with the pharmaceutical company that they own so they may be able to control the content of that education but if that content is directly related to a product of their company typically they would not be allowed to be involved in the development of that education and we would have to tell them we would have to exclude them from the education find someone else who could fill in that role or if they were part of the planning in that initial planning process we'd have to exclude them from the planning at that state that we would find that relationship out and move forward with the planning without that individual. Yeah that's what we do as well. If they have a relationship with the pharmaceutical but it's not related to what they're speaking about I'll ask for their slides and get them peer-reviewed and just document all of that and I can always share my peer review form. It's pretty easy. And I always feel bad asking for peer reviews. Like they're doing me a favor doing the peer review. So I fill in as much as I can. I write like on top, the name of the presentation, what the disclosures are. I mark, you know, what should be attached, their CV and their disclosure form, as well as the slides. And I haven't really had any problems with someone saying there was an actual conflict. So that's not the way that's worked out. Yeah, we've implemented a peer review for a majority of our content, whether or not there are any relationships. Because we have that peer review also look at some of the requirements that we talked about earlier. Is this osteopathically relevant? Does it align with the tenants or the core competencies? So we ask our peer reviewers to look at the content from that perspective, as well as one of these other standards here that, Amanda, you haven't gotten to. But are there logos of commercial ineligible companies that are included in those slides that really shouldn't be? If, you know, it is a logo of AOA, well, that's allowed on educational slides. But again, if it was a logo of a pharmaceutical company, we are not able to use those logos. Their name can be typed, or the brand name of a pharmaceutical product is not supposed to be used. The generic name can be used. But again, it should be typed instead of using a logo or a trademark of that organization. I feel like a really hard one, because you want the money, you want the sponsorships. And they're, of course, a business, so they're wanting to get something in return. And a lot of times you just have to say no to some of the things. But I do feel like a lot of the pharmaceuticals, especially right now, they know the rules. So they're not, you know, going to ask you for contact lists or to have their logo placed where it shouldn't be. So to talk more about that, that's standard four, managing commercial support appropriately. If you do decide that you want to accept the commercial support, you must ensure that funding does not influence the education content. And those ineligible companies cannot pay any of the faculty or the learners directly. And financial support must be documented in an agreement. And you will also have to turn that in if the activity is pulled for reaccreditation. The use of the commercial funds must be very transparent with clear disclosures to all the learners. And providers must maintain records of financial support. So I know we already kind of got into that. Is there anything that reading that made you think of to add? The one thing to add in that I've seen some CME providers and sponsors do when it comes to that disclosure to the learners about any, whether it be relationships or commercial support, is that if you're mentioning the name of an ineligible company, it needs to be typed in text. It cannot be their logo or their brand look from their website. Well, I mean, we all want to, again, as men, I know you want to acknowledge any of that financial contributions. There's other ways, typically in an overall activity, that you could do that looking outside of the educational content. But if you have the educational content, then the name of those organizations or the ineligible companies needs to be typed. Standard 4 kind of brings us into Standard 5. There's a lot of similarities, and that's managing the ancillary activities offered in conjunction with accredited continuing education. So the marketing, the exhibits, and the non-accredited education must remain clearly separate from the accredited continuing education. Marketing from ineligible companies cannot influence educational content, and learners must not be exposed to product promotions during educational activities. Clear distinctions must be made between CME and non-CME activities, and this goes into the 30-minute rule where there needs to be a break between the non-accredited sponsored activity and the accredited. I find a lot of people ask me about this when they're in a really small space, and they can't have the sponsored non-accredited in a different location, because that's also like a fix that you can do just do it in a different room and then have the accredited stuff in its own room. But there just needs to be a 30-minute break, which some people appreciate. I know as an attendee, I appreciate a 30-minute break to stand up, walk around, go to the bathroom. So you could use it as a positive. At our conferences, like at OMED, there's always a few rooms that we'll use for non-accredited activities, and we had signs made that said what was going on in the room and then very clearly on the bottom in big letters, non-accredited activity. And then we just kind of switched the plaques out throughout the day so that it was obvious you had to walk past that sign to get into the room. Yeah, and this requirement, it can be challenging sometimes. Amanda, as you noted, if you are really limited in the space you have at your venue. I actually was speaking to a colleague, this was several months ago, where they had one very, very large ballroom at a venue to hold their education at, but what they were trying to do is have education and they also wanted to have an exhibit hall. And so what we discussed was is there a way, okay, you have that