Frequently asked questions on the College CME Scheme
The purpose of this FAQ is to attempt to provide background information as well as some implementation details on the College Scheme of Continuing Medical Education (CME). The information in this document serves as supplementary to the two "official" documents on CME: the "Academy-approved College Continuing Medical Education Programme" (referred as "College CME Scheme", see College Newsletter June 1996) and "Principles and Guidelines on Continuing Medical Education" published by the Hong Kong Academy of Medicine (referred here as "Academy CME Guidelines", see College Newsletter March, 1996).You will also found this FAQ at the College web site (http://medi.net.hk/~hkcpath/).
Last Update: 17.7.96
1. What is the purpose of CME?
The main objective of CME is to enable Fellows, having been qualified, to remain informed and up-to-date, and to maintain a high standard of practice through continuous professional development.
It is hoped that, through CME, there is greater participation in educational matters and hence promoting the standards of pathology. The College, just like all other Colleges within the Academy, has adopted a system based on the acquisition of CME points, and it intends to issue certificates of CME at the of each 3-year cycle to those who have accumulated 90 points.
College CME Scheme: 1
Academy CME Guidelines: 1
2. We have already many educational activities, why we need a CME scheme?
A structured and documented approach.
The reason for introducing a CME scheme is not to replace any existing educational activity. Rather, it is an attempt to provide a structured system to ensure that these educational activities take place on a persistent and formal basis. With the pressures of service commitments and the explosive growth of new knowledge, it is becoming increasingly important to have an organized way of promoting educational activities to keep abreast of developments and therefore maintain reasonably high standards of professional practice. Similar schemes have been operating for years in several medical colleges in the USA and other countries. The Royal College of Pathologists (UK) has fully implemented a system of CME since 1995, and the RCPath (Australasia) will also start one soon.
3. Is there any evidence that CME is effective ?
Professor FV Flynn, Director of CME of the Royal College of Pathologists of UK, has provided an answer to this question (RCPath Bulletin, Apr 94, p.15):
In a critical review of 50 objectively assessed and randomised controlled trials of CME, scrupulously selected from 777 reports in the literature, DA Davis, MA Thomson, AD Oxman and RB Haynes (JAMA 1991;268:1111-7) concluded that there was good evidence that CME enhanced the performance of participants. Evidence for its effectiveness in improving the outcome of patient care was also obtained but less impressive, probably because so many confounding factors would have intruded.
4. Should CME be compulsory?
There are arguments on both sides.
On the one hand compulsory participation in CME has been seen by some as demotivating and restricting our freedom of education and choice. On the other hand, it is argued that if maintenance and upgrading of standard is intended, then some form of compulsion is necessary. The Hong Kong Academy of Medicine, under which supervision the College's CME scheme is operating, has decided that CME participation should be compulsory to its Fellows of the Academy.
FAQ: 16, 17.
College CME scheme: 2.4
Academy CME Guidelines: 2c, 2e
College CME Scheme Development
5. How has the College's CME scheme come about?
Four years' of preparatory works on our own, and half a year under the direction and guidance of the Academy.
CME has been on the agenda of the College Education Committee since it started functioning in February, 1992. A survey done in 1993 clearly shows a consensus view of setting up CME scheme in Pathology. In July 1994, a half-day forum on CME was organised to provide a venue for Members and Fellows to express their views, concerns, and queries. Invited speakers from the Hong Kong College of General Practitioners, Royal College of Pathologists of Australasia, Hong Kong Society of Clinical Chemistry, andPost-graduate Training Programme in Medical Microbiology were also presented to share their experience on CME. With the suggestions and comments of members, in 1995 a pilot scheme on CME was developed, in which a modest target of 20 CME points in a one-year cycle was set initially. However, before the trial run of the pilot scheme, scheduled on 1 January 1996, the Academy took up the discussion of CME around September 1995, and the College put forth the pilot scheme to the Academy for consideration. The Academy has progressed quickly and the result of its deliberations was published in December 1995 as the "Principles and Guidelines on CME" (College's Newsletter March, 1996), to which all Colleges within the Academy must comply. A tight schedule has been set as the Academy would like to see CME to start in all Colleges in 1996. With invaluable comments from members and after several revisions, the Academy-approved College's CME scheme is now ready.
