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.”