APHA Continuing Education Policies

APHA Continuing Education Guidelines 

APHA Annual Meeting Policies for Program Planners, Planning Reviewers, and for Faculty/Presenters

APHA Conflict of Interest Policy 
Continuing Education Content Integrity Standard
Commercial and Sponsorship Standards 

Introduction: Continuing Education Mission and Accreditations 

Public health related continuing education is a learning experience designed to augment the knowledge, skills or competence, performance, attitudes or the professional development of the workforce. Such learning is aimed to improve the health of the public and the health care delivery system by presenting best practices, evidence-based practice and practice-based evidence in such contexts as public health education, policy, regulation, law or other relevant environment.

The purpose of the APHA CE program is to, "develop, maintain, and increase the competency, skills and professional performance of practitioners through the promotion of professional development, and to strengthen public health practice within the core guidelines of the public health essential services.  

The American Public Health Association's mission includes providing, co-providing or jointly providing quality continuing education for public health and health care professionals. The mission also includes approving educational activities that are developed by external entities and submitted to APHA for approval to award CE contact hour credits in public health and related areas. The Association’s CE program is multi-disciplinary with a single set of policies and processes that meet the requirements of the accreditations that it holds.

The expected results from the multi-discplinary CE program include:  1) increase public health and health care practitioners' ability to identify, adapt and apply strategies to implement and/or integrate new technologies such as Health IT into their practice; 2) increase public health and health care practitioners' ability to identify, adapt and apply strategies to intergrate and implement evidence-based approaches to addressing social determinants of health and other factors that affects patient outcomes; and 3) increase public health and health care practitioners' ability to identify, adapt and implement population health strategies to increase the health status of their target audience.

An Association priority is to assure compliance with the following CE accrediting organizations:

• National Commission for Health Education Credentialing, Inc. for certified health education specialists;
• Accreditation Council for Continuing Medical Education  for physicians and non-physicians;
• American Nurses Credential Center Commission on Accreditation for nurse; and
• National Board of Public Health Examiners for certified public health professional

A number of public health professionals in other disciplines may also benefit from these accreditations for re-licensure, re-certification or other recognitions. It is the responsibility of the individual professional to determine if one can apply the APHA provided, co-provided, jointly sponsored or approved CE contact hour credits to their re-licensure or re-certification.

The responsibility for compliance with accreditation requirements for CE-worthy activities is shared among all APHA planners, faculty/presenters, panelists, moderators, authors,  planning reviewers (referred as content reviewers or content experts), and the CE staff in the APHA Learning Professional Development Programs Unit.

The APHA role of the program planners, faculty/presenters and planning reviewers is to develop educational opportunities that are based on adult learning principles. Important to continuing education is to build on one’s basic professional education, to keep a professional up-to-date, and to expose the learners to knowledge that can be applied to practice in a number of settings. Adult learning principles are also applied when developing the content and selecting the appropriate teaching method/strategy. (Knowles, 1973, 1990; Knowles, 1984; Jarvis, 1985; Merriam, 2001; Merriam & Caffarella, 1991; Senge, 1990, 2006)

Policies for the Continuing Education Lead Planners

Eligibility to become a Program Planner:  Before the Program Planners begin their responsibilities, the lead CE planners must review the completed BioData/COI form from each planner and decide if that individual is free of bias or a conflict of interest, whether potential or actual, and must sign off for one to become a program planner. If even a potential bias or conflict of interest is identified, it must be resolved before that individual can proceed to the program planner role. How it was resolved must be documented with a CE planner sign off and the method and signature retained on file.

Eligibility to become a Planning Reviewer (aka, content reviewer or content expert): Before the Planning reviewers (aka, content reviewers or content experts) begin their responsibilities, the lead CE planners must review the completed BioData/COI form from each planner and decide if that individual is free of bias or conflict of interest, whether potential or actual, and must sign off for one to become a planning reviewer.

Policies for Program Planner and Faculty/ Presenters of the APHA Annual Meeting or Other Meetings

Responsibilities of the Program Planners: The 'Program Planners' are those individuals who are identified as the planner for each Section, SPIGs, Forum, Caucus, and the Student Assembly, and the APHA Boards and Committees that develop scientific sessions. The APHA planners-at-large and the three leaders in the positions of president-elect, president and immediate past president are also program planners. All Program Planners are expected to attend the APHA Planning Orientation that is held each year on the day after the Annual Meeting in the fall.

