Massachusetts Medical Society: Shared Decision Making: Essential Skills for Prostate, Lung & Breast Cancer Screening

Shared Decision Making: Essential Skills for Prostate, Lung & Breast Cancer Screening

Introduction and Shared Decision Making in Prostate Cancer Screening

For patients, making decisions about getting screening tests for cancer involves weighing the benefits of early cancer detection and the possible harms.  The benefit is reduced risk of death from the cancer. Harms include over-diagnosis with associated over-treatment, the adverse effects of unnecessary diagnostic procedures, and the emotional costs of dealing with false positive test results. To assist women aged 40-49 in making decisions about breast cancer screening and supporting all patients making decisions about lung or prostate cancer screening, the best practice involves engaging patients in a robust shared decision-making (SDM) process. This process should be facilitated by a health care provider with full knowledge of the benefits and harms of a screening process and the skill to help the patient identify and apply their relevant values to the decision.

This four-module webinar series is designed to equip providers with the requisite knowledge and skills for facilitating SDM for 3 cancer screening processes: prostate, lung, and breast (for women aged 40-49). Participants will learn how to interpret and communicate quantitative information about the likelihood of benefits and harms from cancer screening tests. The webinar series also highlights specific techniques for supporting patients in identifying and applying their preferences, values and beliefs related to cancer screening and the screening decision. A panel presentation that concludes the webinar offers participants practical strategies and tools for introducing SDM into clinical workflows.

Intended Audience

Family medicine, general internal medicine and other primary care providers

Overall Activity Learning Objectives

  • Define and describe the key elements and 6 steps of Shared Decision Making for cancer screenings
  • Identify the reasons for using Shared Decision Making when offering patients cancer screening
  • Present and compare the benefits and risks of prostate, breast and lung cancer screening using decision aids when appropriate
  • Facilitate Shared Decision Making for cancer screening into practice
  • Identify ways and means for integrating Shared Decision Making for cancer screening into the clinical work flow of practice

Faculty and Planners:

Ronald Adler, MD
Michael Barry, MD
Mark Kennedy, MBA
Lorky Libaridian, MD
Roger Luckmann, MD, MPH
Andrea McKee, MD
Gail Merriam, MSW, MPH
Karen Sepucha, PhD
Leigh Simmons, MD
Stephen Wright, MD

Summary of Disclosure Information

None of the individuals in a position to control the content of this CME activity, and/or their spouse/partner, have any relevant financial relationships with commercial interests to disclose.

This webinar was supported by the Centers for Disease Control and Prevention (CDC) Cooperative Agreement 1 NU58DP006271-01-00. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.

Module 1 - Introduction and Shared Decision Making in Prostate Cancer Screening

Learners should expect to spend approximately 1 hour to complete Module 1.

Part 1: Introduction to Shared Decision Making
The first segment of this module introduces participants to Shared Decision Making (SDM). Michael Barry, MD describes why SDM is important and provides a summary of the key characteristics of SDM. He provides an overview of the use of patient decision aids to support SDM and reviews the evidence for the effectiveness of decision aids. Dr. Barry's presentation ends with an in-depth review of the six steps of the SDM process.

Part 2: Early Detection of Prostate Cancer
In the second segment, Dr. Barry reviews the possible benefits and harms of PSA testing to screen for prostate cancer and the recommendations of the U.S. Preventive Services Task Force and others for prostate cancer screening. He presents and discusses the evidence relevant to estimating the likelihood of benefits and harms among men who are screened. He also describes an approach to SDM for men at average risk for prostate cancer and presents a brief video simulating a typical SDM discussion for prostate cancer. The module concludes with a commentary by Dr. Barry on the video.

