The American Association of Neurological Surgeons continually strives to develop programs that meet the challenges to neurosurgery that are posed by a healthcare system of ever increasing complexity. Because it is neurosurgeons’ knowledge and skills that define our success in serving our patients, the educational programs of the AANS represent the very core of the association and are its single most important function. In recognition of its obligation as the leading provider of neurosurgical continuing medical education (CME), the AANS is expanding its role in the design and delivery of education services for members. This expansion entails restructuring its education program to help neurosurgeons satisfy new requirements that are being phased in by the American Board of Neurological Surgery (ABNS).
The Certification Evolution
In years gone by, a neurosurgeon’s certification by the ABNS was good for a lifetime. But as recently as March 2000, the American Board of Medical Specialties (ABMS), which oversees the ABNS and 23 other specialty boards, voted to evolve recertification into a process known as maintenance of certification. The goal of this process is to provide evaluation and documentation of the continuing competence of practicing physicians. Much of the impetus for this evolution originated with an Institute of Medicine challenge to demonstrate competence and verify performance throughout a physician’s career by the demonstration of lifelong learning and ongoing improvement of practice.
In answer to this challenge, the ABNS, after extensive deliberation, now is well along with plans that will benefit its diplomates and their patients. The new ABNS Maintenance of Certification (MOC
Although the ABNS has not yet fully developed its MOC Program, it is expected that the new program will inspire significant changes to the current CME programs. These changes, both in volume and design, will help prepare neurosurgeons to satisfy the new ABNS requirements. By virtue of the AANS requirement for its Active members to be certified by the ABNS to maintain AANS membership, these members in particular will be affected by future modifications in educational and practice requirements.
AANS Evolution Begins With Evaluation
The AANS, in anticipation of the impending release of the ABNS requirements and in recognition of the need to be prepared to help members meet them, formed the Educational Policy Task Force in April 2002. Its charges were to:
- carry out a far ranging analysis of the AANS’ current educational policies;
- develop a strategy to enable the AANS to provide educational services to its membership for the purpose of enhancing patient care;
- meet ABNS requirements for MOC;
- satisfy state and local requirements for licensure, hospital staff membership, and credentialing; and
- maintain and satisfy the educational requirements for membership in the AANS.
AANS Awards Neurosurgical CME The task force’s initial job was to review current AANS policies regarding the award of continuing medical education credits and the provision of CME tracking services.
The AANS rules and regulations state that, “Active and Active Provisional members shall be required to document receiving the Continuing Education Award in Neeeurosurgery (requiring at least 60 hours of neurosurgical CME credit) at least every three years.” The AANS Continuing Education Award in Neurosurgery serves as proof of specialty specific CME and is intended to be accepted as an integral part of a nationwide credentialing process.
It is primarily specialty specific CME that provides the mechanism to maintain and enhance neurosurgery’s internal educational system, and will enable the specialty to cope with future MOC and credentialing requirements. The AANS Board of Directors has approved the awarding of specialty specific neurosurgical credits to neurosurgeons who attend:
- AANS sponsored or jointly sponsored meetings;
- AANS education and practice management courses;
- Congress of Neurological Surgeons (CNS) annual meetings; and
- AANS/CNS section meetings.
This policy will maintain and ensure the high quality of neurosurgical CME.
AANS Tracks CME Credit The AANS automatically tracks credit for these activities for all of its members except for the CNS annual meeting, although it may be able to do so in the future. Currently, members can forward their CNS certificates of attendance to the AANS for processing and inclusion in their CME tracking records. Providers of neurosurgical CME courses can obtain joint sponsorship and the awarding of neurosurgical CME credits by contacting the AANS (“Educational Requirements for AANS Membership“)
AANS Tracks Category 1 AMA/PRA For meeting activities not indicated above, the AANS will continue to track Category 1 credits for the American Medical Association’s Physician’s Recognition Award, primarily for the purpose of state licensure and local requirements. To add Category 1 AMA PRA credits to a file, a member must forward certificates of attendance to the AANS for processing. However, these credits are not eligible toward the Continuing Education Award in Neurosurgery, and they will not be applicable toward the 60 neurosurgical credit hours to be earned during the three-year cycle required for maintenance of AANS membership.
Your Personalized Transcript The AANS Member Services Department annually mails personalized transcripts to Active and Active Provisional members. This helps members monitor their progress toward reaching the required 60 neurosurgical credit hours and facilitates use of the transcript for other purposes: evidence for maintaining a valid license, unrestricted hospital privileges and assisting in confidential peer review, for example.
