ABSTRACT
As the physician learning environment becomes more global, the importance of a common language for CME/CPD is becoming increasingly important in order that physicians, the regulatory community, and the public may grasp the meaning of particular terms and understand the context in which they are being used. Establishment of a common language for continuing professional development is essential for developing substantive equivalency agreements among regulatory jurisdictions and improving the quality of CME/CPD systems worldwide. The International Academy for CPD Accreditation (IACPDA) developed a glossary of commonly used terms and consensus-based definitions of those terms. There is not an expectation that accrediting bodies must change their terminology to conform to the glossary. Rather, the intent is for the glossary to facilitate greater understanding and potential for harmonization of standards among CME/CPD accreditors, certifying boards, medical regulatory authorities and other stakeholders, thus enabling improvement worldwide in the quality of CME/CPD activities in which health professionals participate, and therefore improvement in their competence and practice performance. This article highlights synergies created by a standardization in CME/CPD terminology and summarizes the methodology used, and design of, the new glossary of terminology by the IACPDA. While the IACPDA has identified modifications and enhancements to be incorporated into future updates, the current glossary is already publicly accessible. The IACPDA welcomes comments from all stakeholders, including the medical regulatory community.
Introduction
Continuing Medical Education (CME) and Continuing Professional Development (CPD) play a central role in the efforts of most medical regulatory authorities to ensure that licensees remain current in their areas of practice by engaging in relevant learning activities. As the physician learning environment becomes more global, the importance of a common language for CME/CPD is becoming increasingly important in order that physicians, the regulatory community and the public may grasp the meaning of particular terms and understand the context in which they are being used. A common CME/CPD language is also essential for developing substantive equivalency agreements between/among jurisdictions and for improving the quality of CME/CPD systems around the world.
However, only a few studies have been published that analyze similarities and differences in the terminology and criteria used by various CME/CPD accreditation, licensure, certification, or revalidation systems around the world.17–19 ,26 ,28–29 Even fewer studies have been published regarding the outcomes of efforts to improve the harmonization among systems.4 ,16 ,23 ,27 While several CME/CPD accreditation systems are evolving to facilitate continuous improvement in the competence and performance of health care providers,20 full implementation of competency-based CME/CPD will require innovation in the means by which learning and practice improvement are captured and conveyed.8 For such innovation to occur, mechanisms are needed to support shared understanding and synergy. One such mechanism — perhaps the most fundamental mechanism — is the development of consensus on commonly used terminology and definitions in CME/CPD.
To facilitate the development of a common CME/CPD language, the International Academy for Continuing Professional Development Accreditation (IACPDA) initiated a project to create a glossary that defines a set of commonly used terms (see Table 1). While the IACPDA membership is currently limited to CPD/CME accreditors and physician regulatory bodies, and not all physician organizations are IACPDA members, the IACPDA recognizes the initial work represented in this first version of a glossary could be further developed and extended to other health care professional accreditors and regulators worldwide.
International Academy for CPD Accreditation Glossary
The International Academy for CPD Accreditation (IACPDA)
The IACPDA is a network of colleagues dedicated to promoting and enhancing CPD accreditation systems throughout the world. It is also devoted to assisting and supporting the development, implementation and evolution of CPD and CME accreditation systems throughout the world. Established in 2013, the IACPDA serves as a platform that facilitates peer-to-peer support for leaders of CPD/CME accreditation systems and encourages networking, mentoring and interactions about common issues. Members of the IACPDA represent 22 organizations in 16 countries.
It should be noted that the IACPDA does not include representation from all CPD/CME accreditors in each country in which it is active. In the United States, for example, as seen in Table 2, members are the Accreditation Council for Continuing Medical Education, the American Academy of Family Physicians and the Federation of State Medical Boards.
Members of the IACPDA
Study Concept and Design
The IACPDA recognized that, with an international membership and a growing need for harmonization among CME/CPD accreditors and regulators, it would be essential to develop a common glossary to inform the future work of the IACPDA and the many stakeholders with whom its members collaborate. These include continuing education providers, accreditors, licensing and certifying boards and other external evaluators. The IACPDA recognized that, while similar terminology may be used by the IACPDA's members and their respective stakeholders, those words are at times interpreted quite differently among various geographies or CME/CPD accreditation system communities. For example, the term “accredited” may refer to a specific educational activity or to an organization that provides continuing education. The IACPDA also recognized that a common glossary would be helpful in completion of many other potential projects, including a survey of international accreditation systems to be completed by member and non-member organizations, substantive equivalency of CME/CPD accreditation systems and establishment of consensus statements (Figure 1).
