Task Force meeting: Morning keynote

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Whew, this has been a long day! And tomorrow will be even longer, seeing as the first session of the National Task Force on CME Provider/Industry Collaboration starts at 7 a.m. (what??). But so far it's been pretty good, though more uneven than I seem to remember from past Task Force meetings.

John Kamp, PhD, JD, Coalition for Healthcare Communication and the meeting's co-chair, started off predicting that the worst days in terms of criticism of CME are behind us, and that we have reached the bottom of the commercial support dive (which, BTW, pretty much everyone else I've spoken with today thinks is awfully optimistic). But who wouldn't agree that it's time to put all the hoo ha on the back burner and concentrate now on improving the quality of CME, as he said, "let's put the focus on moving forward in an age of uncertainty."

The highlight of the day for me was Darrell Kirch, MD, Association of American Medical Colleges, who next took the stage for the opening keynote address. Called "Principled Partnerships: Practical, or Pipe Dream?", his session focused on the culture of both industry and academia, because "culture eats strategy for lunch every day."

The academic culture emphasizes the individual as an independent expert. I loved this line: "Who else has tenure? Castro, the Pope, and Supreme Court Justices." It started with the legacy of Abraham Flexner, who brought medical education out of the realm of business and back to the university, and was further ensconced when, after World War II, we began the practice of investing in research via grants given to individual investigators. And it's only grown stronger since.

The problem, he said, is that healthcare is moving from being centered on individual experts to a more collaborative, team-based approach that is based more on service than competition, and centers more on patients than on experts.

Industry's culture is undergoing a similar shift, he said. Historically it's been all about profit, but now it's moving from immediate shareholder returns to long-term sustainability, from focusing on market advantage to social responsibility (not so sure I buy that one), secrecy to transparency, and bottom line results to the "triple bottom line" of profit, people, and planet.

The need now, he said, was to rebalance the research portfolio to shift the focus from basic science and clinical discoveries to patient and community engagement, and delivery system transformation. "One of our priorities should be fixing the science of fixing the healthcare system," Kirch said, adding that all our tactical decisions should be driven toward achieving this goal.

He introduced a graphic that was referred to the rest of the day that showed the medical education continuum from premed, to med school, to residency/fellowships, to continuing medical education, then another graphic that showed how fragmented that continuum is by all the accreditation and regulatory bodies that become involved in different stages.

The challenge, he said, was to create a true continuum of medical education where learning and assessment are a part of a smooth process from pre-med through CME.

So, is the idea of achieving principled partnerships amidst all these fractured continuums and diverse cultures practical or a pipe dream? He said the truth probably lies between the extremes of prohibiting all industry-provider relationships and allowing them to grow unfettered. But, he added, "Disclosure is not the perfect disinfectant." We need to disclose, but we also need to prove that it is possible to achieve principled partnerships.

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