Continuing Medical Education Policies

State Continuing Education Policies for Pain and Palliative Care

Most state healthcare regulatory boards require continuing education (CE) for practitioners to renew their license. Recently, legislatures and state regulatory boards have begun to require or encourage that CE include education about pain management or palliative care for all or some licensees, to provide practitioners with updated medical, scientific, and clinical knowledge. Evidence that many practitioners lack knowledge about pain management and received little training while in school suggests that such policies are needed and may be a positive step toward improving pain management. Emphasis should be placed on the quality of the curriculum and teaching methods. These policy initiatives should be viewed as experiments until evaluations demonstrate their value.

*STATES THAT REQUIRE* PAIN MANAGEMENT CONTINUING EDUCATION FOR PRACTITIONERS**
	STATE	CITATION	FIRST YEAR ENACTED	POLICY LANGUAGE
1	CA	Article 10. Continuing Medical Education §2190.5	2001	(a) All physicians and surgeons shall complete a mandatory continuing education course in the subjects of pain management and the treatment of terminally ill and dying patients. For the purposes of this section, this course shall be a one-time requirement of 12 credit hours within the required minimum established by regulation, to be completed by December 31, 2006. All physicians and surgeons licensed on and after January 1, 2002, shall complete this requirement within four years of their initial license or by their second renewal date, whichever occurs first. The board may verify completion of this requirement on the renewal application form. (b) By regulatory action, the board may exempt physicians and surgeons by practice status category from the requirement in subdivision (a) if the physician and surgeon does not engage in direct patient care, does not provide patient consultations, or does not reside in the State of California. (c) This section shall not apply to physicians and surgeons practicing in pathology or radiology specialty areas.
2	MI	§ 333.16204. Completion of courses in pain and symptom management as condition for license renewal; applicability	1994	(1) Effective for the renewal of licenses or registrations issued under this article and expiring after January 1, 1997 if the completion of continuing education is a condition for renewal, the appropriate board shall by rule require an applicant for renewal to complete an appropriate number of hours or courses in pain and symptom management. Rules promulgated by a board under section 16205(2) for continuing education in pain and symptom management shall cover both course length and content and shall take into consideration the recommendation for that health care profession by the interdisciplinary advisory committee created in section 16204a. A board shall submit the notice of public hearing for the rules as required under section 42 of the administrative procedures act of 1969, being section 24.242 of the Michigan Compiled Laws, not later than 90 days after the first interdisciplinary advisory committee makes its initial recommendations and shall promulgate the rules as expeditiously as possible.
		§ 333.17033 Renewal of license; continuing education requirements.	1994	(1) Notwithstanding the requirements of part 161, the board may require a licensee seeking renewal of a license to furnish the board with satisfactory evidence that during the 3 years immediately preceding application for renewal the licensee has attended continuing education courses or programs approved by the board totaling not less than 150 hours in subjects related to the practice of medicine including, but not limited to, medical ethics and designed to further educate licensees. (2) As required under section 16204, the board shall promulgate rules requiring each applicant for license renewal to complete as part of the continuing education requirement of subsection (1) an appropriate number of hours or courses in pain and symptom management.
		§ 333.17533. Renewal of license; continuing education requirements	1994	(1) Notwithstanding the requirements of part 161, the board may require a licensee seeking renewal of a license to furnish the board with satisfactory evidence that during the 3 years immediately preceding an application for renewal the licensee has attended continuing education courses or programs approved by the board and totaling not less than 150 hours in subjects related to the practice of osteopathic medicine and surgery and designed to further educate licensees. (2) As required under section 16204, the board shall promulgate rules requiring each applicant for license renewal to complete as part of the continuing education requirement of subsection (1) an appropriate number of hours or courses in pain and symptom management.
		§ 333.17731. Renewal of license; continuing education requirements	1994	(1) Notwithstanding the requirements of part 161, the board may require a licensee seeking renewal of a license to furnish the board with satisfactory evidence that during the 3 years immediately preceding an application for renewal the licensee has attended continuing education courses or programs approved by the board and totaling not less than 150 hours in subjects related to the practice of osteopathic medicine and surgery and designed to further educate licensees. (2) As required under section 16204, the board shall promulgate rules requiring each applicant for license renewal to complete as part of the continuing education requirement of subsection (1) an appropriate number of hours or courses in pain and symptom management.
3	OR	409.560. Pain management education required of certain licensed health care professionals; duties of Oregon Medical Board; rules	2006 (professions have been added since)2005	(1) A physician assistant licensed under ORS chapter 677, a nurse licensed under ORS chapter 678, a psychologist licensed under ORS 675.010 to 675.150, a chiropractic physician licensed under ORS chapter 684, a naturopath licensed under ORS chapter 685, an acupuncturist licensed under ORS 677.759, a pharmacist licensed under ORS chapter 689, a dentist licensed under ORS chapter 679, an occupational therapist licensed under ORS 675.210 to 675.340 and a physical therapist licensed under ORS 688.010 to 688.201 must complete one pain management education program described under ORS 409.510. (2) The Oregon Medical Board, in consultation with the Pain Management Commission, shall identify by rule physicians licensed under ORS chapter 677 who, on an ongoing basis, treat patients in chronic or terminal pain and who must complete one pain management education program established under ORS 409.510. The board may identify by rule circumstances under which the requirement under this section may be waived.
		677.228. Automatic lapse of license for failure to pay registration fee or report change of location; reinstatement	2006	(1) A person's license to practice under this chapter automatically lapses if the licensee fails to:…(c) Complete prior to payment of the registration fee described in paragraph (a) of this subsection, or provide documentation of previous completion of, if required by rule of the board: (A) A pain management education program approved by the board and developed in conjunction with the Pain Management Commission established under ORS 409.500.
		689.285. Continuing pharmacy education; rules; fees	2005	(3) In accordance with applicable provisions of ORS chapter 183, the board shall make reasonable rules: (a) Prescribing the procedure and criteria for approval of continuing pharmacy education programs, including the number of hours of courses of study necessary to constitute a continuing pharmacy education unit and the number of continuing pharmacy education units required annually for renewal of a pharmacist license. (b) Prescribing the scope of the examinations given by the board including grading procedures. (c) Prescribing the content of the form to be submitted to the board certifying completion of an approved continuing pharmacy education program. (d) Necessary to carry out the provisions of this chapter (e) Prescribing the completion of: (A) A pain management education program approved by the board and developed in conjunction with the Pain Management Commission established under ORS 409.500; or (B) An equivalent pain management education program, as determined by the board.
4	RI	Section 6.0 Continuing education	2004	6.2 The application shall include evidence satisfactory to the Board of completion of a prescribed program of continuing medical education established by the Board approved medical or osteopathic society. …6.2.1 Said continuing medical education shall include a minimum of two (2) hours related to current information on any one or more of the following topics: universal precautions, infection control, modes of transmission, bioterrorism, OSHA, ethics, end-of-life education, palliative care, pain management, and other regulatory requirements.
5	WV	§ 30-1-7a. Continuing education	2001	(1) Notwithstanding any other provision of this code or the provision of any rule to the contrary, each person issued a license to practice medicine and surgery or a license to practice podiatry or a license as a physician assistant by the West Virginia Board of Medicine, each person licensed as a pharmacist by the West Virginia Board of Pharmacy, each person licensed to practice registered professional nursing or licensed as an advanced nurse practitioner by the West Virginia Board of Examiners for Registered Professional Nurses, each person licensed as a licensed practical nurse by the West Virginia State Board of Examiners for Licensed Practical Nurses and each person licensed to practice medicine and surgery as an osteopathic physician and surgeon or certified as an osteopathic physician assistant by the West Virginia Board of Osteopathy shall complete two hours of continuing education coursework in the subject of end-of-life care including pain management during each continuing education reporting period through the reporting period ending the thirtieth day of June, two thousand five. The two hours shall be part of the total hours of continuing education required by each board by rule and not two additional hours.

