ACCME Criteria & Standards

CME Mission and Program Improvement

  Mission

The provider has a CME mission statement that includes expected results articulated in terms of changes in competence, performance, or patient outcomes that will be the result of the program. (formerly Criterion 1)

Program Analysis

The provider gathers data or information and conducts a program-based analysis on the degree to which the CME mission of the provider has been met through the conduct of CME activities/educational interventions. (formerly Criterion 12)

Program Improvements

The provider identifies, plans and implements the needed or desired changes in the overall program (eg, planners, teachers, infrastructure, methods, resources, facilities, interventions) that are required to improve on ability to meet the CME mission. (formerly Criterion 13)

 

Educational Planning and Evaluation

Educational Needs

The provider incorporates into CME activities the educational needs (knowledge, competence, or performance) that underlie the professional practice gaps of their own learners. (formerly Criterion 2)

Designed to Change

The provider generates activities/educational interventions that are designed to change competence, performance, or patient outcomes as described in its mission statement. (formerly Criterion 3)

Appropriate Formats

The provider chooses educational formats for activities/interventions that are appropriate for the setting, objectives, and desired results of the activity. (formerly Criterion 5)

Competencies

The provider develops activities/educational interventions in the context of desirable physician attributes (competencies). (formerly Criterion 6)

Analyzes Change

The provider analyzes changes in learners (competence, performance, or patient outcomes) achieved as a result of the overall program's activities/educational interventions. (formerly Criterion 11)

Promotes Team-based Education

  Engages Teams

Members of interprofessional teams are engaged in the planning and delivery of interprofessional continuing education (IPCE). (formerly Criterion 23)

Critical Elements:

• Includes planners from more than one profession (representative of the target audience) AND
• Includes faculty from more than one profession (representative of the target audience) AND
• Activities are designed to change competence and/or performance of the healthcare team.

Engages Patients/Public

Patient/public representatives are engaged in the planning and delivery of CME. (formerly Criterion 24)

Critical Elements:

• Includes planners who are patients and/or public representatives AND
• Includes faculty who are patients and/or public representatives

Engages Students

Students of the health professions are engaged in the planning and delivery of CME. (formerly Criterion 25)

Critical Elements:

• Includes planners who are students of the health professions AND
• Includes faculty who are students of the health professions

 

Addresses Public Health Priorities

  Advances Data Use

The provider advances the use of health and practice data for healthcare improvement. (formerly Criterion 26)

Critical Elements:

• Teaches about collection, analysis, or synthesis of health/practice data AND
• Uses health/practice data to teach about healthcare improvement

Addresses Population Health

The provider addresses factors beyond clinical care that affect the health of populations. (formerly Criterion 27)

Critical Elements:

• Teaches strategies that learners can use to achieve improvements in population health

Collaborates Effectively

The provider collaborates with other organizations to more effectively address population health issues. (formerly Criterion 28)

Critical Elements:

• Creates or continues collaborations with one or more healthcare or community organization(s) AND
• Demonstrates that the collaborations augment the provider’s ability to address population health issues

 

Enhances Skills

  Optimizes Communication Skills

The provider designs CME to optimize communication skills of learners. (formerly Criterion 29)

Critical Elements:

• Provides CME to improve communication skills AND
• Includes an evaluation of observed (e.g., in person or video) communication skills AND
• Provides formative feedback to the learner about communication skills

Optimizes Technical/Procedural Skills

The provider designs CME to optimize technical and procedural skills of learners. (formerly Criterion 30)

Critical Elements:

• Provides CME addressing psychomotor technical and or/procedural skills AND
• Includes an evaluation of observed (e.g., in person or video) psychomotor technical and/or procedural skill AND
• Provides formative feedback to the learner about psychomotor technical and/or procedural skill

Creates Individualized Learning Plans

The provider creates individualized learning plans for learners. (formerly Criterion 31)

Critical Elements:

• Tracks the learner’s repeated engagement with a longitudinal curriculum/plan over weeks or months AND
• Provides individualized feedback to the learner to close practice gaps

Utilizes Support Strategies

The provider utilizes support strategies to enhance change as an adjunct to its CME. (formerly Criterion 32)

Critical Elements:

