JMC Office of CME
Pennsylvania Medical Licenses and CME Requirements

Introduction
As the end of the year approaches, physicians in Pennsylvania become concerned with completing their licensing procedures with the Commonwealth. This brief article is designed to help answer any questions you may have about the CME requirements for licensing in Pennsylvania, and to provide information on resources for acquiring patient safety/risk management credits. We hope that this provides you with a better understanding of CME.

Frequently Asked Questions

• What are the State CME licensure requirements for MDs?
• What Counts for patient safety/risk management requirement?
• Do the patient safety or risk management credit hours need to be in Category 1 or Category 2?
• Do Required Healthstream Courses Count toward licensing requirements?
• If I have 12 Category 1 credit hours in patient safety or risk management topics, may I count these for both the Category 1 requirement and the patient safety/risk management requirement?
• How do I prove Category 2 credits if I am audited?
• What if I don't know my License Renewal Registration Code?
• What will I need to report to in order to renew my license?
• Who regulates CME?
• What is AMA PRA CATEGORY 1 ^TM CME Credit?
• What types of activities qualify for AMA PRA Category 1 Credit?
• How can I get Category 1 Credit directly from the AMA for teaching, publishing and other educational activities?
• What types of activities qualify for Category 2 Credit?

Additional Information

• Are there additional Resources for Patient Safety and Risk Management Credits?
• How can I get CME credit?
• How can I document and track my CME credits?
• RESOURCES FOR PATIENT SAFETY/RISK MANAGEMENT CME CREDITS
• Glossary of CME Terms
• Additional Resources
• For More Information

FREQUENTLY ASKED QUESTIONS

What are the State CME licensure requirements for MDs?

According to the Pennsylvania Medical Society website's (http://www.pamedsoc.org/MainMenuCategories/CME/Accreditation/Physicians/MDDO.aspx). Physicians must have 100 CME credits over the past two years and 12 must be in patient safety/risk management in order to renew their licenses. A minimum of 20 of the total credit hours must be AMA PRA Category 1^TM credits.

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What Counts for patient safety/risk management requirement?

The State Board of Medicine has approved the following list of topics that will satisfy the patient safety/risk management requirement:

• Improving medical records and record keeping
• Reducing medical errors
• Professional conduct and ethics
• Improving communication among physicians and with other health care personnel
• Communication between physicians and patients
• Preventive medicine education
• Health care quality improvement

As long as the CME activity falls within these topics, you can count it toward the patient safety/risk management requirement. The course does not have to state, and very likely may not, that it is a patient safety or risk management course.

Examples of activities that you can use for patient safety/risk management credits include attendance at Morbidity and Mortality Conferences, courses attended that include topics related to those listed above (count only those session that are related), completing online and print-based activities in the areas listed above, or those specifically targeting patient safety or risk management as the topic.

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Do the patient safety or risk management credit hours need to be in Category 1 or Category 2?

According to the regulations, the patient safety or risk management credit hours can be in either Category 1 or Category 2.

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Do Required Healthstream Courses Count toward licensing requirements?

Some of the TJUH required Healthstream courses can be counted as Category 2 credit, and can be used to satisfy the patient safety/risk management requirements. Healthstream courses required annually can count for each year that they were completed. These courses include:

Joint Commission Patient Safety
Bloodborne Pathogens
Hazardous Communication
Emergency Management
HIPAA
Isolation Precautions
Radiation Safety
Cultural Competency
Identifying and Assessing Victims of Abuse and Neglect
Data Security

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If I have 12 Category 1 credit hours in patient safety or risk management topics, may I count these for both the Category 1 requirement and the patient safety/risk management requirement?

Yes. If any of the patient-safety credit hours that a physician has earned are Category 1 credit hours, they can be counted toward both the Category 1 requirement and the patient safety/risk management requirement.

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How do I prove Category 2 credits if I am audited?

The regulations state that Category 2 credit hours must be documented in the form of a physician log or diary.

