The continuing medical education community is under attack by the government and the media for allowing pharmaceutical industry marketing messages to creep into educational activities. But how often do physician participants perceive commercial bias? And when they do observe it, where do they place the blame? When weighing an activity's objectivity, how important are faculty disclosures of their financial relationships with industry? For the first time, Medical Meetings asked those questions in our annual Physicians' Preferences in CME Survey.

Now You See It…

Asked whether they observe commercial bias in certified CME activities frequently, occasionally, rarely, or never, the largest percentage of respondents (39 percent) answered “rarely.” Almost the same number, 38 percent, said they perceive bias occasionally. Only 5 percent reported seeing bias “frequently,” while three times as many physicians (17 percent) answered on the opposite end of the spectrum, saying they never observe bias.

Women seem less likely to note bias, with 19 percent of them saying they never observe it and 50 percent saying they rarely see it, while only 24 percent said they observe it occasionally. Five percent of women, the same percentage as the total group, answered “frequently.”

Younger docs also seem less likely to perceive bias, with 20 percent of the younger-than-45-year-olds answering “never” and 43 percent answering “rarely.” None responded that they saw bias frequently, while about the same percentage of younger docs as the total group, 37 percent, answered “occasionally.”

The middle age group, 45-to-55-year-olds, were more likely to note bias than the overall group, with 43 percent saying they see it occasionally, and 41 percent saying they rarely observe it, although only 4 percent (less than the total group) said they perceive bias frequently. A much lower number in this group — only 10 percent — answered “never.” Docs 55 or older had higher percentages than the total group at both ends of the bias perception spectrum, with 22 percent responding “never,” and 9 percent — the highest number of all the groups — answering “frequently.”

Pointing the Finger

Asked how often different factors contributed to the bias they observed, the biggest culprit was “activity was funded by industry,” with 40 percent of respondents citing that as an occasional contributing factor and 28 percent saying it frequently contributed to bias. Sixteen percent said commercial support rarely contributed to bias, and 5 percent said it never did.

The second-biggest contributory factor was “faculty relationships with industry,” with 42 percent citing that as an occasional contributing factor and 15 percent answering “frequently.” Six percent said faculty relationships with industry never contributed to bias, and 23 percent said they rarely did.

Disclosure Matters

CME providers may find it heartening to hear that all their hard work obtaining faculty disclosures pays off — participants are paying attention. One-third of respondents (32 percent) said faculty disclosures of financial relationships with industry are extremely important when evaluating an activity's objectivity, and 67 percent answered on the higher end of the scale, 4 or above. (Respondents answered on a scale of 1 to 6, with 1 meaning not at all important, and 6 meaning extremely important.) Only 10 percent said disclosures are not at all important.

Disclosure is most important to the 45-to-55-year-olds, 41 percent of whom said it is extremely important, while 28 percent of the older docs and 23 percent of the younger-than-45s said it is extremely important.

Thumbs Up for CME

CME providers are doing a good job designing education, say participants. More than one-third of respondents (38 percent) said that CME activities are “extremely effective” in meeting their needs, while none said that activities are “not at all effective.” Fifty-four percent said that activities are “somewhat effective,” while 7 percent said they are “slightly effective.”

More women than men found CME “extremely effective,” with 42 percent of the female respondents choosing that answer, compared to 36 percent of the men and 38 percent of the total. Older docs were the most positive, with 43 percent of the older-than-55s saying that CME is “extremely effective,” and only 2 percent rating it merely “slightly effective.”

Asked why CME activities are not effective in meeting their needs, several physicians commented that activities do not address “provocative material,” or “unpopular topics.” Other content-related reasons include “Topics not relevant to my practice,” “Difficult to find local events on many topics,” and “Information often redundant/not relevant to current practice.” Others complained that content was esoteric, not up-to-date, too scientific and not clinical enough, and too basic. One said: “Recommendations are not how-to enough.”

Respondents also mentioned format as an impediment, with these observations: “Hard to retain all the information. Simple handouts to share with peers would be invaluable,” and “I do not learn well from live lectures. I do learn well from online or print articles.”

Other respondents said it was tough to take time away from their practice to attend meetings. One noted meetings are “not the most efficient way for me to get credits.” And then there's the fun factor. As one respondent complained: “Not enough of [CME meetings are held] in warm, affordable locations during winter.”

Why Docs Do CME

As for the primary reasons they participate in CME activities, it probably will come as no surprise that the top reason, chosen by 93 percent of respondents, is to obtain CME credit or fulfill licensure and other requirements. The next two top choices are to obtain the latest clinical data, selected by 80 percent of respondents, and to validate their current patient treatment/management strategies, picked by 71 percent of respondents. (Respondents picked multiple answers.)

Getting the latest information is more important to women than to men; 85 percent of the female docs, as compared to 78 percent of the males, picked that answer. Networking is also more important to female docs, chosen by 27 percent of the women, compared to 19 percent of the men and 21 percent of the total group.

Credit Dive

A possible red flag is that respondents earned an average of 48 CME credits in the 12 months prior to the survey, down from the average of 57 credits reported in last year's study. In addition, 24 percent of respondents said they earned fewer credits than in past years. This is a higher percentage than in last year's survey (when 17 percent of docs said they earned fewer credits than in the past) and the survey two years ago (when 19 percent said they earned fewer credits).

