Taking CME to a New Level in Plastic and Reconstructive Surgery

The only thing that is constant in plastic surgery is change. A HISTORY OF CME AND PLASTIC AND RECONSTRUCTIVE SURGERY Plastic and Reconstructive Surgery began publishing continuing medical education (CME) articles only recently, starting in 1999. Up to that point, the Journal did not publish articles with CME tests, even though CME articles had been a staple in many biomedical journals for years. The format for the articles was print-exclusive: the CME article was published in the print Journal, as was the postarticle CME examination. Test takers would physically cut out an answer sheet in the back of the issue, fill in their answers to the questions and their personal information, and mail or fax in the answer sheet to the American Society of Plastic Surgeons for test grading and credit recording. If test-takers passed, they received notification in the mail of their credit; if they did not, they received a failure notice. There was no interaction between the test-taker and the article itself other than the taking of the test. In addition, there was no mechanism whereby the test-taker could evaluate the questions and answers to understand why some answers were correct and others incorrect. It was a static, terse process in which the educational value was limited; the only outcome was that CME credit was conferred. Beginning with the January 2004 issue, a major change took place in the delivery of the CME tests. CME articles were moved to the online Journal exclusively, as was the test-taking procedure. No longer would readers see the article in the print Journal, nor would test-takers cut out a page and fax it to the Society’s offices. Instead, the system became more dynamic, because it was presented on the more dynamic medium of the Web. Test-takers logged in to the Plastic and Reconstructive Surgery Web site, which automatically authenticated their identity. This step removed the tedious process of filling out the hard-copy form, and eliminated any loss of the tests in the mail or through a fax transmission mishap. After logging in, readers and test-takers would see an informational page about the CME program, the learning objectives, and other information pertinent to the specific article being viewed. Another benefit of the online login was that it provided immediate test results: a test-taker knew immediately whether he or she had passed the examination and could print out a receipt of the examination along with the credit conferred. If a doctor did not pass the examination, he or she would know right away and could take the test again by means of the online system. Furthermore, CME credits were logged automatically from the CME site to the Society’s member services records; manual record keeping was eliminated, and the automated system was faster and less prone to mistakes. Changes and improvements to the CME articles’ delivery system and scope continued with the introduction of the Maintenance of Certification in Plastic Surgery (MOC-PS) CME articles in January of 2008.1 A set of 10 MOC-PS CME articles was posted on the PRSJournal.com Web site (an identical set was posted on the American Society of Plastic Surgeons Online Education Center Web site, at www.plasticsurgery.org/medical_professionals/meetings_and_education/online_education/index.cfm). In April of 2008, a second set of 10 MOC-PS articles was posted. These MOC-PS learning modules retain the style of the Journal’s regular CME articles in that they have learning objectives and multiple-choice questions. Each article, derived from the MOC-PS tracer module outlines of the American Board of Plastic Surgery (ABPS), is a clearly defined, succinct overview of a specific topic. The articles cover four specific subject areas: comprehensive plastic surgery, craniomaxillofacial surgery, hand/peripheral nerve surgery, and cosmetic surgery. Successful completion of a MOC-PS online course satisfies the education component for part IV (performance in practice) and the continuing medical education credit is applied to part II (lifelong learning and practice) of the MOC-PS program of the ABPS. Successfully taking the Plastic and Reconstructive Surgery Maintenance of Certification CME test will satisfy the Practice Assessment in Plastic Surgery CME requirement. Instead of taking a teaching course, Maintenance of Certification participants can get their Practice Assessment in Plastic Surgery CME credit through these Journal articles, making the process easier and less expensive.1 This addition to the Journal’s CME program marked an expansion in both scope and capability. THE DIFFERENCE BETWEEN CME CREDIT AND MOC-PS CREDIT The following information explains the differences in the credits obtained by taking the self-assessment tests after reading Maintenance of Certification online articles and after reading CME articles in Plastic and Reconstructive Surgery. Credit for Taking Maintenance of Certification Article Online Tests A total of 20 Maintenance of Certification articles have been published in Plastic and Reconstructive Surgery: 10 in January of 2008 and 10 in April of 2008. All of these articles have multiple-choice tests that can be taken online for two types of credit that are automatically reported to the American Society of Plastic Surgeons and added to the test-taker’s CME and Maintenance of Certification credit totals. Additional patient safety MOC-PS CME articles will be added in the next several months. The first type of credit you can receive is a CME category 1 credit. Diplomates need at least 60 hours of CME category 1 credit by years 3, 6, and 9 of the 10-year Maintenance of Certification cycle. This type of credit will go toward part II of Maintenance of Certification, the lifelong learning component. The second type of credit is a Maintenance of Certification credit toward parts II and IV of Maintenance of Certification after completing the Practice Assessment in Plastic Surgery module, which is also required in years 3, 6, and 9 of the 10-year cycle. To fulfill this requirement of Maintenance of Certification by the ABPS, you must first complete a 10-consecutive-patient data entry process through the ABPS Web site in the practice assessment module of the procedure of your choice. In addition to entering the data of the 10 patients who have undergone that procedure (e.g., blepharoplasty), you have to complete only one of the two possible educational activities: (1) review and take the test of the Maintenance of Certification blepharoplasty article published in Plastic and Reconstructive Surgery in January of 2008, or (2) complete an ABPS–approved Maintenance of Certification–specific educational program in blepharoplasty sponsored by a specialty society. The 20 Maintenance of Certification articles published in January and April satisfy the first of these two activities. Credit for Taking CME Article Online Tests Monthly CME articles published