6. Why should we follow the Academy on CME? Why not Pathology, being a unique specialty, should have its own say in deciding what constitutes "educational activities"?
Having one CME scheme and different educational activities are not mutually exclusive. In fact, there is flexibility in the College CME scheme for you to design your own CME plan.
It is true that Pathology is a distinctive profession, but so are all other Colleges of the Academy. So the real question perhaps is whether the Academy should have a direct role in monitoring CME across all specialties of medicine. This aside, there are good reasons for having similar CME schemes among Colleges of the Academy: (a) satisfying the Academy CME requirements is required for Fellows to remain in the future Specialist Register, so the CME schemes of various Colleges should not differ too much; (b) comparable CME schemes would put us in line with all other Colleges in terms of competence and maintenance of high standards; and (c) for educational activities with cross-disciplinary interests reciprocal recognition may be possible among Colleges.
7. If the College CME scheme has to be approved by the Academy before it can be implemented, does the College has any say in the design of CME activities?
Yes, as long as these activities follow the "Principles and Guidelines of Continuing Medical Education" stipulated by the Academy.
The Academy has directed individual Colleges to design their own scheme for endorsement and approval. One may say that the Academy set up the CME framework, and the College fills in the contents. The College has some flexibility in, say, maximum CME points foreach type of activities. To change the framework, however, one needs the endorsement of the Academy. Nevertheless, as CME is a professional matter, the College feels strongly that we should be responsible for setting up and monitoring the standards of CME.
Academy CME Guidelines: 2a, 2b
8. Can the Academy of Medicine veto the decision of the College Educational Committee on matters relating to CME?
In fact the College's CME proposal has been revised several times before it is finally being approved by the Academy.
Academy CME Guidelines: 2a, 2b
9. Will the CME regulations be regularly reviewed by the College or the Academy?
The College will monitor the quality and standard of the CME activities and review the CME scheme continually which will be adjusted according to the needs of our members. Comments and suggestions from Fellows are important for the College in these reviewing processes. If necessary, especially when alterations of structure of the scheme is required, they will be forwarded to the Academy for consideration.
FAQ: 44, 45
10. What is a CME point?
It is the unit of measurement of CME activity, which equates with one hour of educational time.
In this context, an hour of "educational time" is an hour of audience participation in a Formal College Approved Post-graduate Meeting as defined in the College scheme. Only time actually devoted to education is counted. Breaks, lunch-hours, and other non-educational time should be excluded.
College CME Scheme: 4
Academy CME Guidelines: 4
11. What is a Cycle of CME?
A three-year period.
It is defined in the College CME Scheme as a continuous span of three years, and a new cycle will begin at the conclusion of the previous cycle. A cycle of three years instead of one is to allow flexibility in accumulating CME points. For easy monitoring, the commencement date is either 1 January or 1 July of each year. If you are newly admitted as a Fellow of the Academy, then the commencement of the first cycle should be within six months after the date of admission.
College CME Scheme: 3
Academy CME Guidelines: 3
12. How many CME points I need to accumulate in a three-year cycle?
In the same three-year CME cycle, you may accumulate CME points equally each year, or you may accumulate more points in one year and less in the others. However, for any single year you should have at least 15 CME points.
College CME Scheme: 7
Academy CME Guidelines: 7
13. When is the College CME scheme implemented?
1 July 1996.
All College CME schemes of the Academy would be implemented within 1996. In keeping with the January/July dates for the commencement of each cycle, that means the College's scheme has to go live on 1 July 1996.
FAQ: 5, 11
14. Now 1 July 1996 has passed and I have not registered for CME yet. Does it mean that all my previous educational activities will not be counted?
They will if your registered now.
If you are already a Fellow before 1 July 1996, you should send back your Registration Form as soon as possible, and must be before 30 September 1996, and the commencement of the first cycle is still 1 July 1996. Of course only those educational activities occurring after 1 July 1996, if approved, will be counted.
