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CPD Accreditation Case Clinic

Authors: Jennifer Gordon and Connie Switzer

Date: October 17, 2016

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Conflict of Interest Disclosures

Ms. Jennifer Gordon

Relationships that may introduce potential bias and/or conflicts of interest:

• Paid employee of the Royal College of Physicians and Surgeons of Canada

• Global Education Advisory Boards: No honoraria • Merck • Pfizer

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Conflict of Interest Disclosures

Dr. Connie Switzer

Relationships that may introduce potential bias and/or conflicts of interest:

• I am a member of an advisory board for Abbvie and Merck

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Disclosure of Commercial Support

The 8th National CPD Accreditation Conference has received NO COMMERCIAL financial support.

The 8th National CPD Accreditation Conference has received NO COMMERCIAL in-kind support.

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Learning Objectives

At the end of this workshop, participants will be able to:

1. Evaluate applications against current Royal College CPD accreditation standards.

2. Provide feedback to applicants on how to improve submissions to meet Royal College CPD accreditation criteria.

3. Identify at least one area for enhancement in their CPD programs.

The Plan

• Introductions

• Part 1: Accreditation true or false • Self-study (see handout) • Large group debrief

• Part 2: Accreditation cases

• Part 3: “What’s on your mind?” • Blank card on your table

• Conclusions

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Introductions

• Jennifer Gordon • Associate Director, CPD, Royal College

• Connie Switzer • Chair, CPD Accreditation Committee, Royal College

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Introductions

• Raise your hand if you represent: • A national specialty society • A university office of CME • A simulation program • A regulatory authority • Other

• Take a minute to introduce yourself to others at your table.

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Workshop Ground Rules

• There are no trick questions

• Do not read too much into the cases

• Read silently

• Mutual respect, do not judge others

• One case per slide

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PART 1

True or false?

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Accreditation true or false?

• 14 accreditation-related statements

• Review and complete the handout (self-study!)

• We will come back as a group in 5 minutes

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Accreditation true or false?

Raise the corresponding card to identify whether you believe that the statement is:

• True (green) • False (red) • Unsure (yellow)

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Accreditation Statement #1

The Royal College CPD accreditation standards require CPD activities to have a minimum of 3 learning objectives per session.


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The Royal College CPD accreditation standards require CPD activities to have a minimum of 3 learning objectives per session.


A/False. The Royal College CPD accreditation standards do not set a minimum number of learning objectives.

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Needs assessment data that is 5 years old cannot be used to support the development of a Royal College accredited CPD activity.


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Needs assessment data that is 5 years old cannot be used to support the development of a Royal College accredited CPD activity.


A/ False. The Royal College CPD accreditation standards do not set an expiration date or shelf life for needs assessment data. It is the responsibility of the scientific planning committee to validate that the needs assessment data remains relevant.

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When reviewing an application for Royal College CPD accreditation, the accredited CPD provider must receive and review all conflict of interest disclosure forms which have been signed by each speaker, scientific planning committee member, author, and/or facilitator.


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When reviewing an application for Royal College CPD accreditation, the accredited CPD provider must receive and review all conflict of interest disclosure forms which have been signed by each speaker, scientific planning committee member, author, and/or facilitator.


A/ False. The Royal College requires accredited CPD providers to review the template conflict of interest disclosure form but not necessarily the completed forms for each individual. The accredited CPD provider must assess whether the physician organization/CPD activity’s scientific planning committee has a process in place to review, manage, and disclose any conflicts of interest to participants.

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The scientific planning committee’s knowledge and expertise of the needs of a specific specialty is an acceptable form of needs assessment.


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The scientific planning committee’s knowledge and expertise of the needs of a specific specialty is an acceptable form of needs assessment.


A/ True. The Royal College CPD accreditation standards require the scientific planning committee to be representative of the intended target audience so that the program is planned according to the needs of the target audience. The scientific planning committee members have extensive knowledge of the needs of a specific specialty and therefore, can provide insight into the needs of the specialty. However, the expertise of the scientific planning committee is recommended to be accompanied by data-informed needs assessment strategies (such as a survey, performance data, evaluation reports etc.)

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Certificates of attendance for Royal College-accredited CPD activities may only be issued to specialist physicians (i.e. and not to nurses, dentists, technologists) who attend Royal College MOC Section 1 or 3 activities.


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Certificates of attendance for Royal College-accredited CPD activities may only be issued to specialist physicians (i.e. and not to nurses, dentists, technologists) who attend Royal College MOC Section 1 or 3 activities.