Learning Objectives

  • Define and describe the key elements and 6 steps of Shared Decision Making (SDM)
  • Identify the reasons for using SDM when offering patients cancer screening
  • State and effectively communicate the nature and likelihoods of occurrence of the possible benefits and harms of screening for prostate cancer with the prostate specific antigen (PSA) test
  • Gain confidence in facilitating SDM for prostate cancer screening by observing an episode of SDM as it might be performed in a typical primary care practice

Faculty

Michael Barry, MD is the Director of the Informed Medical Decisions Program at Massachusetts General Hospital, which has the goal of conducting research to facilitate better health decision making. He has dedicated 30 years to the mission of conducting patient-outcome studies and helping people make better health decisions, developing and implementing patient and clinician shared decision-making aids and training programs. He continues to work on strategies to help disseminate the results of patient-centered-outcomes research to patients and clinicians making decisions as part of day-to-day care. He has also participated in clinical guideline panels for the American College of Physicians, the American Urological Association, the National Cancer Center Network, and the American Cancer Society. Dr. Barry was recently selected as a member of the U.S. Preventive Services Task Force. He served as the Chief Science Officer at Healthwise (formerly Informed Medical Decisions Foundation), developing numerous nationwide networks for the implementation and evaluation of shared decision making supported by decision aids.

Course Fees

Massachusetts Medical Society (MMS) Member: Free  
Non-MMS Member: Free   
Allied Health Professionals: Free

Format

Video 

CME Credit

1.00 AMA PRA Category 1 Credit™  

Accreditation Statement for Joint Providership
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Massachusetts Medical Society and the Massachusetts Department of Public Health. The Massachusetts Medical Society is accredited by the ACCME to provide continuing medical education for physicians.

AMA Credit Designation Statement
The Massachusetts Medical Society designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This activity meets the criteria for the Massachusetts Board of Registration in Medicine for risk management study.

MOC Approval Statement 
Through the American Board of Medical Specialties ("ABMS") ongoing commitment to increase access to practice relevant Maintenance of Certification ("MOC") Activities through the ABMS Continuing Certification Directory , this activity has met the requirements as an MOC Part II CME Activity (apply toward general CME requirement) for the following ABMS Member Boards:

Allergy and Immunology
Anesthesiology
Family Medicine
Nuclear Medicine
Physical Medicine and Rehabilitation
Preventive Medicine
Psychiatry & Neurology
Radiology
Thoracic Surgery
Urology

National Commission on Certification of Physician Assistants (NCCPA).
Physician Assistants may claim a maximum of 1.00 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. 

A score of 70% or higher is required to receive AMA PRA Category 1 Credit™.

Activity Term

Original Release Date: September 12, 2018
Review Date: N/A   
Termination Date: September 12, 2021    

System Requirements

Desktops/Laptops  
Windows, XP, Vista, 7, 8  
Mac OSX 10.6 higher  

Most modern browsers including:   
IE 8,9,10  
Firefox 18.0+  
Chrome 26+  
Safari 5+  
Flash player is required for some Online CME courses.

Mobile/Tablet
iOS devices beginning with OS version 5 or higher (includes, iPhone, iPad and iTouch devices)  
Android devices including tablets and phones.  
Windows RT and tablets on Windows 8 are also supported. 


Shared Decision Making in Screening for Breast Cancer in Women 40-49 and for Lung Cancer

Module 2 - Shared Decision Making in Screening for Breast Cancer in Women 40 - 49 and for Lung Cancer

Learners should expect to spend approximately 1 hour to complete Module 2.

Part 1: Breast Cancer Screening in Women 40 - 49
Module 2 features presentations on SDM for two cancer screening measures. The first is by Karen Sepucha, PhD on SDM for Breast Cancer Screening for women 40-49. Dr. Sepucha reviews the current clinical guidelines for screening women younger than 50 with mammography and criteria for identifying younger women at high risk for breast cancer. She uses two case studies to illustrate the performance and use of risk calculations in SDM. Dr. Sepucha describes the evidence for benefits and harms of screening women 40-49 and best practices for risk communication. She ends her presentation with recommendations for eliciting patients’ goals and preferences relevant to screening decisions and facilitating their use by the patient in making an informed, preference-based decision.

Part 2: CT Lung Cancer Screening
The second presentation by Andrea McKee, MD focuses on SDM for lung cancer screening. Dr. McKee uses several cases to illustrate the possible benefits of low dose CT scans in diagnosing lung cancer at an early stage. She reviews the results of the National Lung Cancer Screening Trial, which showed a 20% lung cancer mortality reduction among screened patients. She reviews CT lung screening results from the Lahey Clinic to illustrate changes in rates of lung cancer diagnosis and in the occurrence of false positives in screened cohorts over time. Dr. McKee enumerates and discusses tasks providers must complete to refer a patient for lung cancer screening, including performing and documenting SDM that incorporates a decision aid and smoking cessation counseling when indicated. She concludes her presentation with some practical tips on integrating SDM into clinical practice.

