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188 Nancy L. Davis and Norman B. Kahn, Jr. chapter 16 The History of Evidence-Based Continuing Medical Education in the United States The American Academy of General Practice (AAGP), now the American Academy of Family Physicians (AAFP), was the first medical specialty society to require ongoing continuing medical education (CME) for continued membership. In response to its bylaws of incorporation in 1948, the AAGP created a system for reviewing and approving CME activities. AAFP-prescribed credit remains the CME currency for family physicians today and is accepted by all state licensing boards as equivalent to American Medical Association (AMA) Physician’s Recognition Award (PRA) Category 1 credit. The Genesis of Evidence-Based CME In the late 1990s, the AAFP struggled with how to handle the ever-increasing number of complementary and alternative medicine (CAM) topics being submitted for CME credit approval. Some AAFP members supported these controversial topics while others condemned them. Some felt CAM should be considered within the scope of family medicine, some felt family physicians should be aware of these modalities so they could appropriately counsel their patients, and others felt CAM should not be practiced. In early 1999, the AAFP Commission on Continuing Medical Education (COCME) led by Washington physician Larry Johnson, MD, made CAM a central focus of its agenda; a decision needed to be made regarding the management of CAM in CME. According to Johnson, the COCME wished to ensure all activities were evaluated consistently. At its January 1999 meeting, the COCME invited Murray Kopelow, MD, CEO, of the Accreditation Council for Continuing Medical Education (ACCME) as a guest. Dr. Kopelow suggested that if all CME were evidence based, then all CME could be judged by the same consistent standards . There would be no need to single out CAM topics. As a result of these early discussions, the AAFP formed a Subcommittee on Clinical Content in June 1999 that included members of the AAFP commissions on CME, education, clinical policies and research, health care services , quality, and scope of practice. The subcommittee identified three family physician evidencebased medicine experts to advise the group on an evidence-based approach to CME. Montana State University’s Robert Flaherty, MD, had served on the COCME and was named to the subcommittee along with Mark Ebell, MD, of the Medical College of Georgia, and Lee Green, MD, of the University of Michigan. The subcommittee ’s charge was to design a process for an equitable , evidence-based approach to evaluate CME content and a corresponding process for CME U.S. Evidence-Based CME / Davis & Kahn Jr. 189 providers to develop evidence-based CME content . The subcommittee accepted evidence-based medicine expert David Sackett’s definition of evidence-based medicine: ‘‘the integration of current best research evidence with clinical expertise and patient values.’’∞ In January 2000, the subcommittee invited representatives of external stakeholders in the CME environment to join the group. They included Kopelow of the ACCME; Dennis K. Wentz, MD, AMA Continuing Physician Professional Development (new AMA PRA director Charles Willis, MBA, joined in 2002); Robert Avant, MD, American Board of Family Medicine (ABFM); Delores Rodgers, American Osteopathic Association (AOA); Dale Austin, Federation of State Medical Boards (FSMB); and Bernard Marlow, MD, College of Family Physicians of Canada (CFPC). The addition of these representatives ensured harmonization across the three US and one Canadian CME credit systems and regulators (i.e., AMA, AAFP, ACCME, AOA, and CFPC) and support from the major consumers of CME credit (i.e., the state medical licensing boards—FSMB—and the certifying board in family medicine—ABFM). These stakeholders supported the concept of evidence-based CME (EBCME) content. Willis had a special interest from the perspective of the AMA PRA credit system : ‘‘This was useful to the AMA. We did not approve individual activities but were being challenged by ‘dangerous’ topics, such as anti-aging remedies, that we couldn’t counter without some definition of evidence-based CME.’’≤ The result of this work was the first iteration of EBCME, which was piloted in 2000–2001. Among the criteria were choices of 10 approved evidence-based medicine sources (see Box 16-1) and six approved evidence-based rating scales (see Box 16-2) that allowed physicians to choose a source and rating scale with which they were familiar. Eventually, this scheme was modified into the Strength of Recommendation Taxonomy (SORT) system that is used to evaluate evidence in medical literature (see Box 16-3). The AAFP Box 16-1 Original List of...

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