A/ False. Certificates of attendance must be issued to all participants regardless of practice context or specialty. It is then up to other accrediting bodies to determine if they will accept the certificates against their professional requirements.

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College of Family Physicians of Canada (CFPC) Mainpro+ participants may claim Royal College MOC Section 1 (maximum 50 credits per cycle) as Certified Group Learning Activities.


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College of Family Physicians of Canada (CFPC) Mainpro+ participants may claim Royal College MOC Section 1 (maximum 50 credits per cycle) as Certified Group Learning Activities.


A/ True. CFPC members may claim up to 50 MOC Section 1 credits per cycle based on the policy within the new Mainpro+ system launched June 27, 2016.

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Only Royal College accredited simulation programs (simulation centres) are permitted to offer MOC Section 3 credits for simulation-based CPD activities.


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Only Royal College accredited simulation programs (simulation centres) are permitted to offer MOC Section 3 credits for simulation-based CPD activities.


A/ False. All Royal College accredited CPD providers (including national specialty societies, Canadian university offices of CME/CPD, and other national and provincial organizations) may self-approve and/or review simulation-based CPD activities for MOC credit.

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A rounds program that has been self-approved for MOC Section 1 credits can self-approve a simulation-based CPD activity that is held as part of the regularly scheduled rounds series for Section 3 credits.


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A rounds program that has been self-approved for MOC Section 1 credits can self-approve a simulation-based CPD activity that is held as part of the regularly scheduled rounds series for Section 3 credits.


A/ False. MOC self-approval is limited to MOC Section 1 accredited group learning. The rounds program is required to apply to a Royal College accredited CPD provider if they wish to have a simulation-based CPD activity accredited within their rounds series. Accredited rounds programs are not deemed to be accredited CPD providers and cannot self-approve activities for MOC section 3 credit.

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All authors of an abstract accepted for presentation at a MOC Section 1 accredited activity must sign and submit a conflict of interest disclosure form.


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All authors of an abstract accepted for presentation at a MOC Section 1 accredited activity must sign and submit a conflict of interest disclosure form.


A/ True. All individuals in a position to control the content of an accredited CPD activity must declare their conflicts of interest. This is not limited only to “lead” authors or presenters of abstracts.

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Members of a clinical practice guideline development committee may record their learning in the MOC Program.


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Members of a clinical practice guideline development committee may record their learning in the MOC Program.


A/ True. Clinical practice guideline development is a systems learning activity in MOC Section 2 (self-learning). Learners can record 20 credits per year per guideline committee.

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The entire Royal College co-development statement must be used on program materials; it cannot be truncated.


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The entire Royal College co-development statement must be used on program materials; it cannot be truncated.


A/ True. The statement is “This [program, workshop or seminar] was co-developed with [name of the organizations] and was planned to achieve scientific integrity, objectivity, and balance.”

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A Royal College-accredited national specialty society holding their annual scientific meeting in Montreal, Quebec must comply with the Royal College CPD activity accreditation standards if they wish to offer MOC credits.


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A Royal College-accredited national specialty society holding their annual scientific meeting in Montreal, Quebec must comply with the Royal College CPD activity accreditation standards if they wish to offer MOC credits.


A/ True. All MOC-accredited activities must comply with the Royal College CPD activity accreditation standards. The requirement for all Royal College-accredited CPD activities held in Quebec to comply with the CQDPCM’s Code of Ethics has been removed from the Royal College CPD accreditation standards.

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Accredited CPD providers are only required to report their accredited activities when they submit their re-accreditation applications either to the Royal College or to CACME.


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Accredited CPD providers are only required to report their accredited activities when they submit their re-accreditation applications either to the Royal College or to CACME.


A/ False. Notification of review forms for all CPD activities approved for MOC Section 1/3 must be submitted to the Royal College as they are accredited. In future, a new Royal College data collection process will be rolled out to include elements such as: the number of estimated learners, sponsorship data, delivery method etc. Stay tuned; more information to come this fall and data will be collected for activities starting January 1, 2017.

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An industry sponsor has contributed financially specifically to a yoga health break offered during an accredited annual conference. To recognize their sponsorship, the yoga session may include the name of the sponsor in the scientific program.


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An industry sponsor has contributed financially specifically to a yoga health break offered during an accredited annual conference. To recognize their sponsorship, the yoga session may include the name of the sponsor in the scientific program.