• Utilizes support strategies to enhance change as an adjunct to CME activities AND
• Conducts a periodic analysis to determine the effectiveness of the support strategies, and plans improvements

 

Demonstrates Educational Leadership

  Engages in Research/Scholarship

The provider engages in CME research and scholarship. (formerly Criterion 33)

Critical Elements:

• Conducts scholarly pursuit relevant to CME AND
• Submits, presents, or publishes a poster, abstract, or manuscript to or in a peer-reviewed forum

Supports CPD for CME Team

The provider supports the continuous professional development of its CME team. (formerly Criterion 34)

Critical Elements:

• Creates a CME-related continuous professional development plan for all members of its CME team AND
• Learning plan is based on needs assessment of the team AND
• Learning plan includes some activities external to the provider AND
• Dedicates time and resources for the CME team to engage in the plan

Demonstrates Creativity/Innovation

The provider demonstrates creativity and innovation in the evolution of its CME program. (formerly Criterion 35)

Critical Elements:

• Implements an innovation that is new for the CME program AND
• The innovation contributes to the provider’s ability to meet its mission.

 

Achieves Outcomes

  Improves Performance

The provider demonstrates improvement in the performance of learners. (formerly Criterion 36)

Critical Elements:

• Measures performance changes of learners AND
• Demonstrates improvements in the performance of learners

 

Improves Healthcare Quality

The provider demonstrates healthcare quality improvement. (formerly Criterion 37)

Critical Elements:

• Collaborates in the process of healthcare quality improvement AND
• Demonstrates improvement in healthcare quality

 

Improves Patient/Community Health

The provider demonstrates the impact of the CME program on patients or their communities. (formerly Criterion 38)

Critical Elements:

• Collaborates in the process of improving patient or community health AND
• Demonstrates improvement in patient or community outcomes

Preamble

The health professions are not only defined by expertise, but also by a dedication to put service of others above self-interest. When individuals enter the healthcare professions, they commit to upholding professional and ethical standards including acting in a patient’s best interests, protecting the patient from harm, respecting the patient, fostering informed choices, and promoting equity in healthcare.

While the interests of healthcare and business sometimes diverge, both are legitimate, and collaboration between healthcare professionals and industry can advance patient care. Since healthcare professionals serve as the legally mandated gatekeepers of medications and devices, and trusted authorities when advising patients, they must protect their learning environment from industry influence to ensure they remain true to their ethical commitments.

As the stewards of the learning environment for healthcare professionals, the accredited continuing education community plays a critical role in navigating the complex interface between industry and the health professions. Organizations accredited to provide continuing education, known as accredited providers, are responsible for ensuring that healthcare professionals have access to learning and skill development activities that are trustworthy and are based on best practices and high-quality evidence. These activities must serve the needs of patients and not the interests of industry.

This independence is the cornerstone of accredited continuing education. Accredited continuing education must provide healthcare professionals, as individuals and teams, with a protected space to learn, teach, and engage in scientific discourse free from influence from organizations that may have an incentive to insert commercial bias into education.

The Accreditation Council for Continuing Medical Education (ACCME®) acts as the steward of the Standards for Integrity and Independence in Accredited Continuing Education, which have been drafted to be applicable to accredited continuing education across the health professions. The Standards are designed to:

• Ensure that accredited continuing education serves the needs of patients and the public.
• Present learners with only accurate, balanced, scientifically justified recommendations.
• Assure healthcare professionals and teams that they can trust accredited continuing education to help them deliver safe, effective, cost-effective, compassionate care that is based on best practice and evidence.
• Create a clear, unbridgeable separation between accredited continuing education and marketing and sales.

 

Eligibility

The ACCME is committed to ensuring that accredited continuing education (1) presents learners with only accurate, balanced, scientifically justified recommendations, and (2) protects learners from promotion, marketing, and commercial bias. To that end, the ACCME has established the following guidance on the types of organizations that may be eligible to be accredited in the ACCME System. The ACCME, in its sole discretion, determines which organizations are awarded ACCME accreditation.

