Activity Types

• Live Activities
• Enduring Materials
• Internet Guidelines
• Journal Based
• Performance Improvement
• Speaker Credit/Learning from Teaching

---

Live Activities

A live activity is a certified CME activity that occurs at a specific time as scheduled by the accredited CME provider. Participation may be in person or remotely as is the case of teleconferences or live Internet webinars. These may be offered through a variety of delivery mechanisms; examples include, but are not limited to, national, regional or local conferences, workshops, seminars, regularly scheduled conferences, journal clubs, simulation workshops, structured learning activities presented during a committee meeting and live Internet webinars.

To be certified for AMA PRA Category 1 Credit™, a live activity must:

• meet all core requirements for certifying an activity.

Designating, claiming and awarding credit for participation in a live activity

• Credit designation for each live activity is determined by measuring formal interaction time between faculty and the physician audience; 60 minutes of physician participation in a certified live activity equals one (1) AMA PRA Category 1 Credit™; credit is designated in 15 minute or 0.25 credit increments; accredited CME providers must round to the nearest quarter hour.
• Physicians should claim credit based on their participation time in 15 minute or 0.25 credit increments; physicians must round to the nearest quarter hour.
• The time for simultaneous certified sessions within a live activity can only be counted once toward the designated maximum.
• Only segments of the live activity that comply with the AMA core requirements may be certified for AMA PRA Category 1 Credit™. These certified segments must be clearly identified in the activity materials and included in the designated maximum amount of credit.

Source: AMA Physician's Recognition Award and credit system 2010 Booklet

---

Enduring Materials

NOTE: On February 25, 2014, the ACCME announced the 2014 Simplified Polcies that affect the requirements of Enduring Materials. Contact the CME program to clarify the simplified policies.

Enduring materials are printed, audio, video or electronic activities, including internet, computer-assisted instruction, and broadcast activities. To be designated for credit, enduring materials must:

• comply with the guidelines for category I activities.
• disclose principal speakers and their credentials*.
• disclose contributor support*.
• disclose medium or combination of media used*.
• contain clear instructions to the learner on how to successfully complete the activity to earn credit.
• communicate to the learner the minimum performance level that must be demonstrated in the assessment in order to successfully complete the activity*.
• have estimate of time to complete the educational activity*.
• provide access to supplemental materials to reinforce and clarify specific information.
• prove access to appropriate bibliographic sources to allow further study*.
• medium or combination of media used*.
• record and verify participation.
• provide an assessment of the learner that measures achievement of the educational purpose and/or objective(s) of the activity with an established minimum performance level; this may include, but is not limited to, patient-management case studies, a post-test and/or application of new concepts in response to simulated problems.
• be evaluated at least once every three years, or more frequently if indicated by new scientific developments. (Findings from the evaluation process must be used by the planning committee and departmental administration to revise, update, or plan future versions of the enduring material.)
  • date of original release*
  • most recent review or update*
  • termination date*

* Providers of enduring materials must communicate the above information to participants so that they are aware of this information prior to starting the educational activity.

Designating and awarding credit for participation in an enduring material

• Credit designation for each enduring material must be determined by a mechanism developed by the accredited CME provider to establish a good faith estimate of the amount of time a physician will take to complete the activity to achieve its purpose and/or learning objectives (e.g. the average time it takes a small sample group of the target audience to complete the material); credit is designated in 15 minute or 0.25 credit increments; accredited CME providers must round to the nearest quarter hour.
• Credit should be awarded only to physicians who meet at least the minimum performance level on the assessment as established by the accredited CME provider.

Guidelines for Contributors of Enduring Material

• Product specific advertising of any type is prohibited in enduring materials
• Contributors must be acknowledged, however, acknowledgement must be placed only at the beginning of the enduring material
• Wright State University acknowledgment may state
  • name of the institution
  • mission
  • areas of clinical involvement of the institution
  • corporate logos and slogans, if they are not product promotional in nature

The Standards for Commercial Support and the Standards for Enduring Materials do not prohibit distribution of certified enduring materials by commercial representatives directly to physicians.

