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Neurology Today:
Inside the Aan

Ralph F. Jozefowicz, MD: New Opportunities for Continuing Education

Shaw, Gina

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Ralph F. Jozefowicz, MD, is well poised to serve as Chair of the AAN Education Committee. At the University of Rochester School of Medicine and Dentistry in New York, he serves as Professor in the Departments of Neurology and Medicine and Associate Chair for Education in the Department of Neurology. In 1996, he was appointed Director of Rochester's Neurology Residency Training Program, and has developed it into one of the most successful neurology residency programs in the country. After receiving his undergraduate degree from Johns Hopkins University in 1975, Dr. Jozefowicz earned his medical degree from Columbia University College of Physicians and Surgeons in 1979. He completed his residency in Neurology and fellowship in the Neuromuscular Disease Unit at the University of Rochester School of Medicine and Dentistry. He became Chair of the AAN Education Committee in early 2004.

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HOW HAS THE AAN INVOLVEMENT IN CONTINUING MEDICAL EDUCATION (CME) CHANGED?

Now that the American Board of Medical Specialties (ABMS) will be requiring all physicians to stay up to date by obtaining 30 CME credit hours per year, the Accreditation Council on Continuing Medical Education (ACCME) policies and procedures are becoming stricter. In the old days, CME monitoring was relegated to individual hospitals. If you wanted to continue to have admitting privileges or continue to be on the hospital staff, you would have to demonstrate that you participated in CME. Many hospitals had their own requirements; many universities did not, specifically, because they assumed that their staff was already involved in education.

Within the next two years, the ABMS new Maintenance of Certification (MOC) procedures will go into place. In the old days, neurologists who took the American Board of Psychiatry and Neurology (ABPN) certification examination were certified for life; neurologists taking the certifying examination since 1996 receive a time-limited certificate and must take a recertification exam every ten years.

Starting in 2008, neurologists will not only have to demonstrate that they are knowledgeable every ten years, but every day. The new MOC requirements include four components: professional standing (licensure), self-assessment and lifelong learning (continuing education and a self-assessment examination), cognitive expertise (recertification examination), and “performance in practice.” We don't know precisely what that last component is yet, but the ABPN has been invited to discuss it with the Education Committee at our January meeting.

For the self-assessment examination, the Academy is working with the ABPN on developing a Web-based multiple-choice examination, probably about 100 questions. Practitioners will be able to use it to assess their knowledge base and prepare for recertification; while you don't have to send your results to anyone, you do have to complete it and certify that you've completed it.

Since a minimum amount of CME will soon be required for all physicians, the ACCME is ensuring that organizations that sponsor CME are doing it appropriately, and the Education Committee is working with them to ensure precisely that. For example, we must have clearly stated objectives and a needs assessment for each of our programs.

Also, CME must be free of commercial bias. A lot of pharmaceutical and device companies sponsor CME as a marketing tool, and the ACCME wants to insure that there are firewalls between the companies giving money and the educational programs. We now have stringent requirements for reviewing all of our speakers' potential conflicts of interest, to ensure that they won't adversely influence the contents of their presentations.

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WHAT ARE THE DIFFICULTIES IN ENSURING THAT THERE ARE NO CONFLICTS OF INTEREST?

Figure. Dr. Ralph F....
Figure. Dr. Ralph F....
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It's time-consuming and there's a lot of paperwork. Before you can finalize a program, all of the presenters have to sign disclosure forms – and it's not up to them to determine what is and what isn't relevant to the topic of their discussion to disclose. I like to say that in the old days, all we had was a CV; now it's a CV and a DV, a disclosure vitae. Presenters need to disclose all their sources of funding, so that the course director – not the presenter – can decide if there's a conflict.

We're streamlining this process by adding an electronic disclosure record system for all faculty members. We have hundreds of Academy members speaking at our meetings and at regional conferences, and in previous years, they had to fill out a new disclosure form prior to every presentation. Now, their disclosures are kept on file electronically, and they simply have to update them before their next presentation. We're also publishing a book at each Annual Meeting with everyone's disclosures, including all of our organizers and the committee members who select the faculty. If anyone is interested, it's there and it's available. We want to be as transparent as we can be.

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WHAT ARE THE CURRENT GOALS AND PRIORITIES FOR THE UNDERGRADUATE AND GRADUATE MEDICAL EDUCATION SUBCOMMITTEES?

Of course, neurology is still not a required clerkship in medical school. While 80 percent to 90 percent of medical schools do have some form of neurology requirement, some are as short as two weeks and most are not taken until the fourth year. We're working to make a neurology clerkship a requirement in the third year of medical school.

The Graduate Education Subcommittee, meanwhile, is working with the Residency Review Committee to strengthen the residency review process. They were successful in abolishing the case log that was a brief requirement for all residents, which was good in concept but practically unworkable.

And since the format of the neurology boards will be changing in 2008, we're working with the ABPN on the implementation of that. Beginning with those residents who finish in 2008, neurology residents will no longer be required to go through the oral board exam with a live patient hour and two vignette hours. Instead, the exam will be a one-day computerized test with multiple choice questions and computer case simulations. Since the patient encounter will no longer be a part of the boards, all residency program directors will be required to certify that their residents are qualified to take a history and perform a neurological exam. Implementation of this process is something that every program director will have to work on.

