THE ALLURE OF San Francisco — and anxiety over the looming implementation of the Accreditation Council for CME's updated Standards for Commercial Support — were a great draw for the Alliance for CME's 30th Annual Conference, held January 26 to 29 at the San Francisco Marriott. Almost 1,500 people came to hear the latest on how to translate the Standards into their work processes; grill the ACCME's chief executive Murray Kopelow, MD; learn how to work more effectively with commercial supporters; and discuss how licensing bodies, hospitals, medical education and communication companies, medical schools, and other stakeholders in CME can work together to deal with the challenges and reap the benefits of the changing CME landscape. This year's attendance broke the former record, set at the Alliance's 2001 conference, also held in San Francisco, which drew 1,370 participants.

SRO Sessions

The ACCME-related sessions were such big draws, in fact, that people at several of them ended up sitting on the floor, with crowds overflowing into hallways. One such session, moderated with style by Lawrence Sherman, executive vice president, business development, Jobson Education Group, New York City, used an audience-response system to gauge the audience's knowledge of how to deal with various situations in today's regulatory environment. One of the more interesting questions was whether the Food and Drug Administration or the Office of Inspector General regulates the content of CME. While, technically speaking, CME is regulated by ACCME, not the FDA or OIG, one pharmaceutical company representative said that the reality is that pharma companies view everything they do — including the commercial support of CME — as if it were regulated by these other bodies. “If they [FDA or OIG] open an investigation, everything comes into play,” he said.

A question about honoraria also raised some eyebrows. When asked if honoraria received for serving as faculty on a CME activity for which commercial support has been received creates a personal conflict of interest, almost a quarter of the audience said that it does. (It does not, said the moderator.) Some in the crowd argued that they have had speakers decline because of perceived conflict of interest in these situations. An audience member said, “That's part of our educational process with faculty. We have to help faculty understand that we're the ones getting the grants and controlling the honoraria, not the commercial supporter.” Another suggested that, if speakers continue to worry about this, they could always donate their honoraria to a specialty society or other cause. (For more on the Standards sessions, see page 26).

MOC for the Real World

The conference's theme, though, was not “How to to Comply with the Regs.” It was “Building Bridges to Enhance Performance in Practice,” and many sessions focused on collaboration between the various stakeholders in CME. One was a panel discussion held during the plenary session, which explored the connection between the American Board of Medical Specialties' maintenance of certification system, or MOC, and continuing medical education. ABMS now is telling specialty boards to include MOC — which includes core competencies in lifelong learning, self-assessment, self-directed learning, and documented improvement — as a requirement for their physician certification programs.

To keep CME relevant in this changing specialty certification environment, CME providers must base their activities on measurable, evidence-based data, enhance physician performance, and improve patient care outcomes, panelists said.

As Stephen Miller, MD, president of the Evanston, Ill.-based ABMS, said, “I think we should do away with the idea of residents, students, and practicing or academic physicians. Once you graduate from medical school, you become a lifelong student of medicine.”

With 21 of the 24 ABMS member boards including MOC criteria for recertification and the remainder expected to follow suit this spring, CME providers need to take into account the new reality of MOC when designing their activities. George Mejicano, MD, assistant dean for CME with the University of Wisconsin, Madison, added that MOC is important to physicians because it will be tied to their ability to get and keep a job. “The stick is being able to get employment and compensation,” he said. “The carrot is better health for patients.”

The panelists, representing medical schools, hospitals, medical education and communication companies, and specialty societies, then dug into the challenges and opportunities this new reality brings to each of their work settings. “Education is the primary purpose of specialty societies; testing is the main purpose of the boards,” said William Hering, PhD, director of CME and Programs with the San Francisco-based American Academy of Ophthalmology. “It's important for societies to educate the boards about what physicians actually see in practice, rather than interesting but unlikely scenarios. We have the opportunity to make [certification testing] relevant not to academic interests, but to physicians' real-world practice. Even though we [specialty boards and societies] haven't worked together traditionally, we both have to find ways to help physicians improve their practices.” He added that practice performance assessment, one of the MOC criteria, likely would be the biggest challenge for specialty societies because, unlike hospitals and medical schools, they don't often have ready access to performance data.

Miller said he believed that this same criteria will present the biggest opportunity for hospitals. The idea of a CME credit being based on the amount of time spent in CME activities is changing. According to Miller, this is a change for the better because it will take the education process “out of the classroom and into the practice or hospital.”

Harry Gallis, MD, vice president of regional education with the Carolinas HealthCare System in Charlotte, N.C., said the biggest challenge “is changing the physician's attitude about what they want from us. They should demand [practice-based, evidence-based CME] of us.”

When asked how the shift toward MOC will change their roles as CME providers, the panelists seemed to agree that more collaboration is in their futures. Hering pointed out that the changes specialty society providers face are “enormous. Individualized CME is not something we're used to.” CME providers have to learn what physicians need to know to succeed with the new MOC requirements, he added. And CME providers will have to learn how to work with the boards, something they traditionally haven't had to do. As Mejicano summed up, “We need to collaborate with partners we used to shy away from. Providers need to think of themselves as resources and clearinghouses for others.”

Note: Look for a write-up of a white-hot session that explored the pleasures, pain, perils, and pitfalls of the CME-provider/commercial support partnership in an upcoming issue of Medical Meetings.