Types of Organizations That May Be Accredited in the ACCME System

Organizations eligible to be accredited in the ACCME System (eligible organizations) are those whose mission and function are: (1) providing clinical services directly to patients; or (2) the education of healthcare professionals; or (3) serving as fiduciary to patients, the public, or population health; and other organizations that are not otherwise ineligible. Examples of such organizations include:

• Ambulatory procedure centers
• Blood banks
• Diagnostic labs that do not sell proprietary products
• Electronic health records companies
• Government or military agencies
• Group medical practices
• Health law firms
• Health profession membership organizations
• Hospitals or healthcare delivery systems
• Infusion centers
• Insurance or managed care companies
• Nursing homes
• Pharmacies that do not manufacture proprietary compounds
• Publishing or education companies
• Rehabilitation centers
• Schools of medicine or health science universities
• Software or game developers

 

Types of Organizations That Cannot Be Accredited in the ACCME System

Companies that are ineligible to be accredited in the ACCME System (ineligible companies) are those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. Examples of such organizations include:

• Advertising, marketing, or communication firms whose clients are ineligible companies
• Bio-medical startups that have begun a governmental regulatory approval process
• Compounding pharmacies that manufacture proprietary compounds
• Device manufacturers or distributors
• Diagnostic labs that sell proprietary products
• Growers, distributors, manufacturers or sellers of medical foods and dietary supplements
• Manufacturers of health-related wearable products
• Pharmaceutical companies or distributors
• Pharmacy benefit managers
• Reagent manufacturers or sellers

 

Owners and Employees of Ineligible Companies

The owners and employees of ineligible companies are considered to have unresolvable financial relationships and must be excluded from participating as planners or faculty, and must not be allowed to influence or control any aspect of the planning, delivery, or evaluation of accredited continuing education, except in the limited circumstances outlined in Standard 3.2.

Owners and employees are individuals who have a legal duty to act in the company's best interests. Owners are defined as individuals who have an ownership interest in a company, except for stockholders of publicly traded companies, or holders of shares through a pension or mutual fund. Employees are defined as individuals hired to work for another person or business (the employer) for compensation and who are subject to the employer's direction as to the details of how to perform the job.

Ineligible companies are prohibited from engaging in joint providership with accredited providers. Joint providership enables accredited providers to work with nonaccredited eligible organizations to deliver accredited education.

The ACCME determines eligibility for accreditation based on the characteristics of the organization seeking accreditation and, if applicable, any parent company. Subsidiaries of an ineligible parent company cannot be accredited regardless of steps taken to firewall the subsidiaries. If an eligible parent company has an ineligible subsidiary, the owners and employees of the ineligible subsidiary must be excluded from accredited continuing education except in the limited circumstances outlined in Standard 3.2.

 

Standard 1: Ensure Content is Valid

Standard 1 applies to all accredited continuing education.

Accredited providers are responsible for ensuring that their education is fair and balanced and that any clinical content presented supports safe, effective patient care.

All recommendations for patient care in accredited continuing education must be based on current science, evidence, and clinical reasoning, while giving a fair and balanced view of diagnostic and therapeutic options.

All scientific research referred to, reported, or used in accredited education in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection, analysis, and interpretation.

Although accredited continuing education is an appropriate place to discuss, debate, and explore new and evolving topics, these areas need to be clearly identified as such within the program and individual presentations. It is the responsibility of accredited providers to facilitate engagement with these topics without advocating for, or promoting, practices that are not, or not yet, adequately based on current science, evidence, and clinical reasoning.

Organizations cannot be accredited if they advocate for unscientific approaches to diagnosis or therapy, or if their education promotes recommendations, treatment, or manners of practicing healthcare that are determined to have risks or dangers that outweigh the benefits or are known to be ineffective in the treatment of patients.

 

Standard 2: Prevent Commercial Bias and Marketing in Accredited Continuing Education

Standard 2 applies to all accredited continuing education.

Accredited continuing education must protect learners from commercial bias and marketing.

The accredited provider must ensure that all decisions related to the planning, faculty selection, delivery, and evaluation of accredited education are made without any influence or involvement from the owners and employees of an ineligible company.

Accredited education must be free of marketing or sales of products or services. Faculty must not actively promote or sell products or services that serve their professional or financial interests during accredited education.

The accredited provider must not share the names or contact information of learners with any ineligible company or its agents without the explicit consent of the individual learner.

