Baylor University Medical Center Proceedings April 2014, Volume 27, Number 2 | Page 84

an ethical conflict at worst and difficult at best to declare, seemingly arbitrarily, ahead of time whether a presentation may or
may not meet the criteria for awarding CME credit, the authors
of this paper shifted that burden to the physician seeking CME
credit. We asked the attendee: “Describe how this presentation addressed your current practice-based needs: How will you
use the information presented to 1) change/impact how you
care for your patients; or 2) improve your medical administrative skills; or 3) enhance your research skills.” In other words,
credit would be based on physician response.
With open-minded and close collaboration among the host
university CME office, the national office of the AAHM, and
the ACCME, an agreement was forged to pursue this approach.
Through the support and collaboration of the chair of the institution’s CME committee, we reached a suitable mechanism
for providing CME for physicians attending the AAHM meeting. Members of the local arrangements committee of the host
institution also reviewed the process and supported it. While an
online submission process for physician attendees seeking CME
credit was preferred, time and finances led in this case to a paper
submission process. The revised rules of the national ACCME had
been the barrier preventing participants in history of medicine
meetings from obtaining legitimate credit. Once approved by the
national offices of the AAHM and the ACCME, this hurdle had
become surmountable, and the work became logistical.
It is beyond the scope of this article to persuade the reader
of the value of studying the history of medicine. Rather, the
article focuses on the quandary of awarding CME at history of
medicine conferences. Others have written eloquently of this
struggle. Prior to the 2010 AAHM annual meeting in Rochester,
Minnesota, Bruce Fye, former president of the American College of Cardiology, wrote in a letter in support of CME:
History teaches many valuable lessons that can be incorporated
into medical practice. The history of medicine serves several
useful functions today, when doctors live and work in an environment of escalating expectations, eroding autonomy, and
decreasing discretionary time. Understandably, many doctors
are concerned about the future of medicine as they watch so
many powerful political, economic, and social forces transform
medical practice, research, and education (10).

Jacalyn Duffin, a physician, author, and passionate supporter of
the history of medicine, chronicled the CME quest, observing:
Not only does it illustrate how current standards came into
existence; its pursuit is a mirror of clinical practice. History is
predicated on the idea that things change. It proclaims the importance of life-long learning; its method—question, evidence
and interpretation—reflects diagnostic reasoning (11).

Her book, Clio in the Clinic: History in Medical Practice,
brings a pragmatic realism to the history of medicine in the
form of applied medicine (12). Physicians particularly enjoy
case-based approaches. History of medicine can be taught that
way, a method epidemiologists and public health officials use to
good effect. For example, Kushner’s work on Kawasaki’s disease,
which involved reapplying an updated case definition, allowed
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clinicians to recognize late effects of the disease that had been
missed (13). That is applied history and a reason to keep teaching history of medicine for CME credit. This is not your father’s
history of medicine paradigm.
Numerical results
To the authors’ knowledge, this is the first large-scale effort
implementing this type of CME approach. Since there are no
prior data, we elected to examine our acquired information to
see what we could discover, as quantification may shed light on
a subject when least expected. Einstein has noted in a quote inconclusively attributed to him, “Everything that can be counted
does not necessarily count. Everything that counts cannot necessarily be counted.” On the other hand, “Academics always want
to show we’re serious these days by talking numbers. And two
problems arise when we do that. We get the numbers wrong, and
we forget that numbers can’t tell us everything” (14). Regardless,
numerical data can be an instructive and informative start.
The conference was attended by 351 registrants, of whom
26 (7%) were MDs. Of the physician registrants, all submitted
requests for CME credit. Credit was based on a narrative summary of each presentation for which credit was requested. A
total of 370 narrative statements were submitted and studied by
a physician from the host university in charge of CME for this
annual meeting, as designated by the AAHM. From this review
of individual presentation requests, 56% were accepted and
44% were rejected. The average was 14.2 requests per physician,
with a range of 3 requests (2 people) to 28 requests (1 person).
Eight physicians submitted 21 or more requests. The highest
acceptance rate was 100% (3 of 3). The lowest acceptance rate
was 0% (0 of 12 and 0 of 3).
The primary reason for CME rejection was failure to follow
the instructions: “Describe how this presentation addressed your
current practice-based needs. How will you use the information
presented to 1) change/impact how you care for your patients;
or 2) improve your medical administrative skills; or 3) enhance
your research skills.” The specific failure was documenting how
the talk could be utilized to enhance skills in the three categories
above. Most rejections resulted from the applicants limiting their
remarks to a simple summary of the presentation. There were
two rejections for illegibility. Of the submissions approved, 45%
were approved for patient care, 27% for medical administration,
and 21% for research. A handful, 7%, were approved in multiple
cate gories. The Table provides samples of the responses.
Approximately 130 talks were delivered in the academic sessions. The lunch sessions, the Fielding Garrison Lecture, and the
plenary session featuring two internationally prominent public
health physicians were not included. This was an administrative
oversight, as the forms were not provided in those locations. The
academic sessions lasted 90 minutes and typically featured three
speakers and sometimes two or four. The maximum number
of talks one could attend was about 36. Thus, the maximum
possible number of awarded CME hours was 18 hours at the
rate of 0.5 CME hours per presentation. For this meeting, the
maximum number of CME hours actually awarded to a participant was 10 hours. That person submitted 23 requests, of

Baylor University Medical Center Proceedings

Volume 27, Number 2