*STATES THAT ENCOURAGE* PAIN MANAGEMENT CONTINUING EDUCATION FOR PRACTITIONERS**
	STATE	CITATION	YEAR	POLICY LANGUAGE
1	FL	§ 765.102. Legislative findings and intent	2000	(4) The Legislature recognizes the need for all health care professionals to rapidly increase their understanding of end-of-life and palliative care. Therefore, the Legislature encourages the professional regulatory boards to adopt appropriate standards and guidelines regarding end-of-life care and pain management and encourages educational institutions established to train health care professionals and allied health professionals to implement curricula to train such professionals to provide end-of-life care, including pain management and palliative care.
2	NM	§ 24-2D-4. Pain management continuing education	2005	A board shall encourage pain management continuing education for all health care providers who have prescriptive authority and who treat patients with pain.
3	OH	§ 4731.283. Continuing education concerning intractable pain	1997	Not later than ninety days after the effective date of this section, the state medical board shall approve one or more continuing medical education courses of study included within the programs certified by the Ohio state medical association and the Ohio osteopathic association pursuant to section 4731.281 [4731.28.1] of the Revised Code that assist doctors of medicine and doctors of osteopathic medicine in diagnosing and treating intractable pain, as defined in section 4731.052 [4731.05.2] of the Revised Code.
3	OH	§4731-21-03 Continuing medical education.	1998	The board encourages those practitioners who encounter patients with intractable pain in the usual course of their practices to complete continuing medical education related to the treatment of intractable pain, including coursework related to pharmacology, alternative methods of pain management and treatment, and addiction medicine.
4	TX	§156.055. Continuing education in pain treatment	1999	A physician licensed under this subtitle who submits an application for renewal of a license that designates a direct patient care practice and whose practice includes treating patients for pain is encouraged to include continuing medical education in pain treatment among the hours of continuing medical education completed to comply with Section 156.051(a)(2).

Note: Current as of August 2008
Sources: AMA State Medical Licensure Requirements and Statistics 2008 - Table 16: Continuing Medical Education for Licensure Reregistration; LEXIS legal database; State Regulatory Board Websites