American Academy of Physician Assistants

Certification Maintenance and CME FAQ

 

Important Notice about Recertication


 

In late 2015, NCCPA proposed significant changes to the PANRE process. Get informed at the AAPA News Center: NCCPA’s PANRE Proposal, where you'll find resources, the latest AAPA actions and updates and suggestions about how to stay engaged and take action.

Get the Facts

 
 
 

Requirements

What are the requirements for Certification Maintenance?

In 2014, The National Commission on Certification of Physician Assistants (NCCPA) implemented a change to the PA certification maintenance process in alignment with the 24 member boards of the American Board of Medical Specialties (ABMS). Certification maintenance currently requires that a PA:

1. Take a recertification exam every 10 years.

2. Earn 100 CME credits every two years, including at least 50 Category 1 CME credits as follows: 

  • Of the 50 credits required for Category 1, 20 of them must come from two new categories: self-assessment and/or performance improvement (PI-CME) activities accredited by AAPA. In every two-year CME cycle, PAs can earn a combination of PI-CME and self-assessment credit, or just concentrate on one of those categories of CME.
  • At the end of eight years (four 2-year CME cycles), PAs must have earned at least 40 Category 1 CME credits through self- assessment and at least 40 Category 1 CME credits through PI-CME activities.
  • There are no self-assessment or PI-CME requirements in the fifth CME cycle (years 9 and 10). During the fifth CME cycle, PAs only need to earn the traditional 100 CME credits, with at least 50 being Category 1. That leaves PAs free to choose whatever form of CME is most helpful to them during the 2-year timeframe for their recertification exam.

3. Pay a certification maintenance fee to NCCPA every two years.

Many PAs have questions about these changes, how and when it will affect them, and how it relates to them and their own career path. Below you will find answers to the most common questions. This information is also available as a download: Certification and CME FAQ (PDF).

When do I have to start earning self-assessment and performance improvement credits?

Sign in to your dashboard at www.nccpa.net to find out. Everyone is eligible to earn and log self-assessment and/or PI-CME credits. If this type of credit is not currently required for you the credits will count toward your 50-credit traditional Category 1 CME requirement. During the year that you transition to the requirements enacted in 2014, you can begin earning and logging self-assessment and/or PI-CME credits on May 1 – for credit in the new process – even if you have not yet taken your PANRE for your current cycle. The requirements detailed above were effective immediately for graduates who passed the PANCE in 2014. Practicing PAs who recertified in the 2012-2014 cycle have already transitioned to the new certification maintenance process. Others will transition after their next recertification cycle. Graduates taking the PANCE prior to 2014 transition to the new certification maintenance process after their first PANRE. For example, if a PA recertified in the 2010-2012 cycle, s/he will not transition to this new certification process until the 2018-2020 cycle when their current six-year recertification cycle ends. The following table details how all PAs will eventually transition to the certification maintenance requirements outlined above.



Previous
PANRE or PANCE


Next
PANRE or initial 
PANCE
Certification Maintenance Cycle

Recertification PANRE
 
First CME cycle*
(New
 requirements effective)
Second CME cycle* Third CME cycle* Fourth CME cycle* Fifth CME cycle
(No self-assessment
 or PI-CME requirement)
 
2008 2014 2014 - 2016 2016 - 2018 2018 - 2020 2020 - 2022 2022-2024 2024  
2009 2015 2015 - 2017 2017 - 2019 2019 - 2021 2021 - 2023 2023-2025 2025  
2010 2016 2016 - 2018 2018 - 2020 2020 - 2022 2022 - 2024 2024-2026 2026  
2011 2017 2017 - 2019 2019 - 2021 2021 - 2023 2023 - 2025 2025-2027 2027  
2012 2018 2018 - 2020 2020 - 2022 2022 - 2024 2024 - 2026 2026-2028 2028  
2013 2019 2019 - 2021 2021 - 2023 2023 - 2025 2025 - 2027 2027-2029 2029  

* Each of the first four two-year CME cycles requires the completion of 20 self-assessment and/or PI-CME credits as a part of the 50 Category 1 CME credit requirement.  

I’m planning to regain my certification. Do I need to earn self-assessment or PI-CME?

Yes, you are subject to current certification maintenance requirements. Please see NCCPA’s website for further information. 

Why did certification maintenance change in 2014?