one room, is there a way it can be divided into two? Does that room have air walls that the venue can put up in between two spaces? A lot of hotels and other venues like that, if they have a really large space, typically they might have temporary walls that they can put up in between to break it into smaller spaces, which then it ultimately does make it two spaces. So you can have an exhibit hall in one space and have the education in a separate space. They might both be called Ballroom A, but you could have Ballroom A section one and Ballroom A section two, and they have separate entrances to get into them. Another thing we talked about was, is can they put up pipe and drape to be able to separate between the two? So if there is, how I think of it, if you can create two spaces, even if you only have that one and create sort of the look of two spaces, like I said, with air walls, then you could have that exhibit hall. People could go to that exhibit hall immediately when the education is done because it is a separate space and you don't have to have that 30-minute break. I had no idea those were called air walls. So at the end of this, if I was asked what knowledge did you gain, I would say air walls. I had no idea. Okay. Moving on to the AOA credit. As many of you all know, we are in a three-year cycle. For this slide, I'm just going to talk in general terms. There's a lot of exceptions, so it's just easier to do high level. So to get the most up-to-date information on this kind of stuff, of course, osteopathic.org. There is a CME tab, if you're on the homepage. It's on the top right. So three-year basis, we're currently in the 2025-2027 cycle, which began January 1st. So following the conclusion of the 2022-2024 cycle on December 31st, 2024. So I felt like this presentation was particularly timely as we just started a new cycle, and it will allow all of us to prepare effectively for the requirements that we have ahead. Specific to AOA credit is we have the time-limited, the non-time-limited certification, and these requirements apply to all diplomates holding osteopathic board certification through the AOA and under the AOA Board of Osteopathic Specialists and specialty certifying boards. The limited certification, time-limited certification requires ongoing participation in the OCC to maintain board certification, and diplomates must fulfill specific CME credit requirements as determined by their specialty certifying board under component two. The newly certified physicians entering mid-cycle will have a prorated requirement, and in addition to CME, diplomates must meet other OCC components beyond continuing education. The non-time-limited certification, diplomates may voluntarily participate in OCC, but they're not required to do so. Those that are not participating must complete 120 total CME credit hours per cycle, regardless of their specialty, and diplomates who choose to participate in OCC must meet the same CME credit requirements as time-limited diplomates. No additional OCC components are required unless the diplomate just voluntarily wants to. So, in summary, the time-limited diplomates must participate in OCC to maintain certification while non-time-limited diplomates have the option to either participate or fully fulfill the standard CME requirements. So, next is AOA CME credit categories, and to better understand, I'm going to break it down. So, category one versus category two. Category one CME is typically osteopathic CME. It is provided by an AOA-accredited sponsor. The credit submission process, the AOA-accredited providers must upload credits of course completion. Physicians have nothing else to do once they've completed the activity and claimed credit. If you need the credit on your report and still haven't seen it, you should reach out to the sponsor first. If it's been less than a year since you completed it and it's not on your report, or I'm sorry, if it's been more than a year, then you can go ahead and reach out to the AOA. I have the CME website at the bottom. That's going to be your go-to. Just reach out to them, say I took this course, I don't see it on my credit report, and we can help you getting that resolved. So, once the activity is completed and the certificate is issued, no further action is required on the physician's part. The one big exception to this for category one credit is the standardized life support courses. So like ACLS, PALS, BLS, they are AMA category one accredited, but you will still earn AOA category one CME. And many physicians don't realize they can get credit for these activities. So I encourage both physicians and CME sponsors to check the AOA website for a list of qualifying activities. Category two is typically non-osteopathic CME. So this would include the AMA PRA category one credit. And the credit submission process is physicians must manually submit their certificates for category two CME. Just send it, forward it to, if it's emailed, forward it to the CME at osteopathic.org. And my tip for this would be to save that contact, email contact in your, what's it called? Not a phone book, in your contacts list. So as soon as you get it, you can just forward it. For AOA members, the credit can also be uploaded directly through the AOA portal. You will just enter that information yourself. So my best practice tip would be to submit certificates immediately after completion, rather than waiting until the end of the cycle when the system is overwhelmed with submissions. Also to keep a folder with a physical, either digital or physical, with all your certificates. We are usually flooded with calls and emails from physicians every year, saying they lost their certificates, but still want credit. A few times you've had physicians call that did an activity. Usually they did it online and they can't find the certificate. They can't remember who the activity was with or even the title of the activity, but they still want credit. We can't really help them there in that situation. So that would be my biggest tip just from experience and seeing what kind of issues come up. Next is the A versus B. A typically is live in person, a real-time