Documentation should include:

• The date the activity was completed
• A description of the activity (article title, resident teaching, consultation with peers, etc.)
• Location (name of journal, hospital, home study, web site, etc.)
• The number of credits claimed (actual time spent in the activity)

View the PA State Form for Category 2 Reporting

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What if I don't know my License Renewal Registration Code?

Here are the directions to receive the registration code for medical license renewal online. Each Physician is notified originally via Mail of the registration code.

• If a practitioner has no record of his registration code to renew his/her license on-line,
• The Pa State Board of Medicine will forward the number via email.
• Email your request to the state board of Medicine:
  st-medicine@state.pa.us, (State in the email your request for the registration code and provide the last digits of physicians' social security number, date of birth and physicians' full name)

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What will I need to report to in order to renew my license?

The State Board of Medicine is not requiring a report of CME at the time of license renewal. The license renewal form will contain an area for physicians to attest that they have completed the required hours. By attesting that the requirement is completed, a physician may be subject to a random audit by the Board of Medicine. If audited, a physician will need to show evidence of the completion of the required credit hours. Failure to produce the requested evidence will result in a fine and possible suspension of license.

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Who regulates CME?

Two organizations share the responsibility nationally for CME accreditation.

The Accreditation Council for Continuing Medical Education (ACCME) accredits organizations (like Jefferson and other academic medical centers) to provide AMA Category 1 credit.

The American Medical Association (AMA) identifies the types of activities that can receive credit, and sets the rules for which whether an activity can be designated as Category 1 or claimed as Category 2. In addition, the AMA directly gives credit for some specific Category 1 activities that not designated by an ACCME accredited provider (i.e., publishing an article).

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What is AMA PRA CATEGORY 1 ^TM CME Credit?

The American Medical Association (AMA) defines a national standard of continuing medical education (CME): "...educational activities which serve to maintain, develop, or increase the knowledge, skills, and professional performance and relationships that a physician uses to provide services for patients, the public, or the profession. CME represents that body of knowledge and skills generally recognized and accepted by the profession as within the basic medical sciences, the discipline of clinical medicine, and the provision of health care to the public" (www.ama-assn.org).

Not all continuing educational activities that physicians may engage in, however, are CME. Physicians may participate in worthwhile continuing educational activities that are not related directly to their professional work, and these activities are not CME. Typically service on committees or direct patient care activities are not considered CME. Continuing educational activities that respond to a physician's non-professional educational need or interest, such as personal financial planning, and appreciation of literature or music, are not CME (www.accme.org).

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What types of activities qualify for AMA PRA Category 1 Credit?

AMA PRA Category 1 credit^TM is the most widely recognized term for physician CME. Category 1 activities have been formally planned and designated for credit toward the AMA Physicians Recognition Award (PRA) by an ACCME accredited provider. The following activities can be designated by an ACCME-approved provider for Category 1 credit:

• Live activities
• Enduring materials (i.e. CD-Rom or videotape)
• Journal-based CME
• Web-based activities
• New procedures and skills courses that train and certify physicians to conduct new medical procedures

Ways that you can earn Category 1 Credits through an accredited provider*

• Test Item Writing
• Performance Improvement CME
• Point of Care CME
• Manuscript Reviews

*these require specific designation for credit by a provider, and should not be claimed on your own

The ACCME approved provider distributes Certificates to the participants, and is required to maintain records of participation for six years.

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How can I get Category 1 Credit directly from the AMA for teaching, publishing and other educational activities?

Physicians may also earn Category 1 credit for activities that are not designated as such by providers. To receive credit for these activities, you must submit a request directly to AMA. A description of these activities and how to earn credits for them are outlined in the attached chart. They include:

• Presenting at a Category 1 conference, seminar, or symposium
• Publishing articles
• Poster presentations
• Obtaining a medically related advanced degree
• American Board of Medical Specialties (ABMS) member board certification and recertification
• ACGME accredited education
• International conference recognition

To obtain an application for AMA directly credited Category 1 activities, go to http://www.ama-assn.org/ama/pub/education-careers/continuing-medical-education/cme-forms.page or call the AMA at 312 464 5296.

