THIS IS MORE than an idle question, especially after the recent Alliance for CME meeting in Atlanta where the issue of whether CME providers should be certified was mentioned on a number of occasions. With an eye toward moving “mentioned on a number of occasions” on to a full-blown discussion, I'd like to suggest the following.

What defines a profession, such as medicine? Dealing with complex problems; using a technical body of skills, knowledge, and experience; and showing higher levels of intellectual skills, including reflective judgment and ethical reasoning.

This sounds an awful lot like CME to me. The problems we face are complex: What does a physician need to know? It depends who you ask and how you ask the question. The problems we face admit of multiple possible solutions: How many ways can you do a needs assessment, for example, or evaluate the outcomes of an instructional intervention? And there are multiple stakeholders with conflicting interests: What is the proper relationship between CME providers and industry? Finally, there is a technical body of skills, knowledge, and experience that is required as spelled out by the Accreditation Council for CME. ACCME requirements, of course, can be traced back to educational and management theory. Furthermore, if you can't reflect critically, you're going to have big problems filling out your re-accreditation self-study materials.

Proving Professionalism

Of course, CME, as a profession, lacks an attribute associated with the “major” professions of law and medicine: Licensure. Society demands of practitioners of these professions some proof that they have mastered a minimum set of skills and knowledge, and licensure satisfies this demand. There are other professions, though, that do not require licensure. Journalism is one, as licensing journalists would fly in the face of a free press. Another is government; elected officials face problems of the variety described above, though we can wonder whether they face them with reflective judgment and ethical reasoning. CME is not alone.

But, CME has something journalism and government do not have: Accreditation. I interpret accreditation as a kind of guarantee that problems will be addressed reflectively and ethically, and so it plays the role of licensure in law and medicine. But medicine also has certification, which is evidence (based on tests and testimony of instructors) that board-certified physicians have knowledge, skills, experience, and, we hope, intellectual ability going beyond the minimum essentials documented by licensure. It is this, of course, that raises the question of whether similar certification would be of value to CME.

CME Certification: Pro and Con

Arguing for certification for CME is the assertion that this would demonstrate that CME professionals so designated had something more than is required simply to organize, manage, and evaluate programs according to accreditation standards. It would mean that such individuals are also conversant with the issues facing CME, such as knowledge of who the stakeholders are, what their stakes are, and how to go about dealing with those that conflict with one another. I, frankly, find this an awfully interesting and compelling argument.

Arguing against are practical issues such as who should be certified, how certification should be managed, whether a certain number of people (or people with particular responsibilities) at any given CME office must be certified.

I don't know where others stand on these issues, but I'm certain we'll be hearing a bit about that in the future. Just count me in when the conversation begins.




Henry B. Slotnick, PhD, PhD, visiting professor, CME Office, University of Wisconsin — Madison Medical School, conducts research on how physicians learn. Reach him at hbslotnick@wisc.edu.