There are several reasons, including:

  • Calls for greater accountability and higher quality in healthcare spurred major change in physician certification and certification maintenance programs with movement from CME to continuous professional development. For medical doctors this is referred to as Maintenance of Certification (MOC), and for osteopathic physicians, this is referred to as Osteopathic Continuous Certification (OCC). NCCPA felt it appropriate to consider whether similar changes were needed for PAs with a commitment to patients’ best interests in mind. This process is meant to foster more practice improvement than the traditional forms of CME, which are not required to be connected to one’s own practice. This new certification maintenance presents an opportunity for PAs to engage in a continuing education activity that can lead to improvement of patient outcomes.
  • It is a way to incorporate all six PA competencies into practice and evaluate PAs in these core competencies. The six areas of PA competencies, developed by NCCPA, AAPA, PAEA and ARC-PA, are medical knowledge, interpersonal and communication skills, patient care, professionalism, practice-based learning and improvement and systems-based practice. The current PA certification maintenance process only evaluates one competency—medical knowledge.
  • The Federation of State Medical Boards has recommended that all states adopt Maintenance of Licensure (MOL) similar to the Maintenance of Certification (MOC) model set by the major medical boards. With these changes, PAs will be prepared when state medical licensure requirements also change.
  • By aligning with the requirements of a majority of physician certifying boards, these practiced-based requirements are intended to encourage team-based practice improvement.

Self-assessment

What are self-assessment activities?

Self-assessment is the process of conducting a systematic review of one’s own performance, knowledge base or skill set, usually to improve future performance, expand knowledge or hone skills.

Self-assessment activities, in their most common form, are simply an in-depth medical knowledge test that provides feedback on your performance and the opportunity to learn from the experience. A well-known example is the American College of Physicians Medical Knowledge Self-Assessment Program® (MKSAP®).

Importantly, self-assessment activities are not like taking PANCE or PANRE, where you have one chance per test to get a passing score. Instead, this is exactly what it says – a “self-assessment.” Most activities allow you to take the self-assessment as many times as you like in order to gauge where your own personal knowledge gaps exist. It helps you identify where you need CME or additional self-study to improve your knowledge. Self-assessment activities are meant to help you better recognize gaps in your own knowledge, so that you can better serve your patients.

Where can I find self-assessment activities?

AAPA's self-assessment Web page displays all the self-assessments available to you. Activities are listed in alphabetical order by provider.

If you’d like to search by topic, or if you want to print a simple list, you may wish to download this approved self-assessment activities spreadsheet (PDF). This PDF file intentionally includes expired activities so that it can be used as a reference tool. We recommend that you not store paper copies of the PDF list of self-assessments as it gets out-of-date quickly. A link to the PDF list of self-assessments is found on the very bottom of AAPA’s self-assessment Web page.

How do I know if a self-assessment or PI-CME activity will satisfy certification maintenance requirements?

Only activities approved by AAPA for self-assessment or PI-CME credit will satisfy certification maintenance requirements for these types of credit. Unlike traditional Category 1 CME, there is no reciprocity with other credit systems. AAPA approval ensures that the activities meet the unique practice needs of PAs and satisfy the standards we have established for these new types of activities. One benefit of this single-point approval process is that it is easy to determine whether an activity has been approved since definitive lists of approved self-assessment and PI-CME activities are available on the AAPA website. 

Do I have to take self-assessments related to my current specialty?

Not at all. There is no requirement to take self-assessments in your current specialty area. In fact, self-assessments provide a great opportunity to expand your knowledge of areas that will be included in your recertification exam or to gauge your interest in a different specialty area. AAPA continues to work with several physician organizations, PA specialty organizations and PAs in different clinical areas to gather and develop options for self-assessment activities in a wide range of clinical specialty areas.

Can I complete a self-assessment more than once?

Yes, as long as the activity is completed in different two-year logging cycles AND the activity provider allows this. PAs cannot claim credit for the same activity more than once in the same two-year logging cycle. Be sure to check with the provider of the CME activity if you intend to do an activity more than once, as some providers allow this and others do not.

Do the start and completion dates both have to be within the 2-year cycle in which I am logging self-assessment credits?

No, only the completion date has to be between the start and end dates of the two-year cycle in which you are logging the credit. In other words, it is OK to start a self-assessment activity in one cycle and complete it in the next cycle, as long as you log it during the cycle in which you completed it.

Performance Improvement

What are performance improvement (PI-CME) activities?