---

Internet Guidelines

NOTE: On February 25, 2014, the ACCME announced the 2014 Simplified Polcies that affect the requirements of Internet CME. Contact the CME program to clarify the simplified policies.

Live or enduring material activities that are provided via the Internet are considered to be "Internet CME." To be designated for credit, Internet CME must
Requirements

• Comply with the guidelines for category I activities
• For CME activities in which the learner participates electronically (e.g., via Internet, CD-ROM, satellite broadcasts), all required ACCME information must be transmitted to the learner prior to the learner beginning the CME activity. All new CME activities released on or after January 1, 2008 must conform to this policy. Existing CME activities that are reviewed and re-released after January 1, 2008 must conform to this policy.
• The accredited provider must have a mechanism in place for the learner to be able to contact the provider if there are questions about the Internet CME activity.
• The hardware and software required for the learner to participate must be identified at the start of each Internet CME activity.
• A contact must be identified for the learner to be able to ask questions about the Internet CME activity.
• The policy on privacy and confidentiality that relates to the CME activities provided on the Internet may be found at the CME privacy statement.
• Internet activities must document ownership of copyright, or demonstrate that the provider has received permissions for use of, or is otherwise permitted to use copyrighted materials within a CME activity on the Internet.
• CME activities shall not appear on a pharmaceutical or device manufacturer's product website.
• Links from a Wright State University Boonshoft School of Medicine sponsored activity to pharmaceutical and device manufacturers' product websites are only permitted before or after the educational content of the CME activity, but shall not be embedded in the educational content of a CME activity.
• There shall be clear notification that the learner is leaving the educational Web site.
• Advertising of any type is prohibited within the educational content of CME activities on the Internet including, but not limited to, banner ads, subliminal ads and pop-up window ads.
• If the activity is meant to endure, it must follow additional guidelines described in the enduring materials policy

---

Journal Based

NOTE: On February 25, 2014, the ACCME announced the 2014 Simplified Polcies that affect the requirements of Journal-Based CME. Contact the CME program to clarify the simplified policies.

A journal-based CME activity is a certified CME activity in which an article, within a peer-reviewed, professional journal, is certified for AMA PRA Category 1 Credit™ prior to publication of the journal.

To be certified for AMA PRA Category 1 Credit™, a journal-based CME activity must:

• comply with the guidelines for category I activities.
• be a peer-reviewed article.
• communicate to participants all required information (see enduring materials guidelines).
• provide an assessment of the learner that measures achievement of the educational purpose and/or objective(s) of the activity with an established minimum performance level; this may include, but is not limited to, patient-management case studies, a post-test and/or application of new concepts in response to simulated problems.
• communicate to the participants the minimum performance level that must be demonstrated in the assessment in order to successfully complete the activity for AMA PRA Category 1 Credit™.
• does not contain any advertising or product group messages of 'commercial interests'. Disclosure information cannot contain trade names. The learner should not encounter advertising within the pages of the article or within the pages of the related questions or evaluation materials.

Designating and awarding credit for participation in a journal-based CME activity

• The ACCME does not consider a journal-based CME activity to have been completed until the learner documents participation in that activity to the provider.
• Accredited CME providers should designate individual articles for one (1) AMA PRA Category 1 Credit™.
• Credit should be awarded only to physicians who meet at least the minimum performance level on the assessment as established by the accredited CME provider.

---

Performance Improvement

 Performance Improvement (PI) activities must follow the AMA Guidelines and include all three stages of PI:

1. Identification of local practice gap through assessment of current practices;
2. Creation of educational objectives and formulation of an appropriate intervention based on results from first stage; and
3. Targeted Evaluation Strategy through re-assessment of practices resulting from the second stage and compared to the results of first stage.

A physician must begin a PI CME activity with Stage A to receive any credit.

Request for additional funding for PI activities should be submitted in conjunction with the CME application and must include a clear outline of the activity, targeted audience and time-frame. (See: Reserve Fund)

Performance Improvement Guidelines

The following guidelines come directly from the AMA PRA and Credit system booklet.