Learning Objectives

  • Name examples of patient values that may be relevant to a decision about breast cancer screening
  • State and implement the steps involved in the lung cancer screening process including identifying patients eligible for screening, providing SDM with use of a decision aid as required by Medicare, providing counseling on smoking cessation, and interpreting findings with their recommended follow-up
  • State and effectively communicate the nature and likelihoods of occurrence of the possible benefits and harms of screening for lung cancer with low dose CT scans and screening for breast cancer with mammography for women 40-49

Faculty

Karen Sepucha, PhD is the director of the Health Decision Sciences Center in the general internal medicine division at Massachusetts General Hospital (MGH) and an associate professor at Harvard Medical School. Her research is focused on developing tools and measures to ensure that patients are well informed and meaningfully involved in significant medical decisions. Dr. Sepucha is responsible for efforts to promote shared decision making in primary and specialty care at MGH and across Partners HealthCare. In this work, she has overseen the delivery of more than 50,000 patient decision aids and training of more than 1,000 clinicians in shared decision-making communication skills. Her recent research has focused on the development of survey instruments to measure the quality of decisions; these have been used in national surveys of medical decisions and have been adapted for use in national patient experience surveys. Two performance measures based on these surveys have been endorsed by the National Quality Forum. Dr. Sepucha has been active in local, national, and international efforts to improve decision quality, including the International Patient Decision Aids Standards collaboration. 

Andrea McKee, MD is a partner at Radiation Oncology Associates and currently serves as Chairman of Radiation Oncology at Lahey Hospital & Medical Center’s (LHMC) Sophia Gordon Cancer Center and Lahey Medical Center Peabody. Dr. McKee is a codirector of the Massachusetts State CT Lung Screening Subcommittee and is a member of both the Massachusetts Cancer Prevention and Control Network Steering Committee and the National Lung Cancer Roundtable. She is an advisory board member of the Lung Cancer Alliance and the American Lung Association. Dr. McKee and a team of allied health professionals at LHMC initiated the Rescue Lung, Rescue Life community benefit CT lung-screening program to save lives and open screening access to those at high risk for lung cancer regardless of their financial means. She has coauthored numerous seminal peer-reviewed publications on the design, implementation, and management of clinical CT lung-screening programs and is also an expert in environmental risk factors and lung health in patient care. 

Course Fees

Massachusetts Medical Society (MMS) Member: Free   
Non-MMS Member: Free   
Allied Health Professionals: Free

Format

Video 

CME Credit

1.00 AMA PRA Category 1 Credit™  

Accreditation Statement for Joint Providership
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Massachusetts Medical Society and the Massachusetts Department of Public Health. The Massachusetts Medical Society is accredited by the ACCME to provide continuing medical education for physicians.  

AMA Credit Designation Statement
The Massachusetts Medical Society designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This activity meets the criteria for the Massachusetts Board of Registration in Medicine for risk management study.  

MOC Approval Statement 
Through the American Board of Medical Specialties ("ABMS") ongoing commitment to increase access to practice relevant Maintenance of Certification ("MOC") Activities through the ABMS Continuing Certification Directory , this activity has met the requirements as an MOC Part II CME Activity (apply toward general CME requirement) for the following ABMS Member Boards:

Allergy and Immunology
Anesthesiology
Family Medicine
Nuclear Medicine
Physical Medicine and Rehabilitation
Preventive Medicine
Psychiatry & Neurology
Radiology
Thoracic Surgery
Urology

National Commission on Certification of Physician Assistants (NCCPA).
Physician Assistants may claim a maximum of 1.00 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. 

A score of 70% or higher is required to receive AMA PRA Category 1 Credit™.

Activity Term

Original Release Date: September 12, 2018
Review Date: N/A   
Termination Date: September 12, 2021    

System Requirements

Desktops/Laptops  
Windows, XP, Vista, 7, 8  
Mac OSX 10.6 higher  

Most modern browsers including:   
IE 8,9,10  
Firefox 18.0+  
Chrome 26+  
Safari 5+  
Flash player is required for some Online CME courses.

Mobile/Tablet
iOS devices beginning with OS version 5 or higher (includes, iPhone, iPad and iTouch devices)  
Android devices including tablets and phones.  
Windows RT and tablets on Windows 8 are also supported. 


