THE CME WE WILL see in five years is not at all what we see today. Commercial supporters are becoming more selective. And we see other important changes emerging.

• Focus on individual physician learning and competency

  The American Board of Medical Specialties' requirements for recertification will be based on demonstration of competency in seven areas. CME that fits within a competency area will allow physicians to demonstrate mastery in that area, and thus CME offerings will be driven to a degree by topics that address those competencies.

  The American Medical Association Physician's Recognition Award is also hastening the move toward independent physician education. For example, the new Performance Improvement initiative is aimed at an individual physician who assesses his or her competency in an area associated with the PI activity, implements new behaviors to close the identified gaps in performance, and documents the behavior change and improvement in patient health. The AMA PRA also is about to introduce point-of-care CME, also known as Physician-directed Interactive Internet CME, which will provide credits for useful searches on the Internet for immediate patient interactions.

• Changes in commercial supporters' priorities

  Most commercial interests supporting CME are forming medical education departments charged with distributing a decreased amount of funding. With the emphasis for tying educational support to products now removed, those new medical education departments will be held accountable to senior management to demonstrate that the companies' investment in education produced positive results in physician behaviors and patient health. In addition, because both Office of Inspector General and Accreditation Council for CME rules bar supporters from influencing the development of CME activities, providers will need to have skills to conduct effective needs assessments that lead to interventional strategies used in the design of education.

  This change in process is driving the selection of CME based on documented need and is reducing “me-too” offerings not designed to produce measurable change.

• Public perception of the cost-benefit equation of CME

  In 2003, almost $1.8 billion was spent on CME in America — $970 million of that was financed by the pharmaceutical and medical device industries. What did that money buy? That question is of concern to policy-makers, the pharmaceutical industry, the ACCME, and the Alliance for CME. How does the expenditure for supporting CME relate to national health priorities, such as the U.S. Surgeon General's Healthy People 2010? How has CME affected patient safety issues discussed in the Institute of Medicine publication Crossing the Quality Chasm? Are we moving toward some type of quasi-regulatory approach to the designation of CME funding?

The public is scrutinizing how industry funding is spent and what it buys, and is concerned that commercial support interferes with the provision of quality, unbiased, scientifically valid, objective education. The public interest is trumping the needs of both the educators and supporters of CME to remain in a relationship with no oversight by those representing that public interest. We think this independence will end in the near future.

Academia, we believe, can retool to meet these various new demands — although that process must begin soon. But private-sector education companies will require major re-engineering to be able to address the changes and find the funding to remain profitable. For both academic and private-sector providers, the time has come to look for new ways to provide CME. It is going to require clear vision and a willingness to change.

Steven M. Passin is president of the CME consulting firm Steve Passin & Associates LLC in Newtown, Pa. He has also served as deputy health secretary for California. Contact him at passin@passinassociates.com. Susan O'Brien is senior associate, Steve Passin & Associates. Contact her at obrien@passinassociates.com.