15. How difficult will it be to accumulate 90 CME points in a three-year cycle?
Most Fellows should be able to exceed this minimum requirement comfortably, whether you are working in a busy hospital or in private practice.
In the College scheme one point equates with one hour of CME so the College's requirement to accumulate 90 points over three years could be achieved by devoting 2.5 hours a month to CME. Comparing with the four hours per month in the UK Royal College of Pathologists CME scheme, our target should be more readily achievable.
Participating in the College's CME Scheme
16. Who are eligible to participate in the College's CME scheme ?
Participation in CME Scheme is not for Members and Associates. It is voluntary for Fellows of the College only if you are not a Fellow of the Academy, otherwise joining the College CME scheme becomes mandatory.
College CME Scheme: 2.3, 2.4
Academy CME Guidelines: 2c, 2d, 2e
17. Is participation in the College CME scheme mandatory?
Yes for Fellows of the Academy.
It is mandatory if you are a College Fellow and also a Fellow of the Academy, otherwise it is voluntary. The reason is that being a Fellow of the Academy, participation andfulfilment of an approved CME scheme is required for your name to be included and remained in the future Specialist Register. Failure to comply may lead to suspension of Fellowship of the Academy. Nevertheless, the Academy would like to give you the following message (Council of the Academy, 18 April 1996):
"The mention of sanction and suspension in the Academyˇ¦s guidelines on CME is in compliance with the Hong Kong Academy of Medicine Ordinance. This is intended to encourage CME and should not be viewed as a threat nor as an instrument of punishment to Fellows. Sanction is intended only to be used as a last resort. The Education Committee will receive representations and recommendations from the college concerned, and fair reason will govern deliberations."
College CME Scheme: 2.3, 2.4
Academy CME Guidelines: 2c, 2d, 2e
18. I am a Fellow of the College but not a Fellow of the Hong Kong Academy of Medicine, do I have to join the CME Scheme?
No, it is not compulsory for you join the CME Scheme.
However, if you choose to join, you will be certified by the College for completion of the CME requirements at the end of each three-year cycle.
19. How to participate in the CME Scheme?
1. Register for CME.
2. Participate in approved educational activities and accumulate CME points.
3. Submit an Annual Return each year.
The Registration, Application for Approval, Attendance, and the Annual Return forms can be obtained from the Secretary of the Education Committee, to whom you also send back the completed forms. Remember to make a record of your activities by (a) collecting attendance certificates, (b) signing a record of attendance provided by the activity organisers, who in turn should give you a document of attendance for you to submit your Annual Return annually, or (c) using the Attendance Form. At the end of each three-year cycle, a certificate will be issued to those participants who has accumulated a minimum of 90 CME points.
Approval for CME
20. Should all CME activities receive prior approval for it to be accredited?
"Yes". However, in order to cut down the amount of work involved, the College maintains a list of "pre-approved" activities.
Prior approval is necessary because the standard of activities varies and standards might slip. To start with, the College wish to scrutinising individual programmes before approving them for CME purposes but in the future "pre-approval" may be granted for a limited period of say 3 years, to those well-organized CME programs.
College CME Scheme: 5.1.3, 5.1.4, 5.2.1, 5.3.1, 5.4.4, 5.4.5
Academy CME Guidelines: 5c, 5.2, 5.3, 5.4b
21. What is "pre-approval"?
Activities or journals with blanket approval, for CME purposes, granted for all individual educational sessions of the activities or, in case of journals, articles published.
Pre-approved educational activities are usually regular pathology-related meetings organised by respectable bodies with a good track record. The activities should be open to all Fellows and preferably provide the organisers with feedback, in the form of participant assessment of its value. A limited period of up to 3 years may be given.
22. Where can I found a list of "pre-approved" activities?
Secretary of the Education Committee and the College web site.
The list includes both "pre-approved" programs and journals, and it will be maintained and updated continually by the Educational Committee and posted in the College web site.
23. Who should apply for CME approval, the participant or the organiser?
Normally it is the organiser.