PI-CME activities are a unique chance to earn CME while reflecting on your role in team-based care and how you might improve patient outcomes by altering your own approach or methods. PI-CME is a structured process for evaluating the evidence-base for your own behavior and making carefully considered adjustments accordingly. The activity has 3 phases:

  • Stage A – Compare your current practice in a specific clinical area against recognized, evidence-based standards. Assess your current performance, identify performance gaps and discover opportunities for improvement.
  • Stage B – Develop and implement a plan to improve your practice. For example, you might decide to take a class about a specific procedure, develop new patient education material, change the sequence in which you approach routine tasks, or make a simple process change.
  • Stage C – Reassess your practice to evaluate the effects of your improvement plan. If you were able to improve, what factors facilitated your success? If you were not able to improve, what barriers did you encounter that prevented a successful outcome? What would you do differently next time? 

Where can I find PI-CME?

PI-CME activities are listed on the performance improvement Web page. The popular patient safety activity, available to PAs in any specialty, is shown at the bottom of this page.

Do I need to document improvements in patient outcomes to successfully complete performance improvement activities?

No. It’s important to understand that improving patient outcomes is not the goal of PI-CME activities and is not required in order to earn credit. In the course of the activity you will likely discover information, resources, methods and/or tools that will help you improve your practice and, ultimately, improve patient outcomes. Even so, the primary goal of a PI-CME activity is to achieve proficiency in evaluating and improving a particular aspect of your own clinical practice.

One reason PI-CME activities intentionally separate the evaluation and improvement process from outcome measurement is that this permits PAs the freedom to tackle truly challenging issues where improvements in outcomes may be incremental at best. It can be particularly fruitful to focus your attention on an area where you see significant room for improvement yet you suspect any gains may be difficult to achieve (perhaps due to poor patient compliance, cost considerations, institutional resistance or something else).

Can you give me some examples of issues I could address in performance improvement CME activities?

Engaging in PI-CME will help you to identify and address issues like these:

  • How can we better serve a particular subset of our patients who are not faring as well, who are less likely to take prescribed medications or who are less likely to return to our practice to be seen when needed?
  • What can we do to increase patients’ adherence to post-op instructions in our surgical practice?
  • What elements should be included in a truly multidisciplinary approach to caring for patients with uncontrolled diabetes (or some other chronic condition)?
  • How could we improve the quality of “handoffs” and of communication related to prescribing?
  • Are our protocols for determining when and how to use diagnostic testing evidence-based and congruent with current recommendations in the literature?
  • How could we improve follow-up related to patient referrals?
  • How efficient are our discharge procedures? How could we improve in this area?

How soon do I need to earn performance improvement credits?

You are eligible to complete and log PI-CME credits during your first two-year cycle. You are required to complete 20 credits of PI-CME or self-assessment or some combination of the two in your first, second, third and fourth two-year cycle. At the end of eight years (four two-year CME cycles), you must have earned at least 40 Category 1 CME credits through self- assessment and at least 40 Category 1 CME credits through PI-CME activities. There are no self-assessment or PI-CME requirements in the fifth CME cycle (years nine and 10).

You have considerable flexibility in how you choose to implement these requirements. For many PAs, it may make sense to work on self-assessment first. Consider this strategy if you are not currently in active clinical practice but expect that you might return in the near future, or if you are not satisfied with the relevance of any of the currently available PI-CME options to your area of practice. The catalog of approved PI-CME activities continues to expand, and both the number and diversity of PI-CME activities that will be available in two or four years’ time will be greater than it is today

What if I can’t find performance improvement activities that apply to what I do?

You have several options, including:

  • Use PI Builder, AAPA’s new online tool that enables you to build a personalized PI-CME activity using measures that are relevant to your practice and improvement interests. See below for more information.
  • Take an approved patient safety course.
  • Concentrate your efforts on self-assessment activities in your first two-year cycle. By the time you enter the second cycle it is likely that new performance improvements activities will be available.
  • Check to see if you can receive AAPA Category 1 PI CME credit for quality improvement activities in which you already participate. If not, consider approaching your employer’s Quality Improvement department to suggest that they apply for AAPA accreditation of an existing program in which more than one PA participates.

AAPA continues to work to insure that performance improvement activities are applicable to PAs practicing in a wide variety of clinical settings and specialties. AAPA works with physician organizations, PA specialty organizations and PAs in different clinical areas to this end. 

What is PI Builder?

PI Builder is an online tool that allows an individual PA to build his or her own PI project by selecting from a library of approved measures. PAs can either:

  • Choose measures from the measure library
  • Submit measures that you would like to use for approval
  • Request credit for an institutional quality improvement activity that you have already completed, so long as the project was completed while you were in your current logging cycle, and you are able to demonstrate meaningful participation in the project.

I don’t have continuity of care. How can I participate in performance improvement activities?

