The Importance of Content Validity in Accredited Continuing Medical Education/Continuing Professional Development (CME/CPD)

ABSTRACT

The Cologne Consensus Conference 2025 (CCC25), official meeting of the International Academy for CPD Accreditation (IACPDA), sought to explore opportunities for how accrediting bodies could ensure that the organisations or educational activities they accredit are demonstrating compliance with the IACPDA “Standards for Substantive Equivalency between CPD/CME Accreditation Systems”, with a focus on how to align content selection with needs assessment to ensure that “content presented is relevant and responsive to the identified needs of the target audience”. Based on the fact that it has become unmanageable for the individual doctor and/or faculty member to

• - get an unbiased overview over all evidence related to the clinical question in areas with exponential growth of evidence, or

• - find data relevant to the individual patient in the bulk of evidence without use of advanced search technologies,

accrediting bodies recommend that providers, organizers of education, or even individual learners should consider evidence synthesis reports to be used in (accredited) CE, that are

• 1. independent

• 2. publicly accessible and free of charge

• 3. timely

• 4. comprehensive and transparent, and

• 5. user-friendly.

As well, producers and/or publishers of evidence synthesis reports, ideally, might also offer opportunities for advanced searches, which, in the future, might increasingly be supported by artificial intelligence.

The Cologne Consensus Conference 2025 (CCC25), official meeting of the International Academy for CPD Accreditation, an informal association of accrediting bodies worldwide, was held on Sept. 3 and 4, 2025, in Cologne (Germany). Participation was hybrid – both in-person and virtually.

CCC25 sought to explore opportunities for how accrediting bodies could ensure that the organisations or educational activities they accredit are demonstrating compliance with the IACPDA “Standards for Substantive Equivalency between CPD/CME Accreditation Systems” (here: Standards) [1], whose main pillars are independence, transparency, and needs assessment. CCC25, in particular, discussed how to align content selection with needs assessment to ensure that “content presented is relevant and responsive to the identified needs of the target audience” [1].

Outcomes of patients the individual doctor has already or will encounter are at the heart of the commitment doctors worldwide have made, i.e. to offer care in the best interest of each individual patient through professional autonomy and clinical independence [2,3], and should thus drive needs assessment. Consequently, in accredited continuing education (CE), data sources for needs assessment should be as close as possible related to the environment the doctor is working in, which at the same time is the environment the outcomes of CME/CPD are supposed to take full effect in and/or on (“environment of use”, EOU [4]).

Needs are either

• subjectively perceived: These needs will drive self-directed learning either in the context of a patient encounter (“point of care education”) or by access to suitable education (including online learning as well as onsite in person educational formats). Investigation in subjectively perceived needs recently has been facilitated through use of digital communication means. These approaches help better align the educational activity with the specific needs of learners through methods such as pre-tests and questionnaires used during the pre-activity phase to identify learner priorities. This information can then be used by faculty to tailor presentations more closely to the needs and expectations of actual participants; or

• objectively documented: The approach most closely related to the EOU would be to analyse patient outcomes through analysis of electronic health records, make use of swarm learning [5], etc., since data derived from these sources directly reflect the health-care reality of the EOU. This approach allows for a meaningful closed loop educational scenario with documented needs driving education, educational outcomes driving change, and analysis of change driving future education, all in the same EOU [6]. However, though data from the EOU would represent an ideal source for needs assessment [7,8], its use currently faces limitations, i.e. many electronic health records (EHR) often have not primarily been designed for clinical and/or research purposes. Thus, missing, inaccurate or unstructured data are not uncommon. Further information about patient trajectories and/or outcomes may not be available due to lack of interoperability, data protection regulations or involvement of institutions not ready to cooperate in health care [9].

If data related to the EOU are not available, needs discerned from the same health-care system would be acceptable. But these data might show biases due to race, ethnicity, gender, age, comorbidities, access to health care, availability of diagnostic/treatment options, etc. with regard to the EOU. As last option, if data from the same health-care system would ultimately also be unavailable, needs should be based on published evidence related to the clinical problem. In this case, the biases mentioned above would probably weigh in more heavily.

To align identified needs with related evidence the practice of CME/CPD should not only convey the current state of evidence in general but also provide data reflecting the characteristics of the individual patient the doctor cares for. However, translating the above into strategies for content selection faces several challenges:

• In areas with exponential growth of evidence [10] it has become unmanageable for the individual doctor and/or faculty member to

  • get an unbiased overview over all evidence related to the clinical question [11,12]
  • find data relevant to the individual patient in the bulk of evidence without use of advanced search technologies.

• Furthermore, existing evidence needs to be assessed with regard to clinical relevance [13], robustness of study findings (i.e. methodological quality) [14], and transparency to allow for replicability checks [15].

This is beyond the scope of what most individual faculty members can achieve in preparation of a CE activity [16,17]. Thus, aligning with the Standards’ requirement, that recommendations should be “based on the highest level of evidence available” [1], needs a paradigm shift in strategies to select content for (accredited) CME/CPD activities:

In general, faculty in accredited CME/CPD should be encouraged to use evidence synthesis reports to prepare an overview over the current state of evidence related to a certain clinical problem. This also relates to individual physicians in self-directed learning. The methodological principles and techniques for evidence synthesis have been developed and include systematic reviews, meta-analyses, etc. [18,19].

As discussed in CCC25, accrediting bodies recommend that providers, organisers of education, or even individual learners should consider evidence synthesis reports to be used in (accredited) CE, that are

1. Independent: Authors should not have any ties with industry, and the review itself must not be financed by industry or the report/review must have gone through a rigorous process of review to ensure the validity of the findings.

2. Publicly accessible and free of charge: We are aware that this may collide with business models of publishers. However, since evidence synthesis is essential for opinion forming in CE, there should be no barriers to access of these resources.

3. Timely: Reviews should closely align with newly emerging developments (eg licensing of a new drug or device), and previous ones should be updated accordingly.

4. Comprehensive and transparent: Reviews should assess all information available and clearly document reasons for inclusion and exclusion, respectively. Artificial intelligence (AI) applications may support this process, though, for the time being, all results produced by generative AI still need human verification [17,20–22]. However, there may still be an issue, if evidence synthesis solely has to rely on published data. Authors should share their databases, and reports should always be published unredacted (by e.g. regulators).

5. User-friendly (access, language, media): “Easy access, easy use”, to facilitate routine use of reviews in everyday CE access should be as little time consuming as possible, key messages should be provided in (a) format(s) easily to be transferred into CE presentations, and all information should (at least) be provided in English with additional translation in local languages being strongly recommended.

With this regard IACPDA is calling for partnerships with organisations devoted to production and/or publication of different types of evidence synthesis, who provide evidence synthesis reports under the conditions described above. This will hopefully foster global and equitable availability of independent, comprehensive information in (accredited) CE activities. Currently, the German Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG) and The New Zealand Medical Journal have expressed their intent to support the IACPDA initiative.

As well, evidence synthesis reports need to be supplemented by opportunities to search for data, if existent, matching characteristics of the patient in the EOU [23–25]. This approach needs a trusted evidence base to search in, and thus, providers of evidence synthesis reports, ideally, might also offer opportunities for this type of searches, which, in the future, might increasingly be supported by artificial intelligence.

Disclosure statement

Decalarations of interests of all authors can be found under “Supplementary Material”.

Supplementary Information

Supplemental data for this article can be accessed online at https://doi.org/10.1080/28338073.2026.2687327