Navigating Continuing Medical Education Requirements in Emergency Medicine

Continuing Medical Education (CME) is crucial for physicians to stay updated with the latest advancements and best practices in their field. For emergency medicine physicians, CME is not only a professional obligation but also a means to enhance patient care and maintain board certification. State medical boards and various organizations mandate CME to ensure physicians remain competent and knowledgeable throughout their careers. This article explores the perspectives of emergency medicine physicians on state-mandated, topic-specific CME requirements and provides an overview of CME requirements for maintaining certification in emergency medicine.

The Role of CME in Emergency Medicine

The American Board of Emergency Medicine (ABEM) is one of 24 specialty boards in the American Board of Medical Specialties (ABMS). ABEM's mission is to ensure the highest standards of emergency medicine through its initial and continuing certification processes. Emergency physicians can receive CME credit for participation in these continuing certification activities.

Addressing Public Health Threats Through CME

Legislation may impose CME requirements for physician medical licensure to address recognized public health threats (e.g., human trafficking and opioid overdose). Additional topic‐specific CME requirements by state medical boards may help to address knowledge gaps but should not be a substitute for expanded infrastructural development to address public health concerns.

Perspectives of Emergency Physicians on State-Mandated CME

Understanding the perspective of emergency physicians on state medical board CME requirements has not been evaluated but would be valuable to explore. A survey aims to describe the perspectives of emergency physicians on state‐mandated, topic-specific CME requirements, specifically evaluating whether CME activities address physician knowledge gaps, demonstrate relevancy to current emergency practice, and have associated perceived burden, costs, and the potential to improve patient outcomes.

Survey Methodology

A cross‐sectional survey was designed by the Coalition of Board‐Certified Emergency Physicians (COBCEP) and distributed to all physicians who held certifications with the ABEM. COBCEP is composed of representatives from various membership organizations, including the Association of Academic Chairs of Emergency Medicine, the American Academy of Emergency Medicine, and the American College of Emergency Physicians. The survey was conducted using Survey Monkey.

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The web‐based, closed survey was designed over 13 months by COBCEP representatives in consultation with representatives and survey design experts from the ABMS. The survey was pilot‐tested by the American College of Emergency Physicians (ACEP) EM‐PRN, a cohort of 1000 emergency physicians within ACEP who agree to participate in quarterly surveys. A focus group of five practicing emergency physicians took the survey and were interviewed by a project investigator (M.G.H.), after which authors modified the survey based on pilot and focus‐group feedback. The final survey was organized into three sections: (1) physician and practice setting characteristics, (2) cost and time spent on obtaining state‐mandated CME, and (3) physicians’ opinions on the value of state‐mandated, topic‐specific CME in improving their clinical practice of emergency medicine. All subspecialties, which ABEM‐certified physicians can access, were included as options to declare subspecialty certification (eg, Clinical Informatics, Sports Medicine, and Neurocritical Care Medicine).

Survey Results

The survey response rate was 13.0% (5692/43656). Most physicians in this group held an MD (86.5%, 4762/5506), and about half (47.1%, 2593/5506) of physicians had less than 15 years of experience post‐residency. In comparison, 28.2% (1551/5506) had between 15 and 24 years of experience, and 24.8% (1362/5506) had more than 25 years of post‐residency experience. Almost two‐thirds (63.4%, 3393/5506) of physicians who completed the study survey were not subspecialty certified. Emergency Medical Services was the most common subspecialty among this group of physicians (25.0%, 1374/5506). Community‐based, non‐teaching hospitals (38.0%, 2095/5506), community‐based teaching hospitals (30.0%, 1650/5506), and academic medical centers (17.5%, 963/5506) were the most common practice settings among these physicians. Most physicians practiced primarily in the South (35.4%, 1950/5506) and West (26.5%, 1458/5506) followed by the Northeast (19.1%, 1049/5506) and Midwest (18.7%, 1032/5506) regions of the United States.

Emergency medicine physicians’ perspectives on state‐mandated, topic-specific continuing medical education (CME) are not well understood. These perspectives could inform strategies to tailor CME requirements, reduce barriers to its completion, and enhance knowledge translation for the emergency physician to assimilate into clinical practice and improve patient outcomes. Survey results revealed that 83.6% of physicians practicing in states with state‐mandated, topic-specific CME requirements believed that participation in American Board of Emergency Medicine (ABEM) continuing certification could be used to reduce the need for state‐mandated requirements and 70.8% of physicians believed that requirements were unlikely to improve patient care.

Additional CME Requirements

In addition to state medical licensure CME requirements, physicians reported having additional CME requirements based on practice settings. Local hospital credentialing (35.5%, 1954/5506), employer or contract group (24.4%, 1345/5506), and state health departments (15.1%, 832/5506) were the most common practice settings that required additional CME. Out‐of‐pocket costs for CME exceeded $1000 per year for 65.1% (3586/5506) of physicians. Almost one‐third of physicians (30.9%) reported that their department or employer did not provide sufficient time to complete CME. State‐mandated, topic‐specific CME was required for primary practice state license renewal for 81.2% (4469/5506) of physicians.