A/ True. A sponsor can directly contribute financially to a yoga health break session associated with an accredited group learning activity. The Royal College CPD activity accreditation standards would not prohibit the yoga session from including the name of the sponsor(similar to how a meal break can include the name of a sponsor).

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PART 2

Accreditation cases

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Accreditation Cases

• Thank you to those who submitted a case!

• These are actual cases/questions that have come across the desks of Royal College staff.

• Remember the ground rules: • There are no trick questions • Do not read too much into the cases • Read silently • Mutual respect, do not judge others

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Accreditation Case #1

A physician organization has submitted an application for MOC Section 1 credits (group learning) to an accredited CPD provider. The CPD activity features 30 separate 1-hour sessions held at different times and locations across Canada within a 12-month period.

The budget shows that:

• The CPD activity is sponsored by only one industry partner

• Each speaker is offered a $1500.00 honorarium

• Each planning committee member is offered a $500.00 honorarium

• Each of the 30 sessions occurs over the lunch hour and the physician organization has budgeted $30.00 per person for food and beverage.

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Q/ Given the information above, could this CPD program meet Royal College CPD activity accreditation standards?

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A/ Yes. The Royal College CPD activity accreditation standards and CMA Guidelines for Physicians in Interactions with Industry:

• Do not require multiple sponsors for a single activity

• Require any honoraria that is paid to speakers or planning committee members to be “reasonable”

• Require meals provided to participants to be “modest”

• The CPD activity accreditation standards permit Section 1 accreditation for a 1-year period and there is no limit on the number of times the CPD activity can be delivered within that timeframe.

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A physician organization has recorded a video of a lecture from an accredited live group learning activity. The physician organization wishes to post the recorded video online for future viewing and would like to offer MOC credits to viewers as well as include a post-test for learners after they watch the lecture.

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Q/ Based on this scenario, what additional information would you need from the physician organization to determine whether the video could be accredited for MOC credits?

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A/

• Does the online video have an interactivity component? How do learners interact with one another and with faculty?

• If all CPD activity accreditation standards are met (including interactivity), this video could be accredited for MOC Section 1.

• Do learners get feedback on their knowledge? How is this feedback provided? Does the feedback include the questions that they answered correctly, incorrectly, with references for the correct answer?

• If all CPD activity accreditation standards are met (including the provision of data and feedback) this video could be accredited for MOC Section 3.

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Dr. Doe is a keynote speaker for an annual scientific meeting. Dr. Doe completed her conflict of interest declaration form indicating that she had no relationships with industry or other for-profit entities to declare. The declaration form was reviewed by the scientific planning committee who determined no conflict of interest management procedures needed to be implemented.

During Dr. Doe’s talk, it became apparent that she is a major stakeholder in a pharmaceutical company of the leading manufacturer of a drug related to the therapeutic area of her talk. Dr. Doe promoted the drug during her talk and included an email address for the sales representative in her closing slide.

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Q/ Has this situation (or similar) ever occurred at your organization?

If yes, what did you do? Was any action taken during the talk?

Was any action taken after the talk?

What lessons learned were explored after a conflict of interest became apparent during a live event?

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A/ This is an extreme example of when a conflict of interest, bias, or peer selling become apparent in a real-time, live scenario. Dr. Doe has a professional obligation (under the CMA Guidelines for Physicians In Interactions With Industry) to declare her relationship with the pharmaceutical company, to present a balanced view of therapeutic options, and to not engage in peer-selling. Here are some options CPD providers might consider:

• The Chair of the scientific planning committee interrupt the talk and ask the speaker to remove herself.

• The CPD provider organization sends a letter to Dr. Doe highlighting the CPD activity accreditation and professional standards that she was found to have contravened.

• Dr. Doe would not be invited to speak at future CPD activities developed by the physician organization.

• It is recommended that all accredited CPD providers have an appropriate strategy in place to deal with potential conflict of interest that becomes apparent during a live activity.

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An international respirology conference is being hosted in France by an international physician organization. The physician organization has identified a significant number of participants from North America and Europe and therefore would like to have the Conference accredited for American, Canadian, and European respirologists.

The American Medical Association (United States), Royal College (Canada), and European Union of Medical Specialists (UEMS) have international CPD credit agreements allowing for the conversion of certain credits between systems.

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Q/Given the location, specialty, and existing credit agreements, what process could the physician organization follow so that the conference participants can record CPD credits within the MOC Program?

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A/ The international physician organization should apply to the European Union of Medical Specialists (UEMS) for ECMEC credits. These credits can then be converted to Royal College MOC Section 1 credits as per the agreement that is in place.

