CME as it has existed for the last 60 years must make way for a new era of performance-improvement education, said Norman B. Kahn, MD, executive director and chief executive officer, Council of Medical Specialty Societies, in his keynote address at the National Task Force on Provider/Industry Collaboration meeting, held in October in Baltimore.

Citing statistics from the World Health Organization that rank the U.S. 37th in the world in healthcare, Kahn posed the question: “Are we in CME going to take any responsibility for the way the U.S. ranks?” Kahn challenged the attendees to contribute to a “culture of improvement” in U.S. healthcare.

Traditionally, CME has focused on teaching physicians primarily through lectures, journals, enduring materials, and Web-based education. The prevailing attitude from physicians has been, “Trust me. I'm keeping up,” said Kahn. Today, he said, that's no longer good enough.

During the three phases of performance-improvement activities, physicians compare their performance to national benchmarks; identify gaps and improve practice; and measure their performance over time. “There are new forms of education that can do more than passive education, they can actually be linked to decisions that physicians make in practice and can document changes in practice outcomes,” he said.

Given the recent government probes of CME, such as the Senate Finance Committee and Aging Committee inquiries questioning the independence and effectiveness of CME, it's more important than ever to document the positive impact of CME on patient care, he said. Plus, pharmaceutical companies are starting to make performance improvement a condition of grants. PI-CME is expected to qualify for maintenance of certification credit in all specialties as well as maintenance of licensure. And clinicians will begin to ask for it, Kahn said, because it enables them to be eligible for pay-for-performance programs.

It's also worth a lot more CME credit per activity for doctors than a typical lecture, he pointed out. Clinicians can get 20 CME credits per PI activity, so if their requirement is 50 credits every two years, they can earn most of those with one PI project per year.

For providers, the transition to PI won't be easy; it'll take time, and it will probably be more expensive to implement, he said. Nevertheless, the CME profession must measure its programs' effectiveness or someone else will. “If we keep going straight ahead, we will face a steep decline or go off a cliff,” Kahn said. “We have to go in another direction.”

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  • For examples of CME performance-improvement activities, see “The Great CME Smokeout,” (July/August 2008); and “The PI Challenge,” (June 2007), available at

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