By: Lisa Fennell, Executive Director, Association of Regulatory Boards of Optometry
The Council on Optometric Practitioner Education (COPE®) is a program established by the Association of Regulatory Boards of Optometry (ARBO®) for accreditation of continuing education (CE) for optometrists. COPE was developed in 1993 to accredit individual CE activities, with over 52,000 activities receiving accreditation since the inception of the program. Like other accreditation systems, COPE accreditation assures that optometrists receive education that is designed to be independent, free from commercial bias, based on valid content and effective in improving the quality of care delivered to their patients.
COPE providers must meet rigorous standards for educational quality and independence, and COPE CE activities must be planned, implemented and evaluated in accordance with COPE’s Accreditation Criteria, Standards for Commercial Support (SCS) and accreditation policies. As healthcare and continuing education has evolved, COPE has also made efforts to advance its accreditation system to align with other CE/CME accreditation systems.
Continuing medical education (CE/CME) is used by healthcare professionals for a variety of purposes, including continuing professional development, license renewal and maintenance of certification. Over time, CE/CME has evolved from simply sharing medical knowledge to developing professional competencies to improve patient outcomes. Currently, healthcare is moving toward a team-based approach, and CE/CME is also evolving to include more collaborative education. Traditionally, continuing education has been conducted separately by individual professions. As healthcare providers move toward practicing in teams, education is also evolving to educate different professions together.
At this point, CE/CME is still predominantly accredited by each individual profession. The process to become accredited to provide CE/CME can be staff intensive, time consuming and inefficient. For a CME/CE provider, the many different accreditation processes can be overwhelming. The Joint Accreditation for Interprofessional Continuing Education process developed by medicine, pharmacy and nursing has made great strides toward addressing this issue by providing a standardized process to become jointly accredited. However, many other healthcare professions still have separate, and often very different, accreditation processes.
To meet the needs of this continuously changing environment, COPE has made an effort to adapt its accreditation requirements to be consistent with those used by other CE/CME accreditors. COPE implemented its Standards for Commercial Support (SCS) in 2010 to ensure that all COPE CE/CME is independent, free from commercial bias and based on valid content. The COPE SCS paralleled the ACCME Standards for Commercial Support, providing clear direction to CE/CME providers and commercial supporters. In 2015, COPE adopted the ACCME® Standards for Commercial Support: Standards to Ensure Independence in CME ActivitiesSM, which have also been adopted by other professions including nursing and pharmacy.
COPE continued to research the accreditation requirements of other CE/CME accreditors and again decided to make changes to align the COPE system with the other accreditation systems. The COPE accreditation criteria were revised to add new requirements for educational planning and outcomes assessment. The new criteria require optometric CE providers to address the professional practice gaps of the optometrist learner using an educational planning process designed to change the skill, strategy or patient outcomes of the optometrist. COPE CE providers are also asked to assess the outcomes of their educational activities and to take quality improvement measures to improve future activities. COPE made the decision to adopt the ACCME’s Accreditation Criteria (1–13) in 2015, and the new COPE accreditation criteria were fully implemented as of February 2017.
At that time, COPE had also received requests from its CE/CME providers to develop a provider accreditation process. Additional research showed that most other CE/CME accreditation systems were accrediting providers and not individual activities. This prompted COPE to develop a provider accreditation option, similar to the accreditation systems of medicine, pharmacy and nursing. In February 2017, COPE began offering a hybrid system with two options for accreditation of optometric CE/CME: activity accreditation and provider accreditation.
COPE’s two accreditation options share the same accreditation criteria and SCS. Providers are free to choose either the activity accreditation or provider accreditation option. The first step in the COPE accreditation processes, regardless of which pathway an organization chooses, is for an organization to fill out a pre-application to determine eligibility. If the organization is found not to be a commercial interest, they are eligible to continue the accreditation process. COPE defines a commercial interest as: any entity producing, marketing, re-selling or distributing healthcare goods or services consumed by, or used on, patients. Providers of clinical service directly to patients are not considered a commercial interest.
The COPE activity accreditation process is a two-step process which requires submission of specific activity data for review prior to the activity and submission of additional data, after completion of the activity. Prior to an activity, CE/CME providers are asked to supply information on the educational planning process they used to design the activity including: the professional practice gap(s) of the learners; the educational need(s) of the learners that were determined to be the cause of the practice gap; and the specific skill, strategy or patient outcome that is the desired outcome of the activity. All relevant financial relationships and disclosure information must also be provided as part of the COPE activity accreditation process.
After a COPE accredited activity has taken place, additional information must be submitted, including documentation of commercial support that was received. COPE also requires a post-activity outcome assessment, which includes analyzing changes in the learners based on the goals of competence, performance or patient outcomes. COPE CE providers are asked to use this information to determine the degree to which the activity met their desired educational goals. Lastly, they are asked to describe how the information will be utilized to improve future educational activities.
COPE's provider accreditation process gives CE/CME providers an opportunity to demonstrate that they are in compliance with COPE's accreditation requirements through three sources of data: a self-study report, performance in practice activity review and accreditation phone interview. The self-study report is a documented narrative of the processes an organization uses in the planning, administration and analysis of their educational program. Providers are asked to include specific evidence that shows their CE/CME activities are in compliance with COPE’s criteria and policies. Providers also submit evidence through a performance in practice review of their educational activities to verify that they met COPE’s expectations. Providers are given an opportunity to further discuss their CE/CME practices during a phone interview with COPE.
Initial accreditation is based on the provider’s demonstration of compliance with criteria 1-4 and 7-12. Providers that are found to be in compliance with these criteria become provisionally accredited for a two-year term. At the end of the initial provisional term, providers may apply for reaccreditation. During the reaccreditation process, providers must demonstrate compliance with all 13 criteria. Based on the reaccreditation compliance findings, providers may receive an accreditation status of either: provisional accreditation, accreditation for a 4-year term, probation or non-accreditation. Currently, COPE does not offer accreditation with commendation, but that option may be added in the future.
The scope of accredited CE/CME is continuing to grow every year, and it’s becoming more important for accreditation requirements to be consistent from profession to profession. CE/CME accreditors are encouraged to make efforts to align their requirements with those of other accreditation systems to create a consistent, simplified accreditation process. This will increase the amount of accredited CE/CME that is available to health professionals every year, resulting in improved quality of care and ultimately better health outcomes.