The Glossary as a Foundation for the Future
Methodology
The IACPDA formed a project team made up of a subset of its membership to research and analyze current interpretations of commonly used terminology in order to develop a glossary for use by the CME/CPD accreditation and medical regulatory communities. The IACPDA Glossary Project Team contacted all IACPDA members by email, asking them to provide for review their organizations' respective glossaries, as well as any other glossaries or publications that may have relevance to the project. The team received 10 distinct glossaries from IACPDA members, which contained more than 80 terms. Those were aggregated into one consolidated document.
Terms were classified based upon their relationship to the following categories: accreditation, activity, advertising/sponsorship, compliance, conflict of interest, continuing medical education, continuing professional development, credit, educational grant, evaluation, exhibitor, faculty, objectives, needs, organizations, planning committee and provider. The categorization of these terms was helpful to identify frequency of use and understand where prioritization should be placed; for example, with 14 different definitions of “activity,” this term could have the highest likelihood for misunderstandings between IACPDA member organizations.
The team also reviewed the notes from past IACPDA meetings and the project scope documents to determine which terms IACPDA members most frequently utilized and thus those for which common definitions would be most essential. Those four terms included accreditation, accreditor, continuing professional development and continuing medical education.
Additional input received during the process of soliciting member glossaries, as well as through discussion at IACPDA meetings (both in-person and via teleconference) facilitated identification of the following terms as priorities for the first draft of the glossary: competence, credits/units, knowledge, needs assessment, patient health and performance.
The team then identified a total of 15 terms for which definitions would be drafted: accreditation, accreditor, activity, commercial interest, commercial support, competence, continuing medical education, continuing medical education provider, continuing professional development, credits/units, independence in CME/CPD, knowledge, needs assessment, patient health and performance.
To prepare to draft definitions, the team reviewed the 10 documents received from IACPDA members. The team also performed a review of scholarly literature and a thematic analysis of reference documents obtained.
Once the team had created a first draft of terms and definitions, the draft was shared with the entire IACPDA membership for feedback. After three rounds of review and feedback the glossary was finalized (Figure 2).
Glossary Development Process
Results
Upon compiling the 10 glossaries received from member organizations, the categories and terms in Table 3 were found to be the most frequently cited.
Categories and Terms for Definition
The review of submitted member glossaries and thematic analysis of scholarly literature identified the following five terms as being similarly defined whenever mentioned in the various reference documents:
Activity
Credit/unit
Learning outcomes
Needs assessment
Independence
Conversely, the following terms were found to vary considerably when defined in the various reference documents:
Accreditation
Provider
Continuing Medical Education
Continuing Professional Development
Commercial Interest
The resulting IACPDA glossary, containing 15 terms and definitions, is available on the IACPDA website for use as a resource to members and non-members, including the entire medical regulatory community. It can be accessed at the following address: https://academy4cpd-accreditation.org/cpd-accreditation-glossary/. It is intended to inform and support CME/CPD accreditors, continuing education provider organizations, health care professional learners, certifying and licensing boards, medical regulatory authorities, grant funders, technology vendors, other external evaluators and CME/CPD stakeholders.
Discussion
When a term carries distinct definitions, there is a risk that the intended use of the term will not be understood. For example, in some systems, the term “accreditation” refers to the act of an accreditor awarding credit directly to an educational activity; while in other systems, the term “accreditation” refers to the act of approving a continuing education provider organization to have the authority to award continuing education credit to the activities that organization provides. In that instance, the team determined it was best to develop a hybrid definition: “The framework by which an educational activity is reviewed by an Accreditor or an accredited CPD provider organization to ensure the activity meets the Accreditor's requirements and/or the process by which the Accreditor reviews and approves the organization as an accredited provider.”
Another example was terminology for CME and CPD. The team found that many organizations used the terms CME and CPD as essentially synonymous, while other organizations defined CPD broadly, with CME being a subset of CPD. As a result of these differences, the team determined it would define CPD as a broader term, inclusive of CME: “The learning journey of the healthcare professional as he/she seeks to improve his/her competence and expertise. This learning journey is supported by continuing medical education and other personal/professional activities by the learner with the intention of providing safe, legal and high-quality services aiming at better health outcomes for the patients and the community.”