Finally, we're in the process of deciding whether neurology will stay with the early match, the San Francisco Match (SF Match), or move to the National Resident Matching Program (NRMP). It's looking like we'll be joining the NRMP next year, for several reasons. First, by moving to the NRMP, we'll be able to provide a couples match for our applicants. Also, the NRMP is larger and if residents or a program violate the match rules, it has more clout when it comes to sanctioning candidates or programs. And the electronic application process, sponsored by the Electronic Residency Application Service, is a lot more sophisticated than the SF Match's Central Application Service, providing more options for program directors for the whole process of interviewing candidates.

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HOW ARE THINGS CHANGING WITH THE ANNUAL MEETING?

We're now in the process of reformulating how the entire meeting program is developed. Formerly, we simply looked at the previous year's program and the new proposals for courses, and then we renewed successful existing courses and put others in; it was rather haphazard. Two years ago, we began developing a curriculum patterned on the ABPN recertification exam to be certain that our education program of 170 courses is balanced for all the areas we want to cover. We're also asking for more input from the sections, to make sure that there is a curriculum for every specialty of neurology. It's like a college: you don't just ask the faculty what they want to teach; you identify the specific items the students must learn.

In January 2006 the Annual Meeting Subcommittee will discuss going a step further. I'd actually like to rebuild the curriculum from the ground up. For each topic – say, neuromuscular disease – we'd focus on what kind of curriculum we need. If we need a full-day course in Neuromuscular Disease 101, what topics must it cover? Then, what should be covered at the second level, for people who already have a basic knowledge but want to go to the next level, in terms of seminars and case study programs, for example? All of this should be developed for each topic area to make sure that we have a balance between basic science and the clinical aspects, and among diagnostics, therapeutics, pathophysiology, and other topics.

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HOW IS THE ACADEMY TAKING ADVANTAGE OF ONLINE TOOLS FOR MEDICAL EDUCATION, PARTICULARLY CME?

We're working on enhancing the AAN Web page to make sure it's practical for practicing neurologists. The Academy has a wealth of educational materials, including Neurology, Continuum, Annual Meeting syllabi, and practice guidelines, to name just a few. We now want to have a “Google” on the Academy Web site, in which you could simply enter a search term and all the appropriate articles would come up. It's similar to the popular medical Web search engine “Up To Date,” but we're not reinventing the wheel, just taking what we have to create a one-stop search tool to access all the Academy's information.

Another exciting development is an online electronic image library that we're creating. It will be a catalog of CTs, MRIs, pathologic specimens, and other images that any neurologist could use. For example, if someone's giving a talk and they want an MR image of multiple sclerosis, video clips of patients with a spastic gait, or other images, they would be readily available for download.

We're also working on a new CME product which involves 30-minute modules of case-based CME. Practitioners who have 30 minutes and want to get a CME credit can run one of these interactive, case-based modules on the computer. We'll be evaluating a demonstration module at the January meeting; and we hope to develop 10 to 12 of these every year to have a full library of CME modules.

The Education Committee obviously has a lot on its plate; we're very active. We couldn't do any of this without the outstanding support we receive from the Academy staff. The success of this committee also has a lot to do with the dedication and accomplishments of the committee members – top-notch people who do tremendous work. Our philosophy, as articulated in the strategic plan we developed in January of 2004, is to make the Academy the world's premier medical specialty association for education, the model to which all the other subspecialty associations look. We can be the best.

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AAN EDUCATION PROGRAMS & SERVICES

The AAN Education Committee provides oversight for a wide range of Academy education programs, including the work of the following Subcommittees:

The Annual Meeting Subcommittee evaluates and develops the programs – and assigns directors – for the Annual Meeting courses, workshops, and seminars. The AAN Annual Meeting draws more than 10,000 attendees from all over the world.

Contact: Kris Fridgen, kfridgen@aan.com, 651-695-2726

The Distance Learning Subcommittee, established in 2005, is the newest Subcommittee of the Education Committee. This Subcommittee develops and designs online educational courses and digital tools that assist neurologists and neuroscientists in their professional development. The Subcommittee is now working on three new initiatives: an AAN digital image library, a series of online CME courses, and a practice examination for recertification.

Contact: Andrea Weiss, aweiss@aan.com, 651-695-2742, or Dalal Ahmad, dahmad@aan.com, 651-695-2802

The Residency Examination Subcommittee is responsible for the development, implementation, and evaluation of the Residency In-service Training Examination.

Contact: Mary Cress, mcress@aan.com, 651-695-2754

The Graduate Medication Education Subcommittee monitors residency training programs in neurology and makes suggestions for improvement.

Contact: Lucy Persuad, lpersaud@aan.com, 651-695-2741

The Undergraduate Education Subcommittee monitors residency training programs in neurology and makes suggestions for improvement.

Contact: Gloria Barnard, gbarnard@aan.com, 651-695-2733

The Subcommittee on Education for Non-Neurologists serves as a liaison with other organizations to bring neurological education to allied healthcare professions.

Contact: Valerie Mendoza, vmendoza@aan.com, 651-695-2730

The CONTINUUM Editorial Board Subcommittee develops and maintains CONTINUUM self-assessment programs for neurology practitioners, establishes policies and procedures for administering the programs, and evaluates and periodically revises the programs.

Contact: Andrea Weiss, aweiss@aan.com, 651-695-2742

©2005 American Academy of Neurology

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