Shared Decision Making for Screening in Patients at Higher Risk for Cancer

Module 3 - Shared Decision Making for Screening in Patients at Higher Risk for Cancer

Learners should expect to spend approximately 1 hour to complete Module 3.

Part 1: Recommendations and Information for Patients at Increased Risk for Cancer: Basic Principles
Module 3 features presentations about screening patients at higher than average risk for cancer. Roger Luckmann, MD, MPH explains how recommendations for screening high risk patients are usually developed and reviews the assumptions that may be made in calculating likelihoods of benefits and harms in high risk patients. He reviews the rationale and related assumptions for starting screening at an earlier age for some high-risk patients, for shortening the interval between screens, and for lowering the threshold for a positive test. He suggests some approaches to discussing cancer screening with patients at significantly higher risk than average.

Part 2: Shared Decision Making for Men at Increased Risk for Cancer
The second presentation on SDM for prostate cancer screening for high-risk men is by Mark Kennedy, MBA. This presentation focuses on screening for African American men but addresses SDM for all high-risk men. Mark reviews the established risk factors for prostate cancer of age, race and family history and the potential harms and benefits of PSA testing and of other tests and treatments on the prostate cancer care continuum for men at high risk that differ from men at average risk. He addresses the potential effect of variations in care and the possible implications of not screening high-risk men.  The presentation includes a review of existing screening guidelines and what they mean for high-risk men, and the goals of screening for these men.  For men and their doctors, the presentation provides an approach and rationale for screening high-risk men in the absence of Level 1 research evidence for this group.

Participants will view a brief video simulating an SDM discussion for prostate cancer with an African American patient and hear commentary from Mark on the video that frames how SDM can be conducted most appropriately for this population.  Mark concludes with a review of key considerations for utilizing SDM as a first step in mitigating the harms of PSA testing for high-risk men. 

Learning Objectives

  • Name and assess the impact of assumptions that are typically made when estimating the benefits and harms of cancer screening for patients who are at higher than average risk
  • Summarize recommendations for prostate cancer screening for African American men and men with a significant family history of prostate cancer and state the rationale for those recommendations
  • Develop confidence in facilitating SDM for prostate cancer screening of men with greater than average risk by observing an episode of SDM involving an African American patient as it might be performed in a typical primary care practice

Faculty

Roger Luckmann, MD, MPH Professor of Family Medicine and Community Health, has been a primary care internist and health services researcher at UMass Memorial Medical Center and UMass Medical School for 30 years.  As co-chair of the Prostate Cancer Work Group of the Massachusetts Department of Public Health Comprehensive Cancer Prevention and Control Program (MDPH CCPCP), he played a pivotal role in developing this program on shared decision making for cancer screening. Dr. Luckmann has engaged in research on shared decision-making, decision-aid development and implementation, and outreach to increase adherence to cancer screening guidelines in primary care populations. His research portfolio also includes pioneering work on engaging multi-stakeholder panels in the development of clinical practice guidelines. With leadership from Dr. Luckmann and others, the MDPH, through its CCPCP Network, is expanding the role of public health in making shared decision making and decision aids accessible to both patients and providers throughout the state.

Mark Kennedy, MBA is a senior program manager for the Chronic Disease Prevention and Control Division of the Boston Public Health Commission. As a co-chair of the Prostate Cancer Work Group of the Massachusetts Department of Public Health Comprehensive Cancer Prevention and Control Program, Mr. Kennedy participated in the design and testing of a shared decision-making tool for prostate cancer screening that was piloted in community health centers in Boston and across the Commonwealth. Mr. Kennedy has extensive research experience in the development of education protocols for prostate health and prostate cancer screening targeted to community settings. He currently designs, implements, and manages the portfolio of population health interventions that address cancer screening and chronic diseases.

Course Fees

Massachusetts Medical Society (MMS) Member: Free   
Non-MMS Member: Free   
Allied Health Professionals: Free

Format

Video 

CME Credit

1.00 AMA PRA Category 1 Credit™  

Accreditation Statement for Joint Providership
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Massachusetts Medical Society and the Massachusetts Department of Public Health. The Massachusetts Medical Society is accredited by the ACCME to provide continuing medical education for physicians.  

