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As has been implied in the previous slides, there are currently several types or formats of CME activities, with the most prominent one being live activities consisting of lectures, workshops, seminars, grand rounds and the like. Enduring materials such as printed, recorded, audio, video and electronic activities (i.e., CD-ROMs, Internet activities) can also be designated for credit. Journal-based CME in a peer-reviewed journal is another format as are new procedures and skills training courses. Outside of the U.S., depending on the country or region, these types of enduring materials may or may not yet be eligible for CME credit designation. In the U.S., all of the above can be designated for AMA PRA category 1 credit. Physicians may also claim category 1 credit for being the first or second author in a journal indexed in Index Medicus or teaching at a live activity approved for AMA PRA category 1 credit, among other means. Recently, the AMA announced that “Performance Improvement” activities --”structured, long-term processes by which a physician or group of physicians can learn about specific performance measures, retrospectively assess their practice, apply these measures prospectively over a useful interval, and reevaluate their performance” can be certified for AMA PRA category 1 credit. According to the ACCME, in the U.S. in 2003 there were approximately 50,000 CME-certified courses or regularly scheduled conferences, over 8,000 Internet CME courses (either live or enduring materials), over 5,000 other enduring materials that were CME-certified and over 2,000 journal CME activities.