THERE WAS CONSENSUS THAT THE CREATION OF THE GLOSSARY DID NOT MEAN MEMBER ORGANIZATIONS MUST CHANGE TERMS IN THEIR RESPECTIVE SYSTEMS.
Throughout this process the team wanted to be as inclusive of the various member organizations' accreditation systems as possible. The team even considered having an index of definitions, or listing multiple definitions for single terms in lieu of coming to consensus on common definitions. If, for example, the terms “competence” or “performance” are defined differently, it could potentially mislead or confuse learners, CPD provider-organizations and accreditors. If an activity was promoted or reported to an accreditor as facilitating improvements in performance but really only measures improvements in competence, then learners would not get what they invested their time and money in, the CPD provider organization could be found non-compliant and, finally, this would create challenges between accreditors, especially if reciprocity or substantive equivalency agreements are in place. The IACPDA determined it was best to come to consensus on a single definition for each term to best facilitate its work. There was consensus that the creation of the glossary did not mean member organizations must change terms in their respective systems.
Conclusions
The IACPDA has already identified future modifications for the glossary and plans to make updates as needed. The IACPDA plans to define the following terms in future updates of the glossary: physician organization, conflict of interest, outcome, balance (in educational content), evaluation and assessment.
The establishment of a common understanding of these terms and the various definitions which guide their use will contribute to common standards for CME/CPD accreditation, greater ability for learners and continuing education provider organizations to understand and adhere to standards in various geographies and jurisdictions, and improvements in the quality of CME/CPD activities globally.
As state medical and osteopathic boards in the United States rely on the work of CPD accreditors to ensure high-quality learning activities for licensees, a glossary of common terms will facilitate a shared understanding across the many American regulatory jurisdictions.
Further, as requirements for licensee engagement in CPD as a condition of license renewal continue to evolve, it is presumed that licensees will continue to complement their domestically focused learning and improvement opportunities with those offered abroad. As such, it will be increasingly important for boards to understand the terminology used in international jurisdictions in order to reward meaningful engagement and verify compliance.
Acknowledgments
The authors gratefully acknowledge the support of the members of the International Academy of CPD Accreditation (IACPDA), as well as the Royal College of Physicians and Surgeons of Canada for its in-kind support of the IACPDA.
About the Authors
↵Amy L. Smith, MBA, is Senior Manager of Credit Systems and Compliance at the American Academy of Family Physicians.
↵Kate Regnier, MA, MBA, is Executive Vice President at the Accreditation Council for Continuing Medical Education.
↵Mindi K. McKenna, PhD, MBA, is Continuing Medical Education Division Director at the American Academy of Family Physicians.
↵Mark L. Staz, MA, is Director of Continuing Professional Development at the Federation of State Medical Boards.
↵Mya A. Warken formerly served as Team Lead, CPD Accreditation, at the Royal College of Physicians and Surgeons of Canada; she is currently Accreditation Program Specialist at Engineers Canada.
- Copyright 2018 Federation of State Medical Boards. All Rights Reserved.
References
- 1.“AAFP Credit System Guide.” www.aafp.org/dam/AAFP/documents/cme/accreditation/cme-credit-guide.pdf . American Academy of Family Physicians, Aug.2016. Web. 7 Sept. 2016.
- 2.“ACCME Glossary of Terms.” www.accme.org/news-publications/publications/tools/accme-glossary . Accreditation Council for Continuing Medical Education, Aug.2016. Web. 7 Sept. 2016.
- 3.Alkenizan A , ShawC. Impact of Accreditation on the Quality of Healthcare Services: A Systematic Review of the Literature. Ann Saudi Med2011;314(4):407–16.
- 4.↵Almudeo-Paz A , Brea-RieroP, Buiza-CamachoB, Rojas-De Mora FigueroaA, Torres-OliveraA. Skills Accreditation as an Impetus for Continuous Professional Development. Rev Calid Asist. 2011Jul–Aug;26(4):221–7.
- 5.Aparicio A , et al. Supporting Physician Lifelong Learning Through Effective Continuing Medical Education and Professional Development. J of Med Reg2016; 102(1):7–15.
- 6.Balmer JT. Transforming Continuing Education Across the Health Professions. J Contin Educ Nurs. 2012Aug;43(8):340–1.
- 7.Balmer JT. The Transformation of Continuing Medical Education (CME) in the United States. Adv in Med Ed Pact2013;4:171–182.
- 8.↵Campbell CM , ParboosinghJ. The Royal College Experience and Plans for the Maintenance of Certification Program. J Contin Educ Health Prof. 2013Fall;33Suppl 1:S36–47.