AMA Credit Designation Statement
The Massachusetts Medical Society designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit™.   Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This activity meets the criteria for the Massachusetts Board of Registration in Medicine for risk management study.

MOC Approval Statement 
Through the American Board of Medical Specialties ("ABMS") ongoing commitment to increase access to practice relevant Maintenance of Certification ("MOC") Activities through the ABMS Continuing Certification Directory , this activity has met the requirements as an MOC Part II CME Activity (apply toward general CME requirement) for the following ABMS Member Boards:

Allergy and Immunology
Anesthesiology
Family Medicine
Nuclear Medicine
Physical Medicine and Rehabilitation
Preventive Medicine
Psychiatry & Neurology
Radiology
Thoracic Surgery
Urology

National Commission on Certification of Physician Assistants (NCCPA).
Physician Assistants may claim a maximum of 1.00 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. 

A score of 70% or higher is required to receive AMA PRA Category 1 Credit™.

Activity Term

Original Release Date: September 12, 2018
Review Date: N/A   
Termination Date: September 12, 2021    

System Requirements

Desktops/Laptops  
Windows, XP, Vista, 7, 8  
Mac OSX 10.6 higher  

Most modern browsers including:   
IE 8,9,10  
Firefox 18.0+  
Chrome 26+  
Safari 5+  
Flash player is required for some Online CME courses.

Mobile/Tablet
iOS devices beginning with OS version 5 or higher (includes, iPhone, iPad and iTouch devices)  
Android devices including tablets and phones.  
Windows RT and tablets on Windows 8 are also supported. 


Putting Shared Decision Making into Practice: A Panel Discussion

Module 4 - Putting Shared Decision Making into Practice: A Panel Discussion
Learners should expect to spend approximately 1.25 hours to complete Module 4.

Module 4 features a panel discussion about the challenges that primary care providers face in integrating SDM and decision aids into clinical practice and explores strategies for overcoming those challenges. The panelists will describe approaches to addressing barriers to SDM including clinical work flow issues, time constraints and patients’ limited experience with and preparation for SDM.  The panelists include Stephen Wright, MD from Mattapan Community Health Center, Lorky Libaridian, MD from the Cambridge Health Alliance, Leigh Simmons, MD, from the Massachusetts General Hospital (MGH) and the MGH Health Decision Sciences Center, and Ronald Adler, MD, from the UMass Memorial Hahnemann Family Health Center.

Learning Objectives

  • Identify several ways and means for integrating SDM for cancer screening into the clinical work flow in practice
  • Recognize ways to overcome time constraints in clinical practice that present a barrier to conducting SDM
  • Describe techniques to address limited patient receptivity to and familiarity with shared decision-making discussions

Faculty

Ronald Adler, MD, FAAFP currently leads recruitment and engagement activities for the Southern New England Practice Transformation Network, part of the Centers for Medicare and Medicaid Services’ Transforming Clinical Practice Initiative. He has practiced and taught family medicine at University of Massachusetts Medical School for 25 years, all at a resident-training practice serving vulnerable populations. Dr. Adler trained as an Improvement Advisor at the Institute for Healthcare Improvement in preparation for his role as Director for Primary Care Practice Improvement through the Center for the Advancement of Primary Care at UMass. His interests include women’s health, quality improvement, behavioral health integration, shared decision making, and reduction of waste and harms with an emphasis on avoiding overdiagnosis and overtreatment. He created and led improvement initiatives that focused on diabetes, hypertension, and CAD. He has also led local and statewide initiatives to transform practices into Patient-Centered Medical Homes. 

Lorky Libaridian, MD has over ten years of experience as a practicing internist and pediatrician.  In 2013 she joined Cambridge Health Alliance (CHA), a public hospital/safety net health care organization in the Boston metropolitan area. In 2015 Dr. Libaridian took on the role of the Medical Director for Performance Improvement in Primary Care.  In this role, Dr. Libaridian has guided site leadership, performance coaches and front-line staff in the application of performance improvement science. Dr. Libaridian supports the primary care sites at CHA in improving performance on CHA’s ambulatory quality goals, which focus on evidence-based patient-centered care for children and adults, and include pediatric well care, cancer screening, and medical management of chronic illnesses. Dr. Libaridian works with her colleagues in several fields - including nursing, pharmacy, nutrition, patient partners, information technology and others - to develop guidelines and best practices with the goal of improving the health and wellbeing of all the patients CHA serves.   