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What types of activities qualify for Category 2 Credit?

Category 2 credit is the term used by AMA for activities physicians undertake on their own that should be beneficial to their practice. These activities are not formally planned and designated for Category 1 credit by accredited providers. The AMA does not permit us to give you a certificate for a Category 2 activity. See below for the PA Category 2 Recording Form. Examples include:

• Consultations with peers and experts
• Medical research and study online
• Using non-designated enduring materials
• Teaching residents, medical students or other health professionals
• Reading authoritative medical literature
• Self assessment activities
• Medical writing
• Preceptorships

It is the physician's responsibility to identify and document Category 2 activities. However, these activities must meet the AMA definition of CME (see above), and comply with the AMA ethical opinions on Gifts to Physicians and Ethical Issues in CME, and be a "worthwhile learning experience related to his/her practice."

To see all the AMA information about Category 1 and Category 2 credits, go to http://www.ama-assn.org/ama/pub/education-careers/continuing-medical-education/physicians-recognition-award-credit-system/full-text-booklet.page.

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Are there additional resources for Patient Safety and Risk Management Credits?

Resources to help physicians obtain the required credits in patient safety and risk management.

Through Jefferson-approved Category 1 CME activities:

• the program director of CME approved grand rounds and other regularly scheduled conferences can identify specific sessions that fall within the topics identified by the State Board of Medicine. Attendance at these sessions is reported to the Office of CME and uploaded to the our online CME credit retrieval system twice a year.
  
  
• Sessions during other Jefferson-approved conferences are identified and documented for patient safety or risk management credits, and documented as they occur. These credits are posted to our online CME credit retrieval system.

Through self-declared attendance at qualified meetings.

• Morbidity and Mortality Conferences: ALL M&M Conferences are considered patient safety credit for PA licensing purposes. While not all of these are currently certified for Category 1 credit, your documented attendance at an M&M conference that is not Category 1 certified can be counted towards your required patient safety / risk management credits as a Category 2 activity.
  
  
• Other Jefferson non-CME approved conferences that address topics as indicated by the State Board of Medicine that can be documented if audited can be counted toward these credits as well.

Through Jefferson University Hospitals Category 2 CME Resources, including the following topics:

• Improving medical records and record keeping
• Reducing medical errors
• Professional conduct and ethics
• Improving communications
• Preventative medicine
• Healthcare quality improvement

Remember to keep a record of these activities using the PA Medical Society Category 2 Log at http://www.portal.state.pa.us/portal/server.pt/gateway/PTARGS_0_160484_764027_0_0_18/CME_Category_2_Reporting_Form.pdf

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How can I get CME credit?

In general, you can receive credit for the items listed below. Details pertaining to AMA credit for each activity below are provided. Note that the AMA will provide 25 Category 1 credits for your Board Recertification process.

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How can I document and track my CME credits?

The JeffETC section of the OCME Website (http://jeffline.jefferson.edu/jeffcme/JeffETC/) allows physicians and other participants of JMC-CME accredited programs to receive their transcripts and/or certificates online. Transcripts and certificates are only available for JMC-CME accredited programs completed after July 1, 2003.

Currently this service tracks only Jefferson-sponsored CME activities. Your transcript is based on grand rounds attendence as reported to the Office of CME by your Department, and on other activities that you attended. Note, grand rounds type activity attendence is updated twice a year. If you have questions about your transcript, contact us at 215-955-6992 or jeffersoncme@jefferson.edu.

It is recommended that you keep a running list of activities in which you have participated as well as a folder for CME documentation. On your list, include the activity date and title, accredited provider, location, type of credit, and number of credits. You may also specify special content (i.e., patient safety) to help track specific requirements.