Note: A Royal College accredited CPD provider is permitted to accredit such an activity directly for Royal College MOC Section 1 credits. However, if a Canadian accredited CPD provider does the accreditation, the conversion of MOC Section 1 credits for American or European physicians would not be permissible under the international accreditation agreements.

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A CPD program developed by a physician organization and accredited by an accredited CPD provider includes many components where participants:

a) Read one journal article

b) Read one book chapter

c) Watch a 30 minute podcast

d) Participate in a full-day group learning activity either by: • Attending in-person at a local hotel • Attending via webinar whereby the learner can see and listen to the

lectures, ask questions, and interact with other learners via webchat. e) Complete an online 20 question multiple-choice assessment

program where their individualized results identify the questions they answered correctly and incorrectly. References are provided for the correct answer.

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Question 1 of 2

How should participants record their learning within the MOC Program? What components, if any, should be accredited for MOC credits?

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Q1 of 2

A/ The components may be claimed within the MOC Program Framework as below:

a) Section 2, journal reading= 1 credit per article. No accreditation required.

b) Section 2, reading a book chapter = 2 credits per chapter. No accreditation required.

c) Section 2, podcast = .5 credits per activity

d) Section 1, accredited group learning = 1 credit per hour (both the in-person participants and those participating via webinar). Accreditation required

e) Section 3, accredited self-assessment programs = 3 credits per hour (participants should claim the time they spend answering the questions, reviewing and reflecting on their data, and discussing their feedback with a colleague). Accreditation required.

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Question 2 of 2

Given the number of components of this CPD activity, how might you recommend the certificate of participation be designed?

How many certificates would you provide?

Which statements should be included?

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Q2 of 2

A/ It is recommended that one certificate of attendance be provided the total number of credits per section. The accreditation statements for MOC Section 1 (group learning) and MOC Section 3 (self-assessment program) should be provided.

It is also recommended that a transcript be provided detailing which components each participant should claim within the MOC Program. Each component will have to be entered separately by the learner into the MAINPORT ePortfolio.

In summary: one certificate of attendance but when documenting in the MAINPORT ePortfolio, individual entries are required per credit type.

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A physician organization is planning a live, face-to-face knowledge assessment activity whereby:

• Participants complete a 10-question pre-test (multiple choice questions; answers recorded on an iPad)

• A faculty member delivers a 20 minute lecture

• Participants complete a 10-question post-test (multiple choice questions; answers recorded on an iPad)

• Participants are emailed an answer key 14 business days after the assessment activity takes place. The answer key only includes the correct answers to each question

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Q/ Can the live, face-to-face knowledge assessment activity be accredited for MOC Section 3 credits?

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A/ No. The Royal College MOC Section 3 accreditation standards require that learners be provided within individualized feedback. This feedback must identify the questions that the learner answered correctly, the questions that were answered incorrectly, and the reference(s) for the correct answers. Only providing an answer key to learners without providing any data or feedback around their performance in the tests does not meet the accreditation standards.

In order for this session to meet the Section 3 accreditation standards, it would be recommend that the post-test automatically correct the participant’s responses, provide references for the correct answer, and email each participant’s responses directly to them. If this technology is not available, personalized audience response systems could be used to provide feedback to learners about their knowledge. To enhance the learning experience, the faculty members could engage learners in a discussion after the lecture and post-test have taken place.

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BONUS: The CPD provider organization would be strongly encouraged to aggregate the pre-and post-test data which could be used to:

- Identify unperceived learning needs of their target audience.

- Contribute to CPD activity evaluation strategies beyond the participants’ self-reported achievement of the session’s learning objectives.

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PART 3

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“What’s on your mind?”

Using the blank card at your table ~as a group or individual~ write down questions, cases, issues that remain outstanding for you.

Discuss the issue with your group. Can you resolve it together?

Please leave the card on your table.

We will collect the cards and commit to following up through further discussions, the CPD Accreditation Bulletin, FAQs or future cases.

Thank you!

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How did we do?

Are you now able to:

• Evaluate applications against current Royal College CPD accreditation standards.

• Provide feedback to applicants on how to improve submissions to meet Royal College CPD accreditation criteria.

• Identify at least one area for enhancement in their CPD programs.

Conclusions

• What do you think of the format?

• Any other interesting cases? Keep ‘em coming!

[email protected]

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mailto:[email protected]



Conclusions

Thank you!

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