 

Standard 3: Identify, Mitigate, and Disclose Relevant Financial Relationships

Standard 3 applies to all accredited continuing education.

Many healthcare professionals have financial relationships with ineligible companies. These relationships must not be allowed to influence accredited continuing education. The accredited provider is responsible for identifying relevant financial relationships between individuals in control of educational content and ineligible companies and managing these to ensure they do not introduce commercial bias into the education. Financial relationships of any dollar amount are defined as relevant if the educational content is related to the business lines or products of the ineligible company.

Accredited providers must take the following steps when developing accredited continuing education. Exceptions are listed at the end of Standard 3.

1. Collect information: Collect information from all planners, faculty, and others in control of educational content about all their financial relationships with ineligible companies within the prior 24 months. There is no minimum financial threshold; individuals must disclose all financial relationships, regardless of the amount, with ineligible companies. Individuals must disclose regardless of their view of the relevance of the relationship to the education. Disclosure information must include:

a. The name of the ineligible company with which the person has a financial relationship.
b. The nature of the financial relationship. Examples of financial relationships include employee, researcher, consultant, advisor, speaker, independent contractor (including contracted research), royalties or patent beneficiary, executive role, and ownership interest. Individual stocks and stock options should be disclosed; diversified mutual funds do not need to be disclosed. Research funding from ineligible companies should be disclosed by the principal or named investigator even if that individual’s institution receives the research grant and manages the funds.

2. Exclude owners or employees of ineligible companies: Review the information about financial relationships to identify individuals who are owners or employees of ineligible companies. These individuals must be excluded from controlling content or participating as planners or faculty in accredited education. There are three exceptions to this exclusion—employees of ineligible companies can participate as planners or faculty in these specific situations:  

a. When the content of the activity is not related to the business lines or products of their employer/company.
b. When the content of the accredited activity is limited to basic science research, such as pre-clinical research and drug discovery, or the methodologies of research, and they do not make care recommendations. 
c. When they are participating as technicians to teach the safe and proper use of medical devices, and do not recommend whether or when a device is used.

3. Identify relevant financial relationships: Review the information about financial relationships to determine which relationships are relevant. Financial relationships are relevant if the educational content an individual can control is related to the business lines or products of the ineligible company.

4. Mitigate relevant financial relationships: Take steps to prevent all those with relevant financial relationships from inserting commercial bias into content.

a. Mitigate relationships prior to the individuals assuming their roles. Take steps appropriate to the role of the individual. For example, steps for planners will likely be different than for faculty and would occur before planning begins.
b. Document the steps taken to mitigate relevant financial relationships.

5. Disclose all relevant financial relationships to learners: Disclosure to learners must include each of the following:

a. The names of the individuals with relevant financial relationships.
b. The names of the ineligible companies with which they have relationships.
c. The nature of the relationships. 
d. A statement that all relevant financial relationships have been mitigated.

Identify ineligible companies by their name only. Disclosure to learners must not include ineligible companies’ corporate or product logos, trade names, or product group messages.

Disclose absence of relevant financial relationships. Inform learners about planners, faculty, and others in control of content (either individually or as a group) with no relevant financial relationships with ineligible companies.

Learners must receive disclosure information, in a format that can be verified at the time of accreditation, before engaging with the accredited education.

Exceptions: Accredited providers do not need to identify, mitigate, or disclose relevant financial relationships for any of the following activities:

1. Accredited education that is non-clinical, such as leadership or communication skills training.

2. Accredited education where the learner group is in control of content, such as a spontaneous case conversation among peers.

3. Accredited self-directed education where the learner controls their educational goals and reports on changes that resulted, such as learning from teaching, remediation, or a personal development plan. When accredited providers serve as a source of information for the self-directed learner, they should direct learners only to resources and methods for learning that are not controlled by ineligible companies.

 

Standard 4: Manage Commercial Support Appropriately

Standard 4 applies only to accredited continuing education that receives financial or in-kind support from ineligible companies.

Accredited providers that choose to accept commercial support (defined as financial or in-kind support from ineligible companies) are responsible for ensuring that the education remains independent of the ineligible company and that the support does not result in commercial bias or commercial influence in the education. The support does not establish a financial relationship between the ineligible company and planners, faculty, and others in control of content of the education.

