Other Forms of Learning (Learner)

Learning from Teaching

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.

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New Procedures

Through new procedures and skills courses, providers can train physicians on topics that allow them to request new or expanded clinical privileges. For these activities, usually surgical or with new medical devices, a provider must assess whether a physician has acquired the knowledge and skills to carry out the new procedure.

The AMA PRA requirements for new skills and procedures training consists of four levels so that providers and participants can clearly identify the depth and complexity of the course, and accurately represent the level of skill or knowledge acquired. After completing a new procedure educational activity, physicians can present their credit certificate to the appropriate credentialing authority as documentation of his or her education and training. The four levels are:

1. Verification of attendance:
The physician attended and completed the course.
2. Verification of satisfactory completion of course objectives:
The physician satisfied all specified learning objectives.
3. Verification of proctor readiness:
The physician can successfully perform the procedure under proctor supervision. A physician proctor can competently oversee another physician performing a given procedure.
4. Verification of physician competence:
The physician can successfully perform the procedure without further supervision.

New procedures and skills education as a certified activity involves a detailed set of expectations, for either formal courses or clinical preceptorships. For complete information including appropriate certificate language, providers who certify new procedures activities for AMA PRA Category 1 Credit should refer to www.ama-assn.org/go/pra.

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Test Item Writing

Test item writing activities describe a learning process wherein physicians contribute to the development of high stakes examinations, or certain self-assessment modules, by researching, drafting and defending potential questions. Additionally:

  • The questions must be developed for examinations given by the National Board of Medical Examiners or a member board of the American Board of Medical Specialties (ABMS), or for peer reviewed, published, self-assessment educational activities from a national medical specialty society.
  • The process for this activity must document guidance for the physician question writers on how to use evidence for writing quality questions.
  • The assignments must be at a depth and scope that require a review of the literature and a knowledge of the evidence base for the questions. Physician question writers should document their review of evidence based literature.
  • The physician question writers must personally participate in a group peer review of the questions. The question writers should revise their questions, when necessary, based on feedback from the peer group.

Assigning credit for test item writing:

  • Providers may designate each test item writing activity (the cycle described above) for a maximum of ten (10) AMA PRA Category 1 Credits.

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Manuscript Review (for journals)

Manuscript review activities describe a learning process in which physicians, under the collaborative direction of a journal editor and an accredited provider, critically review assigned journal manuscripts. Additionally:

  • The texts to be reviewed must be original contributions to the medical literature that require multiple reviewers, e.g., not book reviews.
  • The journal editor, working with the accredited provider, will need to educate reviewers about the CME process: establish objectives and criteria for content review, and provide all needed instructions.
  • Manuscript review assignments must be at a depth and scope that require a review of the literature and a knowledge of the evidence base for the manuscripts reviewed. To the extent possible, this review of the evidence base should be documented.
  • The accredited provider, working with the journal editor, should have an oversight mechanism to evaluate the quality of reviews submitted. This process should assure that physicians who submit substandard reviews do not continue to participate or receive credit for subsequent activities.
  • Organizations that are not accredited providers, but that publish journals indexed by MEDLINE, may arrange joint sponsorship agreements with an accredited provider so that their manuscript reviewers can obtain AMA PRA Category 1 Credit.

Assigning credit for manuscript review:

  • Providers may designate each accepted manuscript review, as documented by the journal editor, for a maximum of three (3) AMA PRA Category 1 Credits.

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Performance Improvement

Performance improvement (PI) activities describe structured, long-term 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.

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.

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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:
    • Review original clinical question(s).
    • Identify the relevant sources from among those consulted.
    • 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.

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Other Activities

Providers may designate other appropriately structured activities for AMA PRA Category 1 Credit. For example, committee work, learning plans/contracts, etc. that are developed in accordance with all the requirements for designated live activities (see page 5) can be eligible for AMA PRA Category 1 Credit.

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