For the Annual Meeting, the program planners for the Sections, SPIG, Forums, Caucuses, and the Student Assembly usually have a group of individuals who help with the planning. These other individuals are referred to as 'planning reviewers' (or 'content reviewers' or 'content experts').

The APHA planners and the potential faculty/presenters develop the educational content of the scientific sessions and the Learning Institutes.

Program planners work with the planning reviewers to ensure that the:

1. potential faculty/presenters qualify to present the content that they propose;
2. content proposed is relevant for the Meeting theme and the learning needs of the target audience of professionals who attend the meeting.
3. Individuals who submit abstracts fill in all of the requested information by following the instructions that are in the CONFEX system.

The program planners and planning reviewers use an objective rating form when evaluating the submitted abstracts for acceptance or rejection for presentation at the Annual Meeting. APHA has an evaluation form that is on the CONFEX online system. In addition to the standard form, some components that develop scientific sessions may also use a customized review form that includes the interest of a specific component, such as a Section.

In general, the responsibilities for developing the following elements of the educational component for the APHA Annual Meeting are:

• Overall Meeting theme – APHA Governing Council
• Purpose – Lead CE Planners for each of the accredited disciplines
• Learning needs assessment – APHA Education Board CE Committee
• Identification of at least one gap in knowledge, skill or competence, performance or professional development that is based on the findings of the needs assessment - Lead CE Planners for each of accredited disciplines.
• Development of the Call for Abstracts for the Overall Meeting – APHA Program planners-at-Large
• Development of the Calls for Abstracts those are specific to each component in APHA that plans scientific sessions - Program Planner and planning reviewers for that component (i.e., section, SPIG, caucus, forum)

Responsibilities of the Faculty/Presenters: Each faculty/presenter who submits an abstract has the following responsibilities. The faculty/presenters may interact directly with their respective planners or planning reviewers at any time. Most of the communication occurs through the CONFEX system, but may also be by email or phone contact.

Policy 1 - Educational content and content integrity

The IOM report (2010) noted that educational activities must be conducted with integrity, ensuring freedom from commercial bias or promotion and based on best available evidence. The following parts of an educational session/activity must be independent, objective, and free from bias by a professional, financial or personal interest, or a commercial interest. The Planners may need to work with potential faculty/presenters to assist them in bringing a presentation into compliance with the requirement for content integrity.

Content and educational design components:

• Identification of CE learning needs. The learning need underlies a professional practice gap in knowledge, competence in practice or evidence-based practice. APHA conducts a learning need assessment for public health professionals. The findings are incorporated into the overall Annual Meeting Call for Abstracts that the Association’s program planners publish. The planners from the various APHA components do not need to conduct an additional needs assessment. However, some components choose to identify the learning needs for their component which is usually a specialty. If this happens, the findings are expected to be incorporated into that components Call for Abstracts.
• Identification of a professional practice gap that the presentation will address. Choices are listed in the CONFEX online submission screens.
• Determination of presentation title that reflects the topic to be presented.
• Determination of at least one measurable learning objective. There must be at least one measurable learning objective per abstract submission. Each objective must have only one action verb. APHA provides a list of acceptable action verbs in the CONFEX online system located where the learning objective is entered. APHA only evaluates the first listed learning objective. The Learning Institutes may have additional learning objectives depending on the length of the activity, the number of speakers and the content. A list of acceptable and of non-acceptable objectives is in the CONFEX online submission system on the screen to enter the learning objective for each presentation.
• Selection of content/abstract or outline. An Abstract should be at least 2 sentences that explain/describe the presentation that is proposed. It must be objective, free from bias and promotion. It may not include the names of commercial entities, products or services. Using classes of drugs or generic names of drugs and medical devices is acceptable.
• Selection of faculty/presenters, panelists, responders and moderators. Individuals in these roles either develop the content, learning objectives, and teaching strategies, or they participate in the development, or respond in their own way to what is developed by the lead faculty/presenter or keynote speaker. They all have the ability to influence the content as it is presented to the learners, although how they may influence will vary depending on each of these roles and the choice of the individual. Each presenter/faculty must complete a Qualification Statement that reflects one’s ability to deliver appropriate content. The Program Planners ensure that the faculty/ presenters are qualified by education and/or experience to present the specific content that is in the abstract.
• Selection of educational strategy/method, materials and resources such as handouts reflect the application of adult learning principles. Evidence supports that active engagement in the learning process is key for adult learners. (Benner et al., 2010; Senge, 1999, 2006; IOM, 2010). The learning method is based on how best to convey the content given the needs assessment and the gap this is being addressed. Acceptable strategies include presentation followed by question and answer; keynote followed by discussion; panels with discussions; and/or demonstrations, interactive learning, small group activity and/or roundtable discussion.

