Aaron E. Miller, MD, FAAN, Editor-in-Chief of Continuum: Lifelong Learning in Neurology® and Quintessentials®, discusses the publication process and philosophy behind Continuum, the premier neurology CME publication in the world. Miller spoke with Daniel B. Hier, MD, MBA, FAAN, Education Editor for AAN.com.
AAN.com: Continuum has emerged as the premier neurology CME publication in the world. Can you tell us a bit about the philosophy underlying Continuum?
Miller: The philosophy of Continuum is to provide the best possible, most up-to-date reviews for the practicing neurologist. In order to accomplish this we recruit leaders in the various subspecialties to serve as guest editors who put together top-notch author groups to write each issue. At the same time we strive for Continuum to be as accessible as possible to the general neurologist as well as to those in residency and fellowships and make it user-friendly and relatively informal as though the reader were talking to a colleague in the hall.
AAN.com: Unlike Neurology®, Continuum is not a member benefit. How many subscribers does Continuum currently have? I understand that Continuum is provided gratis to resident members. How many resident subscriptions to you have? What is the annual subscription for Continuum?
Miller: Yes, Continuum has been an AAN-subsidized benefit of Junior membership since 2004; something I was especially gratified to see the AAN Board decide to support. Junior members have been especially appreciative and supportive of Continuum. We have about 2,700 Junior member subscribers and about 4,000 regular paid subscribers (the majority of whom are AAN members). An annual subscription to Continuum for AAN members is $295, and we offer a special step-up rate of $150 to those AAN members in their first three years out of Junior membership.
AAN.com: I noted that there is no advertising in Continuum. Can you explain how the decision was made to create an advertising-free publication?
Miller: Each issue of Continuum provides in-depth review articles in a particular subspecialty topic that together serve as the educational material for the accompanying CME self-assessment questions found at the back of each issue. ACCME guidelines prohibit advertising in "enduring materials" such as Continuum that are accredited for CME.
AAN.com: Continuum covers a large variety of topics of interest to practicing neurologists selected according to a repeating cycle. Can you tell us a bit about this cycle and how topics are selected?
Miller: Continuum follows a rotating core curriculum of 12 subspecialty topics, each of which is repeated every three years. The 12 topics (e.g., headache, epilepsy, cerebrovascular disease, to name three) are those that are of the highest percentage on the ABPN's content outline for the cognitive examination, which is the culmination of the Maintenance of Certification program every neurologist must complete every 10 years.
Continuum publishes six issues a year; four of these are on "core" topics. The remaining two issues are on other essential topics in neurology. It's important to point out that, while the topics themselves are repeated every three years, the guest editor and authors are always different, and they are encouraged to focus on a different aspect of the overall subspecialty topic with each iteration.
AAN.com: Central to the quality of Continuum is the quality of its issue editors and the issue authors. Can you tell us how they are selected?
Miller: I select the guest editors with input from the Continuum Editorial Board and then invite them myself. I encourage the guest editors to invite the best and brightest group of authors within their specialty area to collaborate with them in putting the issue together. I meet with the group early in the process and then let them get to work. We've been very lucky to work with many, many talented and dedicated neurologists who are eager to share their expertise with the neurology community through Continuum.
AAN.com: How do subscribers earn CME? Does this CME show up in their AAN CME Transcript? Can this CME be applied to their Maintenance of Certification (MOC) requirements?
Miller: Subscribers can earn up to 10 AMA PRA Category 1 Credits™ by completing the 40 multiple-choice questions found at the back of every Continuum issue (up to 60 credits per year). They complete a scorecard and mail or fax it in to the AAN or subscribers can complete the questions online. The CME also shows up on the AAN CME Transcript.
Continuum is approved by the ABPN for both the lifelong learning (CME) and self-assessment requirements of MOC. Completing the questions from three issues of Continuum (120 total) constitutes one self-assessment requirement, which is required during both the first and second five-year block of the MOC cycle.
AAN.com: Continuum is now available online at AAN.com. Has that proven to be popular with subscribers?
Miller: The Continuum site at AAN.com, accessible only to Continuum subscribers, includes a complete archive of all past issues, video material produced in conjunction with one issue a year, and the ability to complete CME online, as well as to participate online in the complementary practice improvement program, Quintessentials, which is published in Continuum two times a year. It's a terrific benefit for subscribers.
We are incredibly proud that the Continuum content on AAN.com consistently ranks second or third in page views and sessions, with number one being, of course, the AAN.com home page.
AAN.com: How did you get interested in serving as editor? Are there any significant changes in Continuum coming in the near future?
Miller: My editing career goes back to high school when I was Editor-in-Chief for our nationally award-winning weekly newspaper. I always wanted to return to editing, but it was a long time between gigs! Although the job is quite demanding, the fabulous AAN staff who support me make it far easier and much more rewarding.
During my tenure as Editor-in-Chief of Continuum, numerous innovations have been made, including adoption of the core curriculum, introduction of Ethics and Practice sections, streamlining of Quintessentials, and making Continuum available online. Although we have no immediate plans for other changes, we are always looking for new ideas to make Continuum an even more useful tool for lifelong learning in neurology.
AAN.com: Can you tell us any topics that will be covered in Continuum in the near term?
Miller: In 2009, in addition to Myasthenic Disorders and ALS and Neuroendocrinology, which have already published, look for issues on critical care (with Quintessentials), neuro-ophthalmology (with Quintessentials and a CD-ROM), and childhood neurologic disorders presenting in adulthood. In 2010 we will publish issues on dementia, epilepsy, movement disorders, behavioral neurology, and traumatic brain injury.
Dr. Miller has received personal compensation for activities with Biogen Idec, Pfizer Inc, EMD Serono, Teva Neuroscience, GlaxoSmithKline, Inc., Genentech, Inc., Sanofi-Aventis, Merck Serono, Medicinova, Barofold, and Avigen as a consultant, speaker, advisory board member, or data monitoring committee member. Dr. Miller has received personal compensation in an editorial capacity for Continuum. Dr. Miller has received research support from Acorda Therapeutics, Immune Tolerance Network, Teva Neuroscience, Novartis, and Genentech, Inc.
Within the past 24 months, Dr. Hier received personal compensation for medical legal consulting and consulting to legal firms regarding medical malpractice issues. In that period he also served as editor for MDnetguide, and has given expert testimony, prepared a deposition, and/or acted as a witness or consultant in medical malpractice cases. Dr. Hier has received personal compensation in an editorial capacity for AAN.com.