in Plastic and Reconstructive Surgery also have multiple-choice tests that can be taken online. This activity is also automatically reported to the American Society of Plastic Surgeons and added to the test-taker’s CME credit totals. However, the only type of credit you can receive for completing this educational activity is a CME category 1 credit, of which you need 60 hours in years 3, 6, and 9 of the 10-year cycle to satisfy part II of Maintenance of Certification, lifelong learning. These CME articles will not satisfy the Maintenance of Certification requirement of an educational activity to accompany the Practice Assessment in Plastic Surgery modules that you complete on the 10 consecutive patients in a given procedure on the ABPS Web site in years 3, 6, and 9 of the 10-year cycle. The tests of CME articles published more than 3 years ago cannot be taken for credit, but the articles are suitable for use as study guides. NEW ENHANCED CAPABILITIES: THE EVOLUTION CONTINUES In the spirit of continuous improvement, beginning in October, CME articles will get a new look with online CME multiple-choice test taking. What once was the static presentation of an article and the noninteractive taking of a test will be radically transformed into a truly educational and dynamic learning event. In addition to the standard written questions, selected questions will be accompanied by figures to enhance the educational value of the test. Test-takers who pass the online multiple-choice quiz will be linked to a PDF file that shows them which answers were correct and which were not. There will also be a two- to four-paragraph discussion of why the correct answers were correct and why the wrong answers were wrong, as has occurred with the American Society of Plastic Surgeons in-service examination for years. If a test-taker fails a test, he or she will get another opportunity to take the test online. (Note that for regular CME tests, test-takers get three attempts to pass; with the MOC-PS CME tests, test-takers get two attempts to pass the test.) The posttest discussions will also contain references. Many if not most of these references will be to previous Plastic and Reconstructive Surgery articles. Test-takers will be able to link directly to those articles online for their convenience, as the Journal’s entire library is now available online with linking for those who subscribe. The posttest discussions will also contain “pearls of wisdom,” with illustrations and other images where possible and appropriate to increase the value of the CME experience. For Canadian Maintenance of Certification in Plastic Surgery with the Royal College of Physicians and Surgeons of Canada (RCPSC), the addition of a discussion of the right and wrong answers with references (as seen with the American Society of Plastic Surgeons in-service examination) means that taking and passing CME online tests will now qualify participants for the RCPSC section on Accredited Self-Assessment Programs (section 3 of CME Maintenance of Certification with 2 credits per hour). This has been approved by the RCPSC through the Canadian Society of Plastic Surgeons, which is an RCPSC–accredited provider. Taking the online CME posttest is also automatically reported to the American Society of Plastic Surgeons and added to the test-taker’s CME credit totals. The type of credit that you get for completing this educational activity is a CME category 1 credit, of which you needs 60 hours in years 3, 6, and 9 of the 10-year cycle to satisfy part II (lifelong learning) of the ABPS Maintenance of Certification in Plastic Surgery. Creating and editing the multiple-choice questions, their discussions, and the reference links with illustrations require a significant amount of work by the CME authors, the Journal editors, and the editorial staff. However, those who take the CME online posttests will get much more out of the activity, and maybe even have more fun while learning something! Incorporation of Videos into the CME Process Publishing articles and test questions on the Journal’s Web site provides a much more comprehensive educational medium than print alone, because the Web site can provide videos that offer sound and motion capabilities inherently absent in print. To take full advantage of the potential offered by the Web videos, we are busy planning an exciting new concept of interactive text/video CME series online. The new series will cover the whole of plastic surgery, which will truly keep you up to date in continuing medical education in an innovative and comprehensive new way. The purpose of CME articles is to bring the reader up to date on the latest developments and important new thoughts on very large topics in a very short amount of space. Textbooks can and have been written on subjects this encompassing. Beginning in mid-2010, in a cycle of every 3 years, the Plastic and Reconstructive Surgery series of CME articles will divide our specialty into 36 articles designed to cover the breadth of plastic surgery. The knowledge delivered by the articles in this 36-article series will be the most relevant and clinically useful pearls of information on this topic. Videos will accompany the articles and offer additional content that supplements the textual elements. Readers will thus encounter learning by means of three different primary educational modalities: reading, visual intake (videos), and aurally (again, by means of the videos). At the end of 3 years, the entire series will become a book produced by Plastic and Reconstructive Surgery, with each article constituting one of the 36 chapters. All articles (CME and Maintenance of Certification) will have a safety component rating of 0.5 or 1 hour of credit based on the application of current safety guidelines and principles related to the topic. Each article must emphasize the role and safety of the technique and/or technology to ensure maximum patient safety. Each article in this series of 36 will follow this general template: Essentials of preoperative assessment and management Goals of treatment Advantages and disadvantages (risks and benefits) of the significant alternatives of treatment Key elements of the surgery (anatomy, approaches, and details that achieve the best results) Important details of perioperative management How to avoid and what to do with complications Expected outcomes for the patient and the surgeon As you can imagine, there will be more on this to come. Because the new CME program is well defined and authors are invited, we can no longer receive unsolicited CME manuscripts. We hope you find the CME aspect of the Journal to be better than ever. Its scope, ease of use, interactivity, overall educational value, and expanding use of educational modalities continue to change and improve. We look forward to continued excellence as we bring you ever-better articles in Plastic and Reconstructive Surgery.

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