Performance improvement (PI) activities describe structured, long-term processes by which a physician or group of physicians can learn about specific performance measures1, retrospectively assess their practice, apply these measures prospectively over a useful interval, and re-evaluate their performance. To award AMA PRA Category1 Credit for PI activities, providers must:

• Establish an oversight mechanism that assures content integrity of the selected performance measures. These measures must be evidence based2 and well designed (e.g., clearly specify required data elements, data collection is feasible). PI activities may address any facet (structure, process or outcome) of a physician's practice with direct implications for patient care.
• Provide clear instructions to the learner that define the educational process of the PI activity (documentation, timelines, etc.) and establish how they can claim credit.
• Validate the depth of physician participation by a review of submitted PI activity documentation. Providers may award credit to physicians for completing defined stages of the PI activity. When requested, supply specific documentation of such credit to participating physicians.
• Provide adequate background information so that physicians can identify and understand the performance measures that will guide their PI activity, and the evidence base behind those measures. Providers may deliver this education through live activities, enduring materials or other means. Providers must ensure that participating physicians integrate all three stages described below to develop a complete, structured performance improvement activity.
  • Stage A: Learning from current practice performance assessment
    Assess current practice using identified performance measures, either through chart reviews or some other appropriate mechanism. Participating physicians should be actively involved in data collection and analysis.
  • Stage B: Learning from the application of PI to patient care
    Implement an intervention based on the performance measures selected in Stage A, using suitable tracking tools (e.g., flow sheets). Participating physicians should receive guidance on appropriate parameters for applying an intervention and assessing performance change, specific to the performance measure and the physician's patient base (e.g., how many patients with a given condition, seen for how long, will produce a valid assessment?).
  • Stage C: Learning from the evaluation of the PI effort
    Re-evaluate and reflect on performance in practice (Stage B), by comparing to the assessment done in stage A. Summarize any practice, process and/or outcome changes that resulted from conducting the PI activity.

Assigning Credit for PI Activities

Physicians may be awarded incremental AMA PRA Category 1 Credit for completing each successive stage of a PI activity. Incremental credit for PI activities should be awarded as follows:

• Five (5) AMA PRA Category 1 Credits can be awarded for the completion of each of the three stages (A, B and C). Completion of the full PI cycle is not required.
• Providers may design PI activities so that physicians can enter at any of the three stages. Providers that do so must design a mechanism by which physicians who enter after stage A can document their completion of work equivalent to that described for the earlier stages.
• Physicians completing, in sequence, all three stages (A - C) of a structured PI activity may receive an additional five (5) AMA PRA Category 1 Credits, for a maximum of twenty (20) AMA PRA Category 1 Credits. This credit allocation acknowledges the best learning is associated with completing a well conceived PI activity.

¹ A clinical performance measure is a mechanism that enables the user to quantify the quality of a selected aspect of care by comparing it to a criterion. (Institute of Medicine, 2000)

² Evidence based medicine is "the integration of best research evidence with clinical expertise and patient values." Sackett DL, Strauss SE, Richardson WS, et al. "Evidence-based medicine: How to practice and teach EBM." Second edition. London: Churchill Livingstone; 2000.n, contact Faculty and Clinical Affairs.

---

Speaker Credit/Learning from Teaching

"Learning from Teaching," commonly known as speaker credit, is an activity type developed by the AMA. A speaker may receive credit for the preparation, not the teaching, of an original presentation as part of anAMA PRA Category 1 Credit™ activity. No credits are given for repeat presentations of the same material. It is the responsibility of the physician to only claim the credit once, and credit may not be simultaneously earned as both a presenter and learner.

The AMA defines credit for “learning from teaching” to be a 2:1 ratio. For example:

• If a speaker taught for 1 hour, the “learning from teaching” eligibility would be two AMA PRA Category 1 Credit™.
• If a speaker taught for 15 minutes, the “learning from teaching” eligibility would be 0.5 AMA PRA Category 1 Credit™.

The application is attached to the Conflict of Interest Disclosure document. The application documents the development of individual gap analysis, goals, learning intervention, and outcomes.  

The CME Director will review the application. Improvements in documentation may be required before credit is provided. Applications for this credit must be made no later than 30 days after the event.

Sample Speaker Credit Application (PDF)