Roger Luckmann, MD, MPH, Professor of Family Medicine and Community Health, has been a primary care internist and health services researcher at UMass Memorial Medical Center and UMass Medical School for 30 years.  As co-chair of the Prostate Cancer Work Group of the Massachusetts Department of Public Health Comprehensive Cancer Prevention and Control Program (MDPH CCPCP), he played a pivotal role in developing this program on shared decision making for cancer screening. Dr. Luckmann has engaged in research on shared decision-making, decision-aid development and implementation, and outreach to increase adherence to cancer screening guidelines in primary care populations. His research portfolio also includes pioneering work on engaging multi-stakeholder panels in the development of clinical practice guidelines. With leadership from Dr. Luckmann and others, the MDPH, through its CCPCP Network, is expanding the role of public health in making shared decision making and decision aids accessible to both patients and providers throughout the state. 

Leigh Simmons, MD is an internal medicine physician at Massachusetts General Hospital (MGH) and an assistant professor of medicine at Harvard Medical School, where she also directs the internal medicine clerkship. She is the medical director of the MGH Health Decision Sciences Center, where she studies the use of decision aids to help patients and clinicians in the shared decision-making process. Dr. Simmons develops and conducts communications-skills training for physicians and staff that focuses on improving decision making with patients. 

Stephen Wright, MD, MBA is a general surgeon and provider in the Adult Medicine department at Mattapan Community Health Center and is the Medical/Laboratory Director for Faulkner Labs. His research, as the Principal Investigator and Associate Medical Director at Analgesic Solutions, focused on chronic pain and included national and international phase 2, 3, and 4 studies. Working in the Surgery and Surgical Pathology departments at Mount Auburn Hospital, Saint Elizabeth Medical Center, and Massachusetts General Hospital, he was affiliated with Harvard Street Community Health Center as Chief of Adult Medicine and General Surgery and with Whittier Street Health Center in Adult Medicine, General Surgery, HIV, Men's Health Clinic, and in the Urgent Care Center. Dr. Wright has also conducted vascular surgery research at the Boston VA Medical Center and at Beth Israel Deaconess Medical Center in Boston.

Course Fees

Massachusetts Medical Society (MMS) Member: Free   
Non-MMS Member: Free   
Allied Health Professionals: Free

Format

Video 

CME Credit

1.25 AMA PRA Category 1 Credit™  

Accreditation Statement for Joint Providership
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Massachusetts Medical Society and the Massachusetts Department of Public Health. The Massachusetts Medical Society is accredited by the ACCME to provide continuing medical education for physicians. 

AMA Credit Designation Statement
The Massachusetts Medical Society designates this enduring material for a maximum of 1.25  AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

This activity meets the criteria for the Massachusetts Board of Registration in Medicine criteria for risk management study.

MOC Approval Statement 
Through the American Board of Medical Specialties ("ABMS") ongoing commitment to increase access to practice relevant Maintenance of Certification ("MOC") Activities through the ABMS Continuing Certification Directory , this activity has met the requirements as an MOC Part II CME Activity (apply toward general CME requirement) for the following ABMS Member Boards:

Allergy and Immunology
Anesthesiology
Family Medicine
Nuclear Medicine
Physical Medicine and Rehabilitation
Preventive Medicine
Psychiatry & Neurology
Radiology
Thoracic Surgery
Urology

National Commission on Certification of Physician Assistants (NCCPA).
Physician Assistants may claim a maximum of 1.25 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. 

A score of 70% or higher is required to receive AMA PRA Category 1 Credit™.

Activity Term

Original Release Date: September 12, 2018
Review Date: N/A   
Termination Date: September 12, 2021    

System Requirements

Desktops/Laptops  
Windows, XP, Vista, 7, 8  
Mac OSX 10.6 higher  

Most modern browsers including:   
IE 8,9,10  
Firefox 18.0+  
Chrome 26+  
Safari 5+  
Flash player is required for some Online CME courses.

Mobile/Tablet
iOS devices beginning with OS version 5 or higher (includes, iPhone, iPad and iTouch devices)  
Android devices including tablets and phones.  
Windows RT and tablets on Windows 8 are also supported. 


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