The organiser of an activity should obtain prior approval for CME purposes from the College and notify the approval to the intended audience, for example, in the announcement of the activity. When application for approval is not made by the organiser, as in case of overseas scientific meetings, and "pre-approval" has not been granted for the activity, the participant has to apply for approval. The Application for Approval form is available from the Secretary of the Education Committee.
FAQ: 25, 40, 41, 42, 43, 47
24. Should I apply prior approval every time I plan for attending a scientific meeting?
Yes and no.
You should check with the organiser of the activity to see whether it has been approved for the College CME or has already been in the "pre-approval" list maintained by the Education Committee. If it is the case, then application for approval is not required, Otherwise, prior approval using the Application for Approval form should be obtained.
FAQ: 20, 21, 22, 23
25. I plan to attend an overseas scientific meeting which have CME accreditations by overseas educational bodies. Is there arrangement of reciprocal recognition?
No, but application for approval may not be necessary.
The College is receptive to activities traditionally accepted as CME by other pathology professional bodies, and the regular scientific meetings of these professional bodies are put in the "pre-approval" list. If the meeting you planned is in the list, application for approval is not necessary, otherwise prior approval is required.
FAQ: 20, 21, 22
Types of CME Activities
26. What activities will qualify for CME points ?
There are four major ways that CME points may be earned: (a) passive participation and (b) active participation in approved CME activities, (c) self-study, and (d)publication.
Passive participation means attending approved scientific meetings (eg International meetings, and meetings organised by the College, other medical Colleges, and pathology organisations) or educational meetings (eg clinico-pathological conferences, departmental seminars and journal clubs). The jargon that appears in the Academy' Guidelines and College's Scheme for these meetings is FCAPM (Formal College Approved Post-graduate Meeting).
Active participation includes chairing, lecturing, or presenting in a FCAPM.
Self-study includes doing self-assessment MCQ in pre-approved journals, joining slide-studying programs with CME accreditation, and writing summary after journal-reading. A list of pre-approved journals, which will be updated continually, can be obtained from the Secretary of the Education Committee as well as in the College web site.
For publications, only those related to pathology are accredited.
Other than these four main categories, some Fellows may also obtain CME points through two other types of activities: writing College-approved QA reports and being examiners for College examinations.
College CME Scheme: 5
Academy CME Guidelines: 5
27. Will it be necessary to undertake all four types of CME activity, can I get all my CME points by engage in only one type?
Not all four is required. However, because ceilings of CME points are set for each type, you cannot get enough CME points in just one type.
The aims of such design in the College's scheme are flexibility and practicality. It gives individuals freedom to tailor their CME according to their needs and the practicality of their being able to get involved in the different types of educational activity. Maxima of 45 to 75 points over a three-year cycle have been set for each of the four main categories of activity and consequently 90 points could be accumulated by involvement in only two. The scheme should therefore accommodate the needs of all practising pathologists, including those working in private practice or in academic centres.
College CME Scheme: 5.1.5, 5.2.2, 5.3.3, 5.4.6, 5.6.2, 5.10.3
Academy CME Guidelines: 5.10
28. How about self-study? Who is going to read the 100-word notes that document the activity?
The specialty coordinators of the Education Committee will enlist Fellows of the specialty to read these self-study written summaries.
To validate CME activity attributable to journal reading or other self-study activities certainly is both difficult and involves a lot of work. Hopefully, we only need to do this twice a year.
College CME Scheme: 5.1.3
29. Does the CME regulations discourage inter-disciplinary activities?
There is no such regulation in the CME scheme and it has never been the intention of the College to discourage such activities. On the contrary, the College consider interdisciplinary training, as well as acquisition of special knowledge not directly related to pathology, important as they serve to enrich our profession as a whole, and therefore should always be encouraged. It may be necessary, however, to balance between not to exclude all non-pathology-related activities on the one hand and not to be too liberal and to include activities that are at best only remotely related to our profession on the other.
30. Does the CME regulations discriminate activities not straightly pathology-specific but are needed in the running of a pathology laboratory, such as information technology and management?
