Update of 1995 and 1996 TMA Policy

House of Delegates policies included in the association's Policy Compendium are reviewed periodically for relevance and appropriateness.  At meetings held in May and September 2005 and February 2006, the Council on Medical Education reviewed policy statements originally adopted in 1995 and 1996.  Input from the Committee on Continuing Education was considered by the council in the review of policies relating to continuing medical education. The council's analysis and recommendations for retention, deletion, or amendments to the individual policy statements are summarized in this report. 

The following policy is recommended for retention as it is current, valid, and relevant:

200.030 Preventive Medicine Education : The Texas Medical Association encourages physicians and physicians in training to receive ongoing education to help incorporate the techniques of preventive medicine in their daily practice. TMA also affirms the efforts of Texas medical schools to incorporate disease prevention and health promotion into their curricula, preparing future physicians to put prevention effectively into practice (Council on Public Health, p 88, I-96).

Recommendation 1 : Retain.

In lieu of the following policy, the council recommends adoption of the language below:

320.007  Medical School Funding Town Gown : The Texas Medical Association supports the use of state appropriations to medical schools and graduate medical education programs solely for their education and research missions. However, TMA believes that medical schools should refrain from income-generating activities and services that would result in the generation of funds in excess of those needed to support their education, patient care, and research missions, and that Texas medical schools should refrain from using their state agency/nonprofit status tax exemptions in advertising and promoting their medical services. TMA further supports requiring all managed care organizations that receive managed Medicaid contracts to include graduate medical education training programs within their geographic areas in their network or networks of providers serving Medicaid enrollees (Board of Trustees, p 18, I-96).

Background: In lieu of the detailed policy above, the council recommends new language that encourages collaborative practice arrangements for community and academic physicians.

320.007 Community and Faculty Physician Collaborative Practice Arrangements : The Texas Medical Association encourages collaborative practice arrangements between community-based physicians and physician faculty to foster strong town/gown relationships .

Recommendation 2 : Approve substitute policy.

The following provides the council's recommendations for retention of 10-year old TMA policies relating to continuing medical education. 

70.008  CME Mandated Subject Content : The medical profession alone has the responsibility for setting standards and determining curricula in continuing medical education. Individual needs assessment which leads to the development of personally relevant continuing medical education has been shown to be most effective in achieving positive outcomes on physician practice change and patient care. Mandates for CME hours in specific subject areas may be detrimental to patient care by diverting the utilization of scarce resources to meet requirements rather than for educational activities most germane to the physician's specialty and practice. The Texas Medical Association opposes all mandates for continuing medical education hours in specific subject areas and supports working with relevant medical groups, community groups, and legislators to determine more effective methods of resolving issues which typically lead to mandated subject content (Board of Trustees, p 39C, I-96).

Recommendation 3 : Retain.

200.029 Personalized Education Program : The Texas Medical Association endorses the concept of a Texas personalized education program which provides a systematic method to address individual physicians' educational needs in scientific knowledge, technical skills, and interpersonal skills as they relate to medical practice (Committee on Continuing Education, p 76, I-96).

Medical schools currently design programs for physicians at the request of the Texas Medical Board. An example is The University of Texas Observership program at The University of Texas Health Science Center at San Antonio. The council offers the following substitute policy:

200.029 Personalized Education Programs : The Texas Medical Association urges continuing medical education providers to assist credentialing bodies and the Texas Medical Board in offering individualized, non-punitive educational activities for physicians required to remediate deficiencies in practice or performance.

Recommendation 4 : Approve substitute policy.

Several of the statements in the following policy are dated or are already addressed through other policies and practices.

70.005 CME in Texas, Mandatory : The Texas Medical Association reaffirms its policy to support

voluntary continuing medical education for physicians in Texas.  The Texas Medical Association supports the development of methods to measure the impact and outcomes of CME on physician practice patterns and patient care (Committee on Continuing Education, p 111, A92) . and recommends that physician competence be enhanced through support, funding, and promotion of the following types of efforts and activities:

(1) That TMA support state and federal funding for research and development of self-assessment mechanisms to assist physicians in more accurately identifying their individual needs;

(2) That TMA assist in development of personalized, prescriptive CME opportunities which focus on individual specific needs;

(3) That TMA support state and federal funding for research and development of computerized systems and training to allow physicians to track and analyze their individual practice patterns and CME needs;

(4) That TMA support state and federal funding for continued improvements in computer data                 bases, networks and other systems to improve the acquisition, organization, and retrieval of specific medical information that enhances patient care;

(5) That TMA facilitate efforts to broaden both physicians' and CME sponsors' concepts and understanding of CME and its potential for meeting individual needs in innovative and relevant ways;

(6) That TMA facilitate the development and expansion of systems for physician uses of medical audit and other practice data within the physician's practice environment to improve patient care; and

November 1989 policy stated: "Life-long continuing education for all physicians is a necessary goal. Individual physicians should pursue self-directed learning opportunities through a broad spectrum of continuing education means. The Texas Medical Association supports voluntary continuing medical education and opposes mandatory continuing education as a basis for Texas Medical Association membership or state relicensure. The development of high quality continuing medical education through accredited programs in Texas hospitals and institutions is a high priority." TMA, in studying the issue of mandated CME, approved the following points:  

(1) That TMA continue to recognize traditionally structured CME and self-directed learning as vital for practicing physicians and for assuring the public of physicians' commitment to protecting their health.

(2) That TMA is committed to assuring quality, low-cost CME for all physicians.

(3) That any system of required documentation of CME activities associated with the registration of a physician licensure should allow for traditionally structured CME, self-directed learning, and widely used formats of CME with specific requirements and safeguards.

(4) That establishment of adequate administrative mechanisms to maintain documentation and validation of CME activities associated with the reregistration of a physician license should not pose bureaucratic challenges or costs to the physician or to the state, and

(5) That TMA support reporting of continuing medical education at the time of reregistration of a physician's license to practice medicine in Texas (Council on Medical Education, p 93, I-92).

Recommendation 5 : Retain as amended.

TMA House of Delegates: TexMed 2006