virtual activity. You can also describe them as interactive. Category B is typically self-paced or enduring, with a few exceptions. So when you receive a certificate for completing a CME activity, look at the certificate for the credit type, A, B, if it's an AOA accredited activity. If the certificate states AMA PRA Category 1 credit, it will be converted to AOA Category 2 credit. And to do that, you'll just email the certificate to CME at osteopathic.org. Or if you're an AOA member, you can just go ahead and type it in yourself. Live, first and during AMA credit, Category 1 credit activities. The ACCME accreditation language requires them to write what kind of activity category that activity falls into. So for example, they would say in the language, live activity, and that would be converted to 2A. Or it'll say enduring activity, converted to 2B. If the credit type is not listed on the certificate, I would contact the activity sponsor for clarification to make sure what you're actually looking at is the certificate, because that's another thing that happens. They get like a transcript, or I guess transcript's not the right word, but they're seeing something that's making them think they're done, and they're asking where their credit is. But what's happened is they haven't completed the activity, that they haven't gotten to the end, to the certificate yet. So we just tell them to contact the sponsor, and usually they just need to complete the attestation, and they haven't done that yet. Got anything to add from experience, Lindsay? Well, one thing I'd just like to say to the CME sponsors that are listening to this, there are some great tables in the AOA's accreditation manual for CME sponsors. They're kind of in the middle. I have actually extracted these out of the manual so that I can access it as a document in and of itself that really outlines Category 1A activities, what the different activity types are within their Category 1B, Category 2A, 2B. But these are great tables that I will constantly reference as a sponsor. We're developing education, trying to make sure that we align what we're developing with the right credit type. So I just want to strongly recommend that resource that already exists. Yeah, that's a good one. I actually reference it all the time, because you second guess yourself. Is that this, or is it that? It's almost like my go-to document when I'm entering credit in. A common question that I will get from peers is around enduring educational content, or what you'd consider internet CME, and whether or not it's interactive or if it's not interactive. Can that be considered 1A, or is it 1B? And if you look at that table, then it does say that if the content is delivered asynchronously, so if it is something that someone can do at any point to qualify for Category 1A, the instructor has to respond to participant questions within one week. If that's not possible, then it would be considered 1B credit. So there's some nuances in the activities here, which is where it's just great to refer back to that table. Yeah, we use that little exception for OMED every year to be able to offer. It's a blended activity. It's live and enduring. But we ask the speakers to be able to respond to emails within a week so that we can still offer that 1A credit. OK, I went back to the last. I went to this and then went back because I didn't want people thinking this was the chart we were talking about. This is a totally different chart, but it is also on osteopathic.org. To the right, I've written the pathway if you want to access it. So osteopathic.org, the CME tab, CME policies, and then all the 2025-2027 certification CME cycle information is already up. I just took a snip of the top so it'd be easier to read, but first one listed is anesthesiology. So looking at this chart, you can see that it requires 75 credits, 18 of which need to be AOA category one. So I think this information is valuable to activity sponsors as well. It helps them better understand the specific CMEs of their target audience. And real quick, I just wanted to pull up a credit report just to demonstrate. I'm a visual learner, so I wanted to add this. And I just selected a random family physician. This is for the last cycle. They completed 128.75 CME credits. And as you can see, he exceeded his required amount, which is great. However, this also highlights the importance of regularly reviewing your reports to ensure compliance. So how you'll read this at the top of the report, you'll find a clear breakdown of his CME requirements. In this case, he needed the minimum of 120 CME credits with at least 60 of the credits in category one and 30 of those credits in category 1A. All right, understanding AOA accreditation process. These are some of the key requirements and steps for obtaining and maintaining your AOA accreditation. You must be osteopathically distinct. And it's evidence or practice-based medical education, which includes the body of knowledge and skills essential to the osteopathic profession and patient care and integrates osteopathic tenets and philosophy. There's the 50% rule for total education credits must be presented by osteopathic physicians for up to 10% of the 50%. CME sponsors may count non-DOs who serve as full-time faculty or core faculty in programs with osteopathic recognition. The remaining professionals may include subject matter experts approved by the Education Planning Committee. CME activities must address one or more of the AOA seven core competencies or the tenets. Do you have any tips on any of these? I wanted to talk just a little bit about the 50% rule because I know we hear from CME sponsors that this can be challenging. I know there have been several times as a CME sponsor where I have used the exemption process. I can think of one activity where we had an osteopathic physician who was facilitating a discussion between two patients. So technically, in a one-hour discussion, the osteopathic physician was really only about a third of that and each of the patients was about a third. So it was less than 50%. But we articulated this in the exemption process. All that information is available