The College takes a broad-minded view of CME and accepts management training, development of computer skills, communication skills etc. as appropriate for CME purpose as long as the content can be applied to the running of a pathology laboratory. This is important to ensure that the continuing education of our members extends beyond the restrictions of specialty education and covers other aspects of our lives that help us to do our jobs better.
31. Are traditional intra-hospital/institutional/departmental educational activities, such as journal clubs, departmentalseminars, and slide seminars counted as CME activities?
The question is how we can take their existing informal formats, the ones with good educational values, and fit them into more structured programs as laid down in the CME scheme. Therefore these activities need to be proposed to the Education Committee for approval. In general, approval will be given to those pathology-related activities that are of sufficient standard, have one or more Fellows of the College as speakers, and open to all Fellows.
FAQ 32, 40, 41, 42, 43
32. Will the CPCs and subspecialty meetings that I run for the clinicians in the hospital be recognised?
Yes, provided that...
If you really prepared for them and ensure that they are of good educational value then they will be. However, routine case review sessions without substantial preparation or educational value will not counted. Also, to earn CME points, you need to submit your proposal to the Education Committee for approval. If approved, you may earn 2 CME points for each completed 20-minute of active participation.
FAQ: 31, 40, 41, 42, 43
33. How about QA activities?
Collection of data for quality assurance is not CME; reviewing, presenting, and publishing of the findings could well be.
Following the Academy's guidelines, which have determined that QA activities in themselves do not attract CME points, the College's CME scheme awards 2 CME points for each College approved QA reports, up to a maximum of 20 points in one CME cycle. Please note that external QA programs with CME accredited by the organiser will be counted under the category of self-study.
College CME Scheme: 5.6
Academy CME Guidelines: 5.6
34. Why research activities are not recognized for CME purpose?
CME points have already been accredited for various aspects of the activities:summary of findings in literature search, the presentations, and the publications resulted from research.
College CME Scheme 5.5
Academy CME Scheme 5.5
35. Why are post-graduate teaching activities, other than those already counted under active and passive participation, not counted as CME activities?
This is based on the Academy's Guidelines, and applies to all Colleges.
Postgraduate education can be defined as the education undertaken by graduates in the training grades, whereas CME relates to the education received by those who have completed their training and qualified for independent practice. There is certainly some overlap between the two.
The College understands that proper postgraduate teaching involves considerable work in updating of information and preparation of materials. Given that many postgraduate teaching is already counted under active and passive participations, and publication, the Academy has decided not to count such activities by themselves.
College CME Scheme: 5.9
Academy CME Guidelines: 5.9
36. Why writing a book attracts the same CME points as writing a chapter, the effort involved is obviously very different?
They both get the maximum CME points awarded for a single publication.
Publications vary in the amount of work involved, and therefore it is difficult to award CME points in a consistent manner. As CME is aimed at maintaining the general standard of practice, it is important not to award too many points to a single publication just because it involve a lot of work or it is scientifically important. Therefore a ceiling for any single publication is necessary and, as a result, 10 CME points will be the maximum awarded for such activity under the Academyˇ¦s Guidelines and hence the College CME Scheme.
College CME Scheme: 5.4.4
Academy CME Guidelines: 5.4a
37. Why being an examiner in College examinations gains 10 CME credits per examination?
This is based on the Academy's Guidelines, and applies to all Colleges.
For your information, the UK College of Pathologists, which awards 5 CME points per examination up to a maximum of 30, as well as all other medical Colleges in the UK, accepts this as a way to gain CME points.
College CME Scheme 5.10
Academy CME Guidelines 5.10
38. What about all the teaching I do for the trainees, nurses, and laboratory technicians?
Yes, they count, if you have put time into preparation.
The same principles will apply as in post-graduate teaching. It is however important to realize that the main purpose of College CME scheme is for the continuing education of Fellows, so passive audience participation in these activities will not be counted.
College CME Scheme: 5.8
Academy CME guidelines: 5.8
39. Is the CME scheme targeted to increase the attendance at conferences and lectures?
No, this is not the main purpose.