The task force also reviewed the requirement for each member to attend at least one of every three AANS annual meetings and recommended that this requirement remain unchanged.
Although medical oversight and governmental regulatory agencies may provide valid frameworks for the skills expected of a practicing physician, it remains obvious that only neurosurgeons possess the necessary knowledge and insights to design neurosurgical educational programs for their colleagues. Recently, some educational professionals have stated that traditional CME has been unsuccessful in educating physicians and in improving the quality of patient care. That has not been the case in neurosurgery. Our annual meetings and professional education courses have kept practicing neurosurgeons current with the latest concepts and technical developments and have served as an effective mainstay of neurosurgical continuing education. For example, it was this traditional method of CME that allowed neurosurgery to educate practicing neurosurgeons in transsphenoidal pituitary surgery and to regain its leadership role in spinal surgery.
New Educational Structure Built on EMC2
In order to maintain organized neurosurgery’s position as the primary provider and director of high quality neurosurgical education, the task force recommended the formation of anAAANS educational structure which will better serve to expand and focus our activities and meet anticipated regulatory requirements. This activity will require a more active role for AANS education volunteers and staff.
In September 2002, the AANS Board of Directors established the Education and Maintenance of Certification Committee, known as EMC2. Roberto Heros, MD, president of the AANS, appointed Christopher Loftus, MD, to lead and develop this entity. This committee will construct a framework for the establishment of subcommittees, which in turn will bear the responsibility of expanding the CME activities of the AANS in response to MOC and external requirements. It will be responsible for directing the development and delivery of CME programs and courses and other activities that respond to the educational needs required to satisfy ABNS requirements, such as preparation for a cognitive examination in general neurosurgery and subspecialty areas, and for creating programs that assist neurosurgeons with the development of data to show satisfactory practice outcomes. It also will assist in developing satisfaction assessment evaluation instruments and a verifiable peer review process.
EMC2 will develop appropriate instruments to provide neurosurgeons with the opportunities for lifelong learning and its documentation, not only through traditional CME venues, but also through the development of practice data and audits and in electronic, print and simulator CME. It will also develop programs to assist in the documentation of professionalism and explore the development of new self-assessment options, while supporting the highly successful Self-Assessment in Neurological Surgery program known as “SANS,” which was originally developed by the AANS and the CNS and now is under the direction of the CNS.
New requirements and regulations must be appropriate and pertinent to every neurosurgeons’ goal of excellence in the delivery of neurosurgical patient care. The enactment of the core competencies will provide an opportunity for expansion and redesign of the AANS role in addressing the educational needs of practicing neurosurgeons. This effort may be one of our most important ventures of the 21st century. Under Dr. Loftus’ leadership, these activities are taking shape in a manner that will anticipate the changes dictated by Accreditation Council for Graduate Medical Education and ABNS mandates. It remains important, however, to remember that we not allow prescribed requirements to dictate the entirety of the AANS educational efforts. The association’s past CME offerings, including our annual meetings, remain highly effective and greatly valued. They have been and will continue to be a vital part of neurosurgeons’ education.
Robert A. Ratcheson, MD, is secretary of the AANS and chair of the AANS Educational Policy Task Force. He is chair of the Department of Neurological Surgery at Case Western University and at University Hospitals of Cleveland.
“Our aim is to make it a simple matter for AANS Active members to fulfill the Maintenance of Certification requirements as they evolve,” said Christopher Loftus, MD, chair of the newly established AANS Education and Maintenance of Certification Committee known as EMC2. “It may be tempting to view MOC requirements as another onerous burden, but the ‘membership advantage’ is that the AANS, through EMC2, is taking on the burden.”
Dr. Loftus said that a primary focus of EMC2 is creating an accessible, member-friendly mechanism that will manage the process and eliminate the guesswork-Have I met current the requirements? What do I need to do and how long do I have to do it?-and the attendant worry.
“I envision our members logging into ‘My AANS’ on the AANS Web site, viewing an accounting of their own continuing medical education credits that tells them what they need to accomplish and the timeframe for doing so, reviewing a listing of pertinent CME opportunities, and clicking and registering for a needed course or meeting,” he explained. “A simple, effective, all-encompassing CME management process that is tied into ABNS requirements will free members to concentrate on practicing neurosurgery rather than scrutinizing the details of the MOC process.”
Throughout his career, Dr. Loftus has been involved with various aspects of incorporating neurosurgical education into neurosurgical practice. At present he serves as chair of neurosurgery at the University of Oklahoma and chair of the AANS Publications Committee.