It is not necessary to have ongoing responsibility for the care of patients to participate in PI-CME. If you have access (or can collect) data about a process or activity that impacts the quality of patient care, you can participate in performance improvement activities. Current topics for PAs who do not have continuity of care include assessing and improving the quality of “handoffs” and of communication related to prescribing. Potential topics include proper indications for diagnostic testing, patient safety practices, follow-up related to patient referrals, efficiency of patient care delivery and timely delivery of discharge.

Another option is to take an approved patient safety course to fulfill the PI-CME requirement.

I am not currently in clinical practice. How can I participate in performance improvement activities?

PAs who are not clinically practicing make take a patient safety or quality improvement course to meet the PI-CME requirement.

Patient safety and quality improvement have been chosen as alternatives because they will be relevant to those who have administrative responsibilities, and to those who are temporarily not practicing but will return to a system where these topics are receiving a great deal of attention. 

PA faculty and PAs in administrative roles should consider options provided by PAEA which focus on interprofessional collaborative practice in PA curriculum development and teaching activities.

If your exit from clinical practice is temporary and short - say two to four years - then you could concentrate your efforts on completing self-assessments while you are not practicing, and complete the PI-CME requirement once you are back in practice. 

Can I complete a performance improvement activity more than once?

Yes, as long as the activity is completed in different two-year logging cycles AND the activity provider allows this. PAs cannot claim credit for the same activity more than once in the same two-year logging cycle. Be sure to check with the provider of the CME activity if you intend to do an activity more than once, as some providers allow this and others do not.

Do the start and completion dates both have to be within the 2-year cycle in which I am logging credits?

No, only the completion date has to be between the start and end dates of the two-year cycle in which you are logging the credit. In other words, it is OK to start a performance improvement activity in one cycle and complete it in the next cycle, as long as you log it during the cycle in which you completed it.

What is AAPA doing to increase the diversity of PI-CME offerings?

PAs practice across the entire spectrum of medicine and surgery, making it a challenge to address every PA practice setting simultaneously. We are aware of gaps and are working with individuals and organizations to stimulate the development of new activities. The following are current initiatives aimed at stimulating new PI-CME activity development:

  • AAPA developed PI Builder, an online tool which allows PAs to create their own performance improvement activity or submit for credit quality improvement programs that they have already completed.
  • Tool Kit: AAPA is working with a group of volunteers to develop a Tool Kit for PI-CME activity developers. This Tool Kit is intended to function as a “how-to” guide for organizations and educators interested in developing original PI-CME activities. The Tool Kit will be published online during the summer of 2014.
  • Specialty Organization Outreach: PA specialty organizations are in the best position to understand the needs of PAs who practice in the specialty they represent. AAPA is working directly with a number of specialty organizations to help them address some of the current gaps.

Does PI-CME require statistical expertise? Will I need to write a final paper?

No, there is no statistical expertise or specific research skills required. In fact many activities facilitate the analysis of your data. There is no requirement to write an essay. The emphasis is on the process itself rather than outcomes or final products.

Will I need to get institutional review board approval to perform my PI-CME activity?

No, PI-CME and quality improvement are exempt from IRB review. Only those who may want to publish the results of their improvement effort are advised to check with their IRB manager, as an IRB exemption letter may be required by a journal editor.

In 2011, the Institute of Medicine published a discussion paper, “The Common Rule and Continuous Improvement in Health Care: A Learning Health System Perspective,” to help inform the discussion around IRB review for QI/QA projects and initiatives.

The IOM developed the vision of a learning health system as one that “…gets the right care to the right people when they need it, and captures the results for making improvements.” Collecting information about a provider’s performance as it relates to patient care is thus necessary and should be considered a normal routine activity of any healthcare organization.

To facilitate practice improvement activities, the IOM developed a framework for a “Common Rule” in continuous improvement, which states that unless you are evaluating something other than what is already accepted practice or posing more than minimal risk, the IRB process for human subject research should not be warranted.

For further information you can access the IOM paper here. In addition, you can follow up with your local or a central IRB. Often, they will provide information related to QI/QA activities and may provide a flow chart for determining if an activity is considered human subject research.

aapa_Cat1_CME_logoFind out what the new certification maintenance process means for you and your practice with a one-hour webinar at AAPA's Learning Central. Approved for AAPA Category 1 CME credit. 

 For more information from AAPA staff, contact:

Eric Peterson, AAPA Senior Director of Performance Improvement CME, epeterson@aapa.org, 571-319-4407
Alison Moore, PA-C, AAPA Director of Education, amoore@aapa.org, 571-319-4413
Daniel Pace, AAPA Chief Strategy Officer/Vice President, Education and Research, dpace@aapa.org, 571-319-4419