Eligible Content for CE: CE eligible content is objective and aims to improve practice by enhancing one’s knowledge, skill, competence, performance or professional development. The ultimate intent is to improve health and health care for all people. In public health, scope of the content topics that are acceptable for CE include health care systems and programs; delivery of health care; health-related policy, regulation, laws, funding, and other topics that keep the professional up-to-date in their specialty. CE eligible content should be based on the best available evidence or experience. Evidence-based practice and practice-based evidence for health professionals are the most preferred types of content. The content of a presentation is congruent with the presentation’s title, identified gap and learning objective. The content is appropriate for the suggested target audience. The APHA needs assessment applies to all of the sessions and presentations that are selected for the Annual Meeting.

Ineligible Content for CE: Types of content that are not eligible for awarding CE contact hour credits include: Management of personal finances and investments for target audience; content that promotes a product, service or other entity in a preferential or biasing manner; advocating, lobbying; political campaigning; rallies; strikes; and other actions that aim to influence or promote actions in a particular direction.

Content Integrity: Content integrity is the development of a learning presentation that is based on objective evidence and/or experience. Objectively presenting evidence that is positive or negative on a topic is acceptable. The basis for positive or negatives need to be given in a a factual manner and supported with evidence where possible. Comparisons and contrasts need to be factual in order to appropriately inform the audience and protect content integrity. Content integrity is free of bias.

Bias: Bias may be described as showing partiality or personal preference that may influence what content is presented or how it is presented.  It is truly interjecting preferences or attempting to influence the learners toward one Bias is distinct from presenting the pro’s and con’s or the positive effects as contrasted with potential downsides of a product, services, program, approach to care, policy or other topic.  

Measuring Outcomes: The lead continuing education planners for the Annual Meeting review and modify, as appropriate, the Learner Evaluation form. The form is available for all program planners to view. If a particular subgroup of the target audience wishes to conduct an additional evaluation from the learners that subgroup may do so. However, the learner evaluation that the CE planners develop is the one that must be completed and submitted as one of the requirements for an individual to earn CE contact hour credits.

One of the approaches to outcomes measurement is to evaluate whether the activity helped to close or narrow the gap between the learners’ current knowledge or abilities and what is desired. Selection of a desired outcome(s) is (are) purposeful in nature and drives development of objectives, content, and teaching/learning strategies. The learners will be informed of the intended outcome and the criteria for successful completion prior to the beginning of the learning activity. The evaluation feedback is analyzed and incorporated as one of the sources of input for the learning needs assessment of future programs.

Policy 2. Policy on Conflicts of Interest

Program planners and planning reviewer should assess each accepted submission for a conflict of interest, or COI. All planners, planning reviewers, faculty/presenters, panelists, respondents, and moderators are required to complete a BioData/COI Form that is on the CONFEX online system where the names of individuals in these roles are entered.The faculty/presenter, panelist, responder, or moderator could have a COI. Also these individuals need to declare if a spouse or partner (personal or professional) may have a relationship that is defined as a COI.

A COI is an affiliation or relationship of a financial nature with a Commercial Interest Organization or Entity whose the products or services are consumed by patients AND these are included in the educational topic/content of the presentation. Such a relationship constitutes a COI because it might bias a person’s ability to objectively participate in the planning, implementation, or review of a learning activity. A COI may be actual or potential. If a reasonable person might perceive a COI, then it is a perceived conflict. If there is only a potential or perceived COI, then it must be treated the same as if a COI actually exists. An actual COI exists when one has a financial, professional and/or personal relationship with a Commercial Interest Entity.