on osteopathic.org on the CME sponsors pages. So I encourage you to read more about that. The process to request the exemption is quite straightforward. There's an online form to fill out right now and you have to write a rationale as to why you don't have that 50% and why this education is still relevant if you don't have that 50%. In this specific case, the Planning Committee, as we discussed, it still made sense to move forward because the whole purpose was obtaining the patient perspectives on that education. So we did have a DO involved so that we could have the osteopathic perspective, but it was the patients we wanted to hear from. And so that activity was approved through the exemption process. So if you are running into situations like that, don't fear the exemption process. Please reach out to AOA and talk to someone about what that might entail, knowing that it is an option and you could still offer credit for that activity. Good point. I totally forgot about the exemption form. Yes. It's just a quick form online. Let's move on to leveraging accreditation for professional growth. The AOA accredited CME provides osteopathic physicians with structured, high quality framework for lifelong learning while ensuring compliance with professional standards. So here's some benefits physicians can use to contribute to their career advancement. It helps with meeting their licensing and certification requirements. Many of the state medical boards require CME for license renewal and the AOA accredited CME ensures compliance to these mandates. It enhances clinical knowledge and skills. The AOA accredited CME is designed to align with osteopathic principles and practice, ensuring physicians receive the training that's relevant in their field. Courses include specialty specific content and it helps them stay up to date with the latest medical knowledge. The third one is improving professional credibility and career advancement. Completing the AOA CME training signals a commitment and a commitment to excellence and professional development, which can enhance a physician's reputation among their peers, employees, employer, and patients. The fourth one is expanding opportunities for leadership and teaching roles. Physicians that are engaged in AOA accredited CME often qualify for leadership positions within medical organizations, hospital committees, and academic institutions. Next would be supporting practice growth and patient care improvement. High quality CME directly impacts patient outcomes, helping physicians enhance clinical decision-making, patient safety, and treatment effectiveness. It strengthens osteopathic identity and community. It reinforces osteopathic distinctiveness, ensuring that physicians continue to integrate OMT and whole person care into their practice. So by leveraging the AOA accredited CME, osteopathic physicians not only meet their professional requirements, but also enhance their skills, their credibility, and their career trajectory, ultimately leading in better patient care and professional fulfillment. So speaking for the physicians that are listening in on this session, or speaking to the physicians listening in on this session, continuing medical education, it's that continuous growth, that continuous learning that you've already been doing your entire medical career. You started out in medical school, your undergraduate medical education, then it continued to graduate medical education. For the rest of your career, the AOA is here and it's accredited sponsors to help you get that education that you need to further your career and continue learning because you are all lifelong learners. So that's why these organizations are here to help you learn as you go throughout the rest of your career. I love that. So joint providership, I know Lindsay is one of our very active joint providers, but you can use joint providership to optimize any opportunities with other organizations and collaborate with AOA accredited CME providers to expand your educational offerings while still maintaining your compliance with the standards. By partnering with an accredited provider, non-accredited organizations can offer high quality CME activities that meet the AOA requirements, broadening access to education for osteopathic physicians. A successful joint providership ensures that all CME activities align with accreditation guidelines, enhance physician learning, and ultimately improve patient care. To maximize these opportunities, it's essential to establish clear roles, maintain thorough documentation, and ensure that all educational content remains independent and free from commercial bias. If an organization teams up with an accredited sponsor, it's the accredited sponsor's job to make sure the activity is in compliance. The accredited sponsor will be the one to provide all the documentation if it's requested for re-accreditation. So that's also something to remember when an organization reaches out to you interested in joint providership. I know I ask a series of questions trying to vet if the partnership is mutually beneficial. The other non-accredited sponsor has nothing to lose if your activity goes out of compliance. So that's also something I keep in the back of my mind when trying to determine if it's going to be a good fit. So periodically the AOA will, and by AOA I mean me, I will contact other AOA sponsors and say, are you doing joint providership? Because periodically we will get contacted from outside organizations wanting to offer AOA CME. And as the accreditor, we don't accredit these activities usually. So what I do when I get contacted is I reply with a list of all the AOA sponsors and a list of all the AOA sponsors that have told me they are participating in joint providership. But I do try to ask once a year just kind of to gauge where people are. If you had maybe told me before you weren't interested and now y'all are ready, just send me a quick email after this. But I know me and Lindsey probably have, both of us have some horror stories of some relationships that did not pan out to be as beneficial as we were originally thinking. So it's important to ask a lot