- 9.Chaudry HJ , et al. Ensuring Competency and Professionalism Through State Medical Licensing. JAMA2015; 313(18):1791–2.
- 10.“CME Center of Kuwait Institute for Medical Specialization — CPD. Glossary.” www.kims.org.kw/cme/ . CME Center of Kuwait Institute for Medical Specialization, Aug.2016. Web. 7 Sept. 2016.
- 11.“Council of Medical Specialty Societies - Glossary.” www.cmss.org/ . Council of Medical Specialty Societies, Aug.2016. Web. 7 Sept. 2016.
- 12.“EBAC Glossary.” www.ebac-cme.org/ . European Board for Accreditation in Cardiology, Aug.2016. Web. 7 Sept. 2016.
- 13.Havens C , MallinJ. Climate Change: It's Not About the Weather: Continuing Medical Education and Maintenance of Certification and Licensure. The Permanente Journal Summer2011;15(3)88–92.
- 14.“HPCSA CPD Guidelines_Glossary.” www.hpcsa.co.za/ . Health Professions Council of South Africa, Aug.2016. Web. 7 Sept. 2016.
- 15.“International Academy for Continuing Professional Development Accreditation.” https://academy4cpd-accreditation.org/cpd-accreditation-glossary/
- 16.↵Maillet B , MaisonneuveH. Long-life Learning for Medical Specialists Doctors in Europe:CME, DPC and Qualification. Press Med. 2011Apr;40(4 Pt 1):357–65.
- 17.↵Maisonneuve H , MatillonY, NegriA, PallaresL, VigneriR, YoungHL. Continuing Medical Education and Professional Revalidation in Europose: Five Case Examples. J Contin Educ Health Prof. 2009Winter;29(1):58–62.
- 18.McKenna MK , StazM. Trends in CPD Certification, Accreditation and Licensure in the US. Research poster presented at the annual conference of the International Society for Quality in Health Care (ISQua); 16–19 Oct 2016: Tokyo, Japan.
- 19.McKenna MK , StazM. Cutting Edge CME / CPD Accreditation, Certification and Licensure in the US and Other Countries. Research poster presented at the annual conference of the Society for Academic Continuing Medical Education (SACME); 16–20 May 2017: Scottsdale, Arizona, USA.
- 20.↵McMahon GT , AboulsoudS, GordonJ, McKennaM, MeuserJ, StazM, CampbellCM. Evolving Alignment in International Continuing Professional Development Accreditation. J Contin Educ Health Prof, 2016Summer;36Suppl 1:S22–6.
- 21.Moore D , GreenJ, GallisH. Achieving Desired Results and Improved Outcomes: Integrating Planning and Assessment Throughout Learning Activities. J Contin Educ Health Prof. Winter2009; 29: 1 — 15.
- 22.Nicklin, W, Fortune, T, van Ostenberg, P, O'Connor, E, McCauley, N. Leveraging the Full Value and Impact of Accreditation. Int J Qual Health Care (2017) 29 (2):310–312.
- 23.↵Novakovich EM. Impact of Accreditation Standards on the Quality of Continuing Nursing Education Activities as Perceived by the Learner. J Contin Educ Nurs, 2017Apr1;48(4):157–164.
- 24.Pomey MP , et al. Does Accreditation Stimulate Change? A Study of the Impact of the Accreditation Process on Canadian Healthcare Organizations. Impl Sci2010(5).
- 25.“Royal College - CPD Glossary.” www.royalcollege.ca/rcsite/home-e . Royal College of Physicians and Surgeons of Canada, Aug.2016. Web. 7 Sept. 2016.
- 26.↵Saltman DC , KiddMR, JacksonD, ClearyM. Transportability of Tertiary Qualifications and CPD: A Continuing Challenge for the Global Health Workforce. BMC Med Educ2012, 12:51.
- 27.↵Sellars J , ClouderL. Impact of the Accreditation of Clinical Educators Scheme: Reflections From One Higher Education Institution. Physiotherapy, 2011Dec;97(4):339–44.
- 28.↵Tran D , TofadeT, ThakkarN, RouseM. US and International Health Professions' Requirements for Continuing Professional Development. Am J Pharm Educ2014;78(6)1–9.
- 29.Vandendael K , Van HemelryckF, Federation of European Cancer Societies. Continuing Medical Education and its Accreditation — An Overview of the Situation in the European Union and in the US.
