Types of provider designated AMA PRA Category 1 Credit TM activities and how to assign them credit (from the AMA Physician’s Recognition Award and Credit System, 2006 edition)
Accredited providers may designate the following types of activities for AMA PRA Category 1 Credit. All activities must comply with the AMA PRA Category 1 Credit requirements detailed previously. In addition:
- Providers should be aware of those activities that are available to physicians on a direct credit basis; i.e., providers do not designate them for credit, physicians claim the credit directly from the AMA (see page 16).
- Accredited providers do not designate activities for AMA PRA Category 2 Credit™ (see page 18).
A. Live Activities
CME activities that physicians must attend (in person or virtually) in order to claim credit can be offered in a variety of formats that range from national conferences and live Internet teleconferences to local workshops, seminars, grand rounds or departmental scientific meetings.
Assigning credit for learner participation in live activities
- Sixty minutes of physician participation (i.e., formal interaction between faculty and the physician audience) in a certified live activity equals one (1) AMA PRA Category 1 Credit.
- Activities may be designated for, and credit awarded to physicians in, 15 minute or 0.25 credit increments; in both cases providers or physicians may round to the nearest quarter hour.
- Simultaneous certified sessions within a live activity can only be counted once toward the designated maximum.
- If sections of a designated activity do not fit the AMA definition of CME, and are non-promotional, then these sections must be clearly identified in the activity materials and excluded from the designated maximum amount of credit.
Providers may also award AMA PRA Category 1 Credit to their faculty for teaching at the provider’s designated live activities. This credit acknowledges the learning associated with the preparation for an original presentation.
Assigning credit for teaching at Category 1 live activities
- Faculty may be awarded two (2) AMA PRA Category 1 Credits for each hour they present at a live activity designated for such credit.
- Faculty may not claim simultaneous credit as physician learners for sessions at which they present; however, they may claim participant credit for other sessions they attend as learners at a designated live activity.
- Credit may only be claimed once for repeated presentations.
B. Enduring materials
Enduring materials include printed, recorded, audio, video and/or online/electronic activities that may be used over time at various locations, and that in themselves constitute a structured CME activity. To be designated for AMA PRA Category 1 Credit, enduring materials must:
- Provide clear instructions to the learner on how to successfully complete the activity.
- Provide access to appropriate bibliographic sources that allow for further study, and that reinforce and clarify specific activity topics.
- Provide for some type of learner interaction or self assessment; examples include patient management case studies, a post-test, and/or application of new concepts in response to simulated problems.
Assigning credit for enduring materials
- Establish a good faith estimate (e.g., through a small focus group) of the amount of time a physician will take to complete the activity and satisfy its purpose and/or learning objectives.
- Sixty minutes equals one (1) AMA PRA Category 1 Credit. To calculate the Designation Statement’s credit maximum, providers may round to the nearest quarter hour or credit.
- Providers may choose to make credit contingent on passing a post-test or completing an exercise, but it is not required.
C. Journal-based CME
Journal-based CME describes the process by which accredited providers identify an article, within a peer-reviewed, professional journal, that serves as a planned learning activity. To designate journal-based CME activities for AMA PRA Category 1 Credit, providers must incorporate a mechanism for physician reflection and/or interaction with the article content. The latter can be accomplished through an evaluation or examination that physicians return to the provider.
Assigning credit for journal-based CME
- Providers may designate individual articles for one (1) AMA PRA Category 1 Credit. If a provider wishes to designate an article for a higher amount of credit, they must use the process described in the previous section for enduring materials.
G. Performance improvement
Performance improvement (PI) activities describe structured, longterm 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 Category 1 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.
H. Internet point of care learning
Internet point of care (PoC) CME describes structured, self-directed, online learning by physicians on topics relevant to their clinical practice. Learning for this activity is driven by a reflective process in which physicians must document their clinical question, the sources consulted and the application to practice. To award AMA PRA Category 1 Credit for this activity, accredited providers must assure that they:
- Establish a process that oversees content integrity, with responsibilities that include, but are not limited to, the appropriate use and selection of professional, peer-reviewed literature, and keeping search algorithms unbiased.
- Provide clear instructions to the physician learner on how to access the portal/database, how their online activities will be tracked, and how the provider will award credit for their participation.
- Verify physician participation by tracking the topics and sources searched. Implement reasonable safeguards to assure appropriate use of this information.
- Provide access to some mechanism by which participants can give feedback on overall system effectiveness, and evaluate whether the activity met the participant’s learning objectives, or resulted in a change in knowledge, competence or performance as measured by physician practice application or patient health status improvement.
- Establish a mechanism by which participating physicians may claim AMA PRA Category 1 Credit for this learning cycle, if they:
1. Review original clinical question(s).
2. Identify the relevant sources from among those consulted.
3. Describe the application of their findings to practice.
Assigning credit for Internet PoC learning
AMA PRA Category 1 Credit for Internet PoC learning should be awarded as follows:
- Physicians conducting structured online searches on clinical topics may claim a half (0.5) AMA PRA Category 1 Credit for documented completion (either at the point of care or later) of the three step learning cycle defined above.
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.