1. Decision-making and disbursement: The accredited provider must make all decisions regarding the receipt and disbursement of the commercial support.

a. Ineligible companies must not pay directly for any of the expenses related to the education or the learners.
b. The accredited provider may use commercial support to fund honoraria or travel expenses of planners, faculty, and others in control of content for those roles only.
c. The accredited provider must not use commercial support to pay for travel, lodging, honoraria, or personal expenses for individual learners or groups of learners in accredited education.
d. The accredited provider may use commercial support to defray or eliminate the cost of the education for all learners.

2. Agreement: The terms, conditions, and purposes of the commercial support must be documented in an agreement between the ineligible company and the accredited provider. The agreement must be executed prior to the start of the accredited education. An accredited provider can sign onto an existing agreement between an accredited provider and a commercial supporter by indicating its acceptance of the terms, conditions, and amount of commercial support it will receive.

3. Accountability: The accredited provider must keep a record of the amount or kind of commercial support received and how it was used, and must produce that accounting, upon request, by the accrediting body or by the ineligible company that provided the commercial support.

4. Disclosure to learners: The accredited provider must disclose to the learners the name(s) of the ineligible company(ies) that gave the commercial support, and the nature of the support if it was in-kind, prior to the learners engaging in the education. Disclosure must not include the ineligible companies’ corporate or product logos, trade names, or product group messages.

 

Standard 5: Manage Ancillary Activities Offered in Conjunction with Accredited Continuing Education

Standard 5 applies only when there is marketing by ineligible companies or nonaccredited education associated with the accredited continuing education.

Accredited providers are responsible for ensuring that education is separate from marketing by ineligible companies—including advertising, sales, exhibits, and promotion—and from nonaccredited education offered in conjunction with accredited continuing education.

1. Arrangements to allow ineligible companies to market or exhibit in association with accredited education must not:
a. Influence any decisions related to the planning, delivery, and evaluation of the education.
b. Interfere with the presentation of the education.
c. Be a condition of the provision of financial or in-kind support from ineligible companies for the education.

2. The accredited provider must ensure that learners can easily distinguish between accredited education and other activities.

a. Live continuing education activities: Marketing, exhibits, and nonaccredited education developed by or with influence from an ineligible company or with planners or faculty with unmitigated financial relationships must not occur in the educational space within 30 minutes before or after an accredited education activity. Activities that are part of the event but are not accredited for continuing education must be clearly labeled and communicated as such.

b. Print, online, or digital continuing education activities: Learners must not be presented with marketing while engaged in the accredited education activity. Learners must be able to engage with the accredited education without having to click through, watch, listen to, or be presented with product promotion or product-specific advertisement.

c. Educational materials that are part of accredited education (such as slides, abstracts, handouts, evaluation mechanisms, or disclosure information) must not contain any marketing produced by or for an ineligible company, including corporate or product logos, trade names, or product group messages.

d. Information distributed about accredited education that does not include educational content, such as schedules and logistical information, may include marketing by or for an ineligible company.

3. Ineligible companies may not provide access to, or distribute, accredited education to learners. 

Accreditation Statement

The accreditation statement must appear on CME activity materials and brochures distributed by accredited organizations, except that the accreditation statement does not need to be included on initial, save-the-date type activity announcements. Such announcements contain only general, preliminary information about the activity such as the date, location, and title. If more specific information is included, such as faculty and objectives, the accreditation statement must be included.

CME Activity and Attendance Records Retention

Attendance Records: An accredited provider must have mechanisms in place to record and, when authorized by the participating physician, verify participation for six years from the date of the CME activity. The accredited provider is free to choose whatever registration method works best for their organization and learners. The ACCME does not require sign-in sheets.

Activity Documentation: An accredited provider is required to retain activity files/records of CME activity planning and presentation during the current accreditation term or for the last twelve months, whichever is longer.

Content Validity of Enduring Materials

Providers that produce enduring materials must review each enduring material at least once every three years or more frequently if indicated by new scientific developments. So, while providers can review and re-release an enduring material every three years (or more frequently), the enduring material cannot be offered as an accredited activity for more than three years without some review on the part of the provider to ensure that the content is still up-to-date and accurate. That review date must be included on the enduring material, along with the original release date and a termination date.