For activities designated for Category 1 credit by accredited providers, you will receive CME certificates. Keep these certificates in your CME folder as documentation. It is also a good idea to keep copies of your publications, agendas from Category 1 activities at which you presented, and any other non-designated activities for which you may request Category 1 credit in this folder. If you are applying for the AMA PRA, you will need to list your CME activities as well as provide documentation for non-designated Category 1 credits. Remember, the State Board of Medicine may audit your records to document your license renewal statements relating to continuing education.

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RESOURCES FOR PATIENT SAFETY/RISK MANAGEMENT CME CREDITS

• Attendance at Department M&M Conferences. 1 CME credit*. Requires formal sign- in sheet and log noting attendance and topic.

*while not all departmental M&M Conferences carry Category 1 CME credit, all can be used toward patient safety and risk management credit requirements

External Sources for CME Credit

Other CME Sites
Content updated: October, 2012

Following are suggested sites for physicians who want to obtain CME credit online or who want information on national CME programs/events to attend:

Pennsylvania Medical Society Patient Safety/Risk Management Resources - The PA Medical Society offers a variety of Category 1 and 2 activities focused on safety.

Medscape from WebMD - Medscape offers continuously updated continuing education activities by specialty for physicians and other health professionals. There are over 100 courses to choose from that have been developed by ACCME-accredited organizations. It is recommended that you use the following guidelines for searching the site to identify courses that will qualify as patient safety topics.
http://www.medscape.com

http://cmelist.com/quality.htm from Bernard Sklar, MD, MS - This is an annotated list of online CME. Links to, and descriptions of, more than 300 Online CME sites offering more than 12,500 courses and more than 22,000 hours of CME credit.

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Glossary of CME Terms

Accreditation: The decision by the ACCME, or a recognized state medical society, that an organization has met the requirements for a CME provider as outlined by the ACCME. The standard term of accreditation is four years.

AMA Physician's Recognition Award (PRA): An award issued by the AMA to physicians who have documented completion 50 hours of continuing medical education per year. The AMA offers one, two, and three-year certificates for the AMA PRA. Physicians must complete an application documenting the CME credits and submit a processing fee between $29 and $58 to apply for the award.

Cognates: Designation of CME offerings that have been reviewed and approved by the American College of Obstetrics and Gynecology (ACOG). The CME offerings that award COGNATES are directed toward OB/GYN physicians.

Elective Credit: CME credit for AAFP members that has not met the criteria for or may not have been submitted for review as Prescribed credit.

Enduring Materials: Enduring materials are printed, recorded or computer assisted instructional materials which may be used over time at various locations and which in themselves constitute a planned CME activity. Examples of such materials for independent physician learning include: programmed texts, audio-tapes, videotapes and computer assisted instructional materials which are used alone or in combination with written materials. Books, journals (unless specifically designated) and manuals are not classified as enduring materials.

Prescribed: CME credit from an activity that has been developed and submitted in accordance with AAFP requirements and that has subsequently been reviewed and approved by the appropriate section of the AAFP.

Self Directed Learning: Individual learner's initiative and responsibility to (with or without assistance) identify, assess, and set priorities for learning needs; define goals; select and organize learning activities; and evaluate outcomes in terms of performance.

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Additional Resources

American Medical Association	www.ama-assn.org
Alliance for Continuing Education in the Health Professions	www.acehp.org
Jefferson Medical College Office of CME	www.jeffline.jefferson.edu/jeffcme/
American College of Obstetrics and Gynecologists	www.acog.org
American Academy of Family Physicians	www.aafp.org
Accreditation Council for CME	www.accme.org
American Osteopathic Association	www.osteopathic.org

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For More Information

Jefferson Medical College Office of Continuing Medical Education
Phone: 1-888-JEFF-CME or 215-955 6992
Fax: 215-923-3212
Web: http://jeffline.jefferson.edu/jeffcme/
Email: jeffersoncme@jefferson.edu

Suggested Log Format for Licensing CME Documentation

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