Physician Beliefs and Barriers

Among physicians with state‐mandated, topic-specific CME requirements, 83.6% (3728/4469) believed that continuing certification should eliminate the need for state‐mandated, topic-specific CME requirements. Most physicians (70.8%, 3164/4469) believed that state‐mandated, topic-specific requirements were unlikely or very unlikely to improve patient care. State‐mandated, topic-specific CME was reported as rarely (54.4%, 2430/4469) or never (17.9%, 800/4469) covering new material that physicians did not already know. Most physicians (70.0%, 3129/4469) disagreed or strongly disagreed that state‐mandated, topic-specific requirements for CME should exist. Time (72.1%, 3224/4469) and relevance (65.5%, 2929/4469) were the most commonly reported barriers to completing state‐mandated, topic-specific CME.

Funding and CME

Among physicians with state‐mandated, topic-specific CME requirements, physicians with no funding were more likely to report that continuing certification should eliminate the need for state CME (1535/1803; 85.4%; p < 0.001), state CME requirements were very unlikely to improve their patients’ care (678/1803; 37.6%; p < 0.001), and CME rarely covered new material (978/1803; 54.7%; p = 0.039) compared to physicians with funding. Physicians with no funding were more likely to strongly disagree (727/1803; 40.3%; p < 0.001) with the statement that CME should exist compared to physicians with funding. Cost (969/1803; 53.7%; p < 0.001), relevance (1197/1803; 66.4%; p < 0.001), and time (1300/1803; 72.1%; p < 0.001) were more likely to be barriers in completing state CME for non‐funded physicians compared to physicians with funding.

Limitations of the Study

A potential limitation of the study is the low response rate of 13.1%. Despite this response rate, however, one can have a relative degree of confidence in the survey's results as the respondent characteristics suggest that this is a representative sample of all ABEM‐certified physicians. The number of physicians who self‐reported holding a subspecialty in emergency medical services (EMS) (1374) is higher than those whom ABEM recognizes as subspecialty‐certified in EMS (1048) at the time of survey distribution. It is possible that the physician may have completed the survey more than once or responded as a practicing EMS physician but one who is not EMS certified. Overall, physicians were not required to provide identifying information to encourage participation unless the respondent wished to be entered into the drawing for the gift card incentive. The number of ABEM‐certified osteopathic physicians who responded (744, 13.5%) to this survey is slightly higher than the proportion of all ABEM‐certified physicians who are DOs (5303 of 44304 or 12.0%) (dataset: ABEM secure database; May 2023).

It is conceivable that there could be a social desirability bias, so the reported results may overestimate the value of CME to patient care. On the contrary, mandated CME for licensure or hospital credentialing purposes may be seen as unfavorable due to potential inconvenience and/or lack of physician autonomy.

CME Requirements for Board Certification in Emergency Medicine

To maintain board certification in emergency medicine, physicians must meet specific CME requirements set forth by certifying bodies such as the American Board of Physician Specialties (ABPS) and the American Osteopathic Association (AOA). These requirements ensure that physicians remain current with the latest medical knowledge and advancements in emergency care.

American Board of Physician Specialties (ABPS)

ABPS Diplomates are encouraged to apply for recertification one year before the current certification expires. Diplomates have a period of four years after their certification expires to submit a recertification application, provided their account status is active. ABPS will accept for recertification Diplomates originally certified by the American Board of Medical Specialties (ABMS) or the Association Bureau of Osteopathic Specialists (AOABOS) member boards in any specialty in which ABPS currently certifies physicians.

CME Requirements for Recertification

Documentation of CME hours: An average of 50 hours of Category 1 CME per year with at least 25 CMEs in the field of Emergency Medicine. Over the eight-year certification period, the totals would be 400 CME, with 200 of those CME credits from Emergency Medicine related topics. Copies of an official CME summary from the granting organization or copies of individual certificates must be submitted for all completed CME activities.
Self-Assessment CME: Complete at least 50 questions of self-assessment CME each year, except in the final year of the recertification cycle. The number of self-assessment questions completed should be indicated in the designated column on the ABPS CME summary form.

American Osteopathic Association (AOA)

All AOA members, other than those exempted, are required to participate in the CME program and to meet specified CME credit hour requirements. For members with a 150 CME hour requirement, 60 CME hours must be obtained in either Category 1-A or 1-B with a minimum of 30 credit hours in Category 1-A.

CME Self-Reporting and Tracking

Using the AOA’s new online CME tracking services, physicians can easily self-report AOA Category 1 and 2 CME activities hosted by non-AOA-accredited CME sponsors. The CME self-reporting and tracking system is free for AOA members, with unlimited access to report activities, download and print CME reports.

Board of Certification in Emergency Medicine (BCEM)

The Board of Certification in Emergency Medicine (BCEM) requires all applicants to have completed residency training in a program approved by the Accreditation Council of Graduate Medical Education (ACGME) or the American Osteopathic Association (AOA) and deemed acceptable to the Board of Certification in Emergency Medicine (BCEM). Such training must include substantial and identifiable training in Emergency Medicine as determined by the Board of Certification in Emergency Medicine and approved by the ABPS.

Strategies to Enhance CME Relevance and Reduce Barriers

Tailoring CME requirements to increase relevance to their patient populations and reduce barriers to completing CME could enhance knowledge translation and improve patient outcomes. Legislators should consider a provision for paid time‐off to complete required CME courses, especially in those states with a larger number of credits required.

As the stress on the nation's health care system increases, patients are faced with growing challenges accessing definitive care due to a lack of referral resources (e.g., substance use disorder treatment). The topic‐specific CME requirements are applied carte blanche to all physicians within a state with rare exceptions. State laws may mandate what CME topics are required for medical licensure. This type of approach aims to increase relevancy to physician practice; however, it may fall short in limiting the burden of CME-mandated activities for some specialties.

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