Time pressures are the biggest reason for the decline, with more than half of respondents, 55 percent, saying they were too busy to take time away from their practice, while 35 percent said it was too costly to leave their practices. The other two choices, “certified activities did not meet my needs,” and “employer restrictions on attendance/reimbursement,” were both chosen by 14 percent of respondents. (Respondents picked multiple answers.)

Meetings Rule!

Despite time pressures, physician respondents earned 41 percent of their credits during the 12 months prior to completing the survey by attending out-of-town meetings — a big jump from last year's 32 percent. The next-most-popular choice was “attending local meetings,” with physicians earning 19 percent of their credits through that method, down from 24 percent last year. They logged 17 percent of their credits through reading journals, the same percentage as last year, and the third-most-favored method.

The percentage of credits earned through performance improvement activities dipped: In this year's survey, docs said they earned fewer than 1 percent of their credits through performance improvement activities, compared to 3 percent in last year's survey. While 17 percent of respondents said they plan to use performance improvement activities in the 12 months following completion of the survey, that's actually a lower figure than in last year's survey, when 19 percent said they planned to use it.

e-CME Expands

Docs earned 11 percent of their credits through online CME, up from 7 percent last year. For the second year, we asked docs what online CME methods they used, and about 44 percent of respondents answered the question. Internet point-of-care (online self-directed learning) was the most popular, chosen by 64 percent of those respondents, compared to 62 percent last year.

Internet point-of-care is poised to increase even more in the near future, as 46 percent of doctors said they plan to use that method in the next 12 months, compared to 26 percent who answered in the affirmative in last year's survey. As we saw last year, the female respondents are more likely than the males to try POC; 50 percent of the women, compared to 44 percent of the men plan to use Internet point-of-care in the coming year. It appears to be most popular with the younger docs: 63 percent say they plan to participate in POC, compared to 55 percent of the 45-to-55s and only 24 percent of the older-than-55s.

After Internet POC, the next-most-popular e-CME method was “enduring Internet activities (i.e., pre-recorded presentation),” with respondents clocking 25 percent of their online credits via that method, up from 21 percent last year. Doctors were much less likely to use MP3casts/podcasts, logging fewer than 1 percent of their credits through that method, down from 5 percent last year. However, they earned about 7 percent of their credits through live Internet activities such as webcasts, up from 5 percent last year.

The Lure of Locale

As to how they choose whether to attend those popular out-of-town meetings, as usual, “geographic location” topped the list, coming in with a mean score of 4.6, where 1 equaled not at all important and 6 equaled extremely important. Location was followed by “meeting dates” with a 4.5 rating. In third place, “availability of education (cannot find local equivalent),” and “meeting length (days away from home/work),” tied with a 4.4 ranking.

There was also a tie for fourth place: “Need/desire for continuing education credits,” and “CME provider's reputation” both came in next with a 4.3 rating, followed by “meeting registration fee” and “speaker reputation,” both scoring 4.2. “Miscellaneous costs (travel, food, and lodging),” came in 6th with a 4.1 ranking; “ability to tie meeting attendance to family vacation” scored 3.7. “Opportunity to consult with colleagues about patient care problems” ranked 3.5. In last place, “employer requires attendance” scored 2.1.

The most popular venue was conference centers, chosen by 55 percent of respondents, followed by hotels (52 percent), and resorts (49 percent). (Respondents picked multiple answers.) Twenty-seven percent picked restaurants, 20 percent hospitals, 18 percent cruises, 15 percent medical center/facilities, and 13 percent universities.

California, Florida, and New York retained their position as the three most-preferred states for meetings. Illinois, Arizona, Colorado, Nevada, Massachusetts, Pennsylvania, and Washington state also made the top 10.

More than half, 51 percent, of respondents said they would be willing to visit a foreign country to obtain CME credits. As in previous years, favorite destinations included Canada, Mexico, the Caribbean, and European countries, particularly England and France. Docs also mentioned Asia, particularly China; Greece; and Australia.

Love Those Lectures

When it comes to delivery formats at meetings, docs say that lectures with Q&A sessions are the most effective in motivating them to change their behavior. On a 6-point scale with 1 representing not at all effective and 6 representing extremely effective, docs gave lectures with Q&A sessions a mean rating of 5, placing it first out of eight choices. However, some interactivity does appear to be important to doctors, as lectures without a Q&A session came in next-to-last, with a 3.4 rating. While CME providers aiming to measure outcomes often include pre-and post-session tests with lectures, this method is not that appealing to respondents, who gave it a mean rating of 3.6, putting it in 6th place.

Case-based learning came in second, with hands-on, skill-building sessions coming in third. Not surprisingly for a group that prefers the formality of lectures, “unstructured discussions about topic” came in last, with a mean rating of 3.0


This year's survey consisted of 23 questions. Responses to all of these were cross-tabulated by gender, age, and by number of out-of-town meetings respondents attended in the previous 12 months. To purchase the full report, visit The Research Store at

Survey Snapshot

More than two-thirds of respondents, 67 percent, are male. The average age of respondents is 51. Respondents have been in the medical field an average of 22 years.