Though there may be such an effect, this is certainly not the primary target of the College CME scheme. The main purpose of the CME Scheme is to establish a mechanism to keep Fellows informed and up-to-date, and to maintain a high standard of professional practice.
FAQ: 1, 2
College CME Scheme: 1
Academy CME guidelines: 1
Organizing CME activities
40. What should I do when organising educational activities for CME purposes?
Submit an application for approval to the College Education Committee.
The application should include the following:
(b)Organisers and coordinators
(c)Date/Frequency and duration
(f)Speakers and the topic of each session
(I)Number of CME points proposed
FAQ 41, 42, 43
41. Before I submit my proposal for consideration, are there any special points I should be aware of?
Special attention should be paid to (a) Content, (b) Speaker, (c) Venue, (d) Audience, and (e) Evaluation.
The content should be targeted to the educational needs of the intended audience, such as that covers significant recent advances relevant to the practice of our Fellows. The speakers should be accepted experts in their field and good communicators. The venue should be both practical and convenient for the intended participants. The target audience should be Fellows. Ideally the organisers should include evaluation of the proposed activity such as by providing participants with a means by which they can easily record their rating of the relevance, quality and effectiveness of the activity.
FAQ: 40, 42, 43
42. What are the responsibilities of the organiser when approval for CME is granted?
(a)Inform the intended audience, for example in the program announcement, the number of CME points approved.
(b)Monitor the attendance by maintaining a record of participants, which should be kept for at least 18 months.
(c)Monitor the quality and quantity of proposed CME activities. This could be achieved by providing participants with a means by which they can easily record their rating of the relevance, quality and effectiveness of the activity.
(d)Provide documents to participants at the conclusion of the activities or annually as evidence of participation and the number of CME points earned for theirsubmission of CME Annual Return.
FAQ 40, 41, 43
43. The program I am going to organise have several sessions, should I apply approval for the whole program, or should I apply approval for each separate session?
Whole program, if the main theme, venue, speakers, and intended audience of the sessions are all about the same.
FAQ: 40, 41, 42
44. How will CME be organised within the College?
Through the Education Committee.
The Education Committee will coordinate and oversee CME activities. Major tasks for the Committee will be the registration of participants, the approval of proposed CME activities after scrutiny of their content and assessment of their quality, the reading of written summaries and MCQs relating to self-study CME activities, the maintenance of records of the annual CME scores of all participants, and the recommending to the College Council for issuing the certificates of CME.
45. Who makes decision on matters relating to approval and calculation of CME credits?
The Education Committee.
Methods of calculating the CME points are already stipulated in the CME scheme, which in turn is based on the Academy Guidelines. In terms of day-to-day operation of the College CME Scheme, it is the responsibility of the Education Committee to deal with all matters relating to approval and calculation of CME credits. However, before the College CME scheme can be implemented, as well as all subsequent changes, it has to be approved by the Academy of Medicine, where rules and regulations, applicable to all Colleges, are set and enforced. Also, the CME scheme and related matters need to be endorsed by the College Council.
College CME Scheme 2.1, 2.2
Academy CME Guidelines 2a, 2b
46. If I disagree with the decisions of the Education Committee on CME approval, can I appeal?
To the College Council. Before that, however, the Education Committee would be happy to reconsider its decision when additional information is available.
Getting More Information on CME
47. Apart from this FAQs, where else can I obtain information on the College's CME?
(a)Secretary of the Education Committee:
Dr. TL Que
Tel: 2468-5465, fax: 2468-5467
(b)The CME specialty coordinators:
Dr. KL Au
Tel: 2990-1818, fax: 2370-0969, e-mail: firstname.lastname@example.org
Dr. KC Lee
Tel: 2990-1804, fax: 2370-0969, e-mail: email@example.com
Dr. MS Tsui
Tel: 2746-7961, fax: 2745-1804
Dr. Albert Chan
Tel: 2990-1806, fax: 2370-0969
Dr. Dominac Tsang
Tel: 2958-6849, fax: 2385-2455, e-mail: firstname.lastname@example.org
(c)Any member of the Education Committee
(e)College web site (http://www.hk.linkage.net/~hkcpath/ )