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Hereditary Colorectal Cancer PI CME Activity Stage B: Learning from the application of an intervention
The goal of this Performance Improvement Continuing Medical Education (PI CME) is to improve physicians’ ability to recognize and manage patients at high risk for developing colorectal cancer (CRC).

This PI CME activity consists of three stages. You have arrived at Stage B, during which you will participate in an intervention designed to improve performance in identifying and managing patients with hereditary colorectal cancer.

To complete Stage B and receive CME credit:

  1. Review the PI CME Stage B Overview
  2. Participate in intervention(s) (Options include completing the interactive course “Colorectal Cancer: Is Your Patient at High Risk?” and reviewing the Tools)
  3. Complete the Stage B Post-Assessment
  4. Complete the Stage B Evaluation
This program was funded in part by unrestricted educational grants from Myriad Genetics and Humana, and by the Veterans Health Administration contract #VA200P0034. Should you have any questions regarding this activity please contact Katie Johansen Taber at katherine.johansen@ama-assn.org or 312-464-4964.
Hereditary Colorectal Cancer PI CME Activity

Stage B: Learning from current practice performance assessment
Upon completion of Stage B, proceed to Stage C. 

Release Date: June 29, 2012
Expiration Date: June 28, 2015

Approved for 20 AMA PRA Category 1 Credits™.  Physicians will be awarded 5 AMA PRA Category 1 Credits™ upon successful completion of Stage A and 5 AMA PRA Category 1 Credits™ upon successful completion of Stage B. An additional 10 AMA PRA Category 1 Credits™ will be awarded for successful completion, in sequence, of Stages A-C of this activity.

Objectives
At the end of this activity, physicians should be able to: 
  1. Collect a family history targeted to cancer.
  2. Identify red flags that indicate the presence of a hereditary colorectal cancer syndrome.
  3. Develop an appropriate genetic testing strategy for diagnosis of a suspected hereditary colorectal cancer syndrome.
  4. Identity collaborators for providing pre-and post-test risk communication and counseling to patients.
  5. Identify surveillance and management strategies for patients with, or at risk for developing, colorectal cancer.
Target Audience
This activity is designed to meet the educational needs of all primary care physicians, but is also appropriate for other specialists such as gastroenterologists and surgeons. Other non-physician health care providers, such as genetic counselors and nurses, may find the activity beneficial.

Statement of Need
Guidelines developed by the National Comprehensive Cancer Network and the American College of Gastroenterology have outlined risk assessment, genetic testing, and management strategies. There is a demonstrated need for physicians to become more knowledgeable about hereditary CRC and the established guidelines for managing patients at risk.

Statement of Competency
This activity is designed to address the following ABMS/ACGME competencies: patient care, medical knowledge, quality improvement, and interpersonal and communication skills. 


Accreditation Statement
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement
The American Medical Association designates this Performance Improvement Continuing Medical Education (PI CME) activity for a maximum of 20 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Planning Committee
 Emily Edelman, MS, CGC – Project Director/NCHPEG
 Katherine Johansen Taber, PhD – Senior Scientist/AMA 
 Therese Ingram Nissen, MA – Instructional Designer/NCHPEG
 Kate Reed, MPH, ScM, CGC – Project Director/NCHPEG
 Jessica Sempek, MS – CME Program Committee/AMA

Faculty
 Abdallah Elias, MD – Family Practitioner and Clinical Genetics Fellow, Johns Hopkins Hospital, Content Reviewer
 Emily Edelman, MS, CGC – Project Director, NCHPEG, Author
 Therese Ingram Nissen, MA – Instructional Designer, NCHPEG, Author
 Katherine Johansen Taber, PhD – Senior Scientist, AMA, Author
 Sonia Kupfer, MD – Instructor of Medicine, Gastroenterologist, University of Chicago, Content Consultant
 Kate Murphy – Project Director of Research Communication, Colorectal Cancer Coalition, Content Consultant
 Kate Reed, MPH, ScM, CGC – Project Director, Author
 Jessica Sempek, MS – CME Program Committee, AMA
 David Swee, MD – Associate Dean for Education, RWJ Medical School, University of Medicine and Dentistry of New Jersey, Content Consultant
 Scott Weissman, MS, LGC – Genetic Counselor, NorthShore University HealthSystem, Content Consultant

Disclosure Statement
In order to assure the highest quality of CME programming, and to comply with the ACCME Standards for Commercial Support, the AMA requires that all faculty, planning committee members and members of the AMA CME Program Committee disclose relevant financial relationships with any commercial or proprietary entity producing health care goods or services relevant to the content being planned or presented. 