of questions beforehand. Yes, I mean joint providership is something where you do need to know as a CME sponsor, do you have the bandwidth to take on? Because it does add a level of work outside of the scope of just what your activities are as an organization. Because you're now overseeing the activities of potentially one or more other organizations. As Amanda mentioned, ACOFP, we do have a robust joint providership program. We have some of our affiliate chapters which are smaller and they don't have the staffing or the capacity to be AOA sponsors themselves. So then we will provide the credit to their activities as a smaller organization that we work with to be able to offer the credit for their learners. Because we strongly believe that I mean if there's learning happening, if there's education being given on especially as it relates to all of the osteopathic tenants and practices and principles, that we want to make sure we can do everything we can to offer the osteopathic credit for those activities. There's been sometimes if a as we've seen new colleges of osteopathic medicine become built over the last several years. I know we had one of them reach out to us to offer education and or to offer credit for some of their activities as they were trying to build themselves up and establish what their framework was. As I've been doing continuing education for several years, joint providership is a really great opportunity if you as a non-accredited organization, if you don't have a lot of staff, if you don't have the expertise to meet the CME requirements, or if you might not have the financial framework in order to manage that entire CME process. You can partner with someone else and partner with something you know like ACOFP to offer those credits. But down the road you might in two three years down the road you might build up that framework yourself to then be able to apply to AOA and offer those credits. You know and that's something I do say to some of our smaller chapters where you know maybe right now they might not be at a capacity to offer credit themselves, but if they decide that it's important for what their chapter and their affiliate wants, they might work to do that in the future. So otherwise joint providership is always an option that'll be there so that we can make sure that physicians can get the credit that they should when the education is happening. I think that's the ideal situation for a smaller organization just to instead of jumping into accreditation and having to do a whole program kind of learning. It's almost like you're the mentor for those smaller organizations showing them what they need to do and how they need to do it. If it is a larger organization and their main thing is education and they're not accredited themselves. I one of the first questions I ask is who accredited your activities before and why don't why aren't you working like why are you asking me now like what's happened. So that's a big question I ask to weed out people that might that might not be a beneficial partnership. Sure. This slide I just put a few tips for enhancing the quality and effectiveness of CME. You could implement these strategy to foster engaging high impact learning experiences. You could focus on these evidence-based educational designs to improve physician competency, learner outcome, and ultimately patient care. Most of these are also requirements for education. And again you can they're pretty pretty self-explanatory but there is more information on osteopathic.org if you would like more of a description on implementing both not both all of these. But you can create programs that are engaging using these they're effective and impactful and they'll lead to better physician education which is the goal. So we are wrapping up. Each CME sponsor is required to attend a CME sponsored conference at least once during every three-year cycle. So if you are a CME sponsor like Lindsay for example who has attended this activity you are satisfying that requirement. So right now before you forget send an email to cmesponsors at osteopathic.org and just say your name the organization you're with what sponsor you are and say I completed the DO Day CME presentation and you will get credit for attending this activity and then you're done for the rest of the cycle. Now we encourage you to share this education with your peers if you have others at your sponsoring organization that also are involved in education please share this education with them. Just know when it comes to that requirement this was a question that I had as I started working in the osteopathic education field does everyone who's involved in the education program and the CME program at our CME sponsor need to complete the education or is it the main contact at the sponsor that needs to complete the education. So while we encourage everyone to continuously be educated and learn about the new things and new ways that we can develop and deliver education it is one person the main contact at your CME sponsor that needs to meet that requirement for every three-year cycle at least that is as of the recording of this presentation that may change in the future but as of this recording it is the main contact of your CME sponsor. I was going to say something about that now I've lost my train of thought but oh I remember what it was I am going to share the slides so I haven't seen what the screen looks like that we're going to be showing on right now but there should be a link to get the slides you can print them off share them with whoever you want and then if you do have any questions this is our contact information and thank y'all for attending and hope you have a great rest of the conference. Anything before we go Lindsay? No thank you all for joining us for this session again if you have questions feel free to reach out to either of us and we hope you continue learning. Thank you.

Continuing Medical Education

Osteopathic Physicians

AOA Accreditation

Educational Activities

Commercial Bias

Conflicts of Interest

Joint Providership

Licensing Requirements

Clinical Knowledge

Patient Care Improvement

Osteopathic Community