The types of relationships that may constitute a COI are categorized as follows. An individual may have more than one type at the same time.

• A ‘financial interest’ may include, but is not limited to, a financial benefit that is expected by an individual through employment such as a wage or salary, self-employment, independent contractor, an intellectual property right that results in a royalty or other remuneration, consulting or speaking fee, teaching pay, honoraria, ownership interest (e.g., stocks, stock options, or other ownership interest, excluding diversified mutual funds), membership on advisory committee, review panel, board, or other activity from which remuneration is received or expected.
• A ‘professional interest’ may include, but is not limited to, a situation in which an entity receives a contract or grant and manages the funds, but an individual is the principal, named investigator, or is in any position to influence the results or outcomes. This includes students.
• A ‘personal interest’ may include, but is not limited to, a financial relationship that is held by one’s spouse or partner. Also any of the relationships mentioned above may also be a ‘personal interest’.

A COI must be disclosed while a conflict is present and for 12 months after it is ended.

Refusal to disclose disqualifies one from participating in CE granting activities.

A Commercial Interest Organization or Entity is described as any entity either producing, marketing, reselling, or distributing healthcare goods or services consumed by or used on patients or an entity that is owned or controlled by an entity that produces, markets, resells, or distributes healthcare goods or services consumed by or used on patients AND the content of the educational activity/session/Institute or presentation includes these products or services.

Entities that are exempt from being a Commercial Interest Entity are are nonprofit or government entities and other non-healthcare related companies.

APHA is required to have a process to identify and resolve any COI before the CE activity is presented. This form requires disclosure of any financial, professional or personal conflict and it requires a signature to agree to follow the APHA policies that resolve the conflict. The process is:

• Planners, presenters, authors, moderators, panelists, or speaker respondents must complete an APHA COI form before assuming these roles.
• A completed COI form is available via website when it is opened up to all attendees to view which is weeks before the activity. Disclosure of whether a COI may or may not exist is included in the APHA Annual Meeting program, both online and in hardcopy.
• Exception: When there is a last minute change in presenter, moderator, panelist, or respondent, then this is announced at the beginning of the educational session and a completed COI form is submitted to the CE staff as soon as possible either when the change happens, or immediately after the session.    

APHA meets the requirements for disclosure to activity/session learners through the advance publication in the online APHA program. No verbal disclosures are required at the time of the presentation. However, presenters or moderators may opt to give an oral disclosure but this is not a requirement and documentation is not required.  

Policy 3. Commercial Support 

Commercial support is defined as financial or in-kind contributions given by a commercial interest entity, which is to pay for some or all of the costs of the educational activity/session.

The planner should contact the CE staff to follow the appropriate process if accepting commercial support related to learning institute, roundtable scientific sessions or theatre sessions.

Use of section enrichment funds to provide remuneration to speakers must be reviewed by the CE staff to assure compliance for CE.

APHA will accept commercial support for learning institutes, scientific session, roundtable or theater,in accordance with ACCME Standards of Commercial Support and ANCC Content Integrity Standards for Industry Support in Continuing Nursing Eductional Activities.

Policy 4. Sponsorship 

Sponsorship is a financial or in-kind contribution from an organization when the organization does not fit the category of a commercial interest organization.   

When a provider of a continuing education activity joins with another entity and the other entity contributes either financials or in-kind, then the relationship becomes a sponsorship.

The provider, APHA remains the provider and the other organization is called the sponsor.

For the APHA Annual Meeting any contribution must be processed through the Association and the APHA Sponsorship form must be completed. Any funds contributed must be submitted to APHA and the Association must distribute the funds according to the sponsorship form designations.

Contributions or gifts in-kind that are given to APHA or one of the Sections or other components might be marketing assistance, a meeting room, or event registration assistance must be documented. All such contributions to the Association and its components must be processed by APHA and a sponsorship form must be completed.

Contact the APHA staff regarding requirements for soliciting contributions that are related to the educational sessions.