The following disclosure was provided:
• Scott Weissman, MS. LGC discloses Genetic Counselor relationship with Informed Medical Decisions. 

No other individuals involved in the planning, review or delivery of this content have any relevant relationships to disclose.

Bibliography
 NCCN Colorectal Cancer Screening Guidelines, V.2.2011.nccn.org/professionals/physician_gls/f_guidelines.asp
 ACG Guidelines for Colorectal Cancer Screening 2009, http://s3.gi.org/physicians/guidelines/CCSJournalPublicationFebruary2009.pdf
 Vasen, H., Watson, P., Mecklin, J.-P., & Lynch, H. (1999). New clinical criteria for hereditary nonpolyposis colorectal cancer (HNPCC, Lynch syndrome) proposed by the International Collaborative Group on HNPCC. Gastroenterology, 116(6), 1453–1456.
 Jasperson, KW, et al. (2010) Hereditary and familial colon cancer. Gastroenterology, 138:6
• Surgeon General’s “My Family Health Portrait” at https://familyhistory.hhs.gov.
 Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group (2009). Recommendations from the EGAPP Working Group: genetic testing strategies in newly diagnosed individuals with colorectal cancer aimed at reducing morbidity and mortality from Lynch syndrome relatives, Genetics in Medicine, 11(1), 35-41.
• Hendriks, Y. M., de Jong, A. E., Morreau, H., Tops, C. M., Vasen, H. F., Wijnen, J. T., et al. (2006). Diagnostic approach and management of Lynch syndrome (hereditary nonpolyposis colorectal carcinoma): a guide for clinicians. CA: A Cancer Journal for Clinicians, 56(4), 213-225.
• Umar, A., Boland, C. R., Terdiman, J. P., Syngal, S., de la Chapelle, A., Ruschoff, J., et al. (2004). Revised Bethesda Guidelines for hereditary nonpolyposis colorectal cancer (Lynch syndrome) and microsatellite instability. J Natl Cancer Inst, 96(4), 261–268.
• Riley BD, Culver JO, Skrzynia C et al. (2011) Essential elements of genetic cancer risk assessment, counseling, and testing: Updated recommendations of the National Society of Genetic Counselors. Journal of Genetic Counseling [epub ahead of print].Available at www.springerlink.com/content/ax33415046874623/.
• American Society of Clinical Oncology. (2003) ASCO Statement Update: Genetic testing for cancer susceptibility. Journal of Clinical Oncology 21: 2397–2406.
 Schneider KA. (2002) Counseling about cancer: Strategies for genetic counseling. 2nd edition. New York: Wiley-Liss.
 Genetic Information Nondiscrimination Act (GINA) www.nchpeg.org/documents/GINA_discussion_guide_2june10.pdf.
 US Multi-Society Task Force on Colorectal Cancer, and the American College of Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the Screening and Surveillance for the Early Detection of Colorectal Cancer and Radiology (2008). CA: a Cancer Journal for Clinicians, 58, 130–160. Accessed December 6, 2010 from http://caonline.amcancersoc.org/cgi/reprint/58/3/130
 Lindor, N. M., Petersen, G. M., Hadley, D. W., Kinney, A. Y., Miesfeldt, S., Lu, K. H., et al. (2006). Recommendations for the care of individuals with an inherited predisposition to Lynch syndrome: a systematic review. JAMA, 296(12), 1507–1517.
 Nielsen, M., Franken, P. F., Reinards, T. H., Weiss, M. M., Wagner, A., van der Klift, H., et al. (2005). Multiplicity in polyp count and extracolonic manifestations in 40 Dutch patients with MYH associated polyposis coli (MAP). Journal of Medical Genetics, 42(9), e54.
 Winawer, S., Fletcher, R., Rex, D., Bond, J., Burt, R., Ferrucci, J., et al. (2003). Colorectal cancer screening and surveillance: clinical guidelines and rationale-update based on new evidence. Gastroenterology, 124(2), 544–560.

Hardware/Software Requirements
• Adobe Flash 9.0.115 or above
• Audio speakers or headphones
• Screen resolution of 800X600 or higher.
• MS Internet Explorer 8.0 or higher, Firefox, Opera, Safari, etc.
• Adobe Reader 5.0 or higher

Should you have any questions regarding this activity please contact Katie Johansen Taber at katherine.johansen@ama-assn.org or 312-464-4964. 

Type:     PI CME Activity
FREE
Activity Price
25 Registered Users
Credits
5 Credits> AMA> AMA PRA Category 1 Credit

0 Credits> AMA> Certificate of Participation for Non-Physicians