“We must build common ground, work in a collaborative and cross-functional manner, and create the right mind-set and behaviors to bring about change,” said Fred Hassan, president and CEO of Pharmacia Corp. during his keynote speech at the 13th Annual Conference of the National Task Force on CME Provider/Industry Collaboration. Held at the Wyndham Baltimore Inner Harbor Hotel September 10 to 12, the conference attracted a record 448 registrants.

It was unusual to invite someone of Hassan's stature in the pharma industry to be keynote speaker, but the American Medical Association's choice was a deliberate underscoring of the meeting's theme of collaboration between all the stakeholders in CME. “Industry is a vital stakeholder. There is a genuine commitment from industry to improve CME,” he insisted. “We can do more.”

Getting Together

The conference detailed examples of a few successful collaborations that have recently borne fruit. One such effort is the PhRMA Code on Interactions with Healthcare Professionals, said Hassan, who also is chair of the Pharmaceutical Research and Manufacturers of America Board of Trustees. “We did not agree on every point, but we got something done.”

While the code is a good start, Hassan said the industry needs to develop a code of ethics that shares common ground between all the CME regulatory agencies. “The job isn't over” just because the PhRMA Code is in place, he said.

Another example is the new joint accreditation application process instituted across the Accreditation Council for CME, the American Council on Pharmaceutical Education, and the American Nurses Credentialing Center. The purpose was to “simplify the application process for CE providers seeking accreditation by two or more of the organizations,” said Jean Floyd, PhD, RN, executive director, ANCC. “Each accrediting organization retains its own eligibility requirements, accreditation decision-making processes, and fees. The joint accreditation is being field-tested until September 2003.

CME at Risk

The successful collaborative methods are the good news. The bad news: CME's effectiveness continues to be challenged.

“There's a growing concern that [CME] doesn't say a lot about physician continuing competence,” said Dale Austen, deputy executive vice president, Federation of State Medical Boards. That's why some state boards want to find other ways to ensure physicians are competent for relicensure, he said, adding that the Texas board has decided that the idea of retesting physicians for relicensure has merit, and may be implemented as early as 2005. [According to Texas State Board of Medical Examiners' spokesperson Jane McFarlane, as it's currently being discussed, retesting would only replace CME on the year when the physician is taking the relicensure exam, which in Texas is once every 10 years.] Currently, half of FSMB's 70 member boards do not use CME as a relicensure requirement for MDs or DOs; the other half do.

A disturbing trend is emerging even with the boards that require CME for relicensure. Ten boards have implemented CME content requirements for license renewal, such as a certain number of hours on HIV education. Stephen Miller, MD, executive vice president with the American Board of Medical Specialties, said the content is determined by “noneducators, nonprofessionals,” and is not always relevant. “I've been incredulous at what I've seen. Do you need two hours of how to tie your shoes? Would you feel comfortable flying on a plane piloted by someone who just went to flight school twice a year with no competency test?”

Vetting Content

To address some of the concerns expressed by the Federation of State Medical Boards and other organizations, the Accreditation Council for CME and the American Academy of Family Physicians have implemented policies to ensure that CME content is evidence-based.

The ACCME, which had just released its new content validation accreditation policy days before the meeting, worked with the American Academy of Family Physicians to showcase how the two organizations were handling this. Both Murray Kopelow, MD, chief executive of the Accreditation Council for CME in Chicago, and Nancy Davis, PhD, director, CME, with the AAFP, Leawood, Kan., agreed that there is a need to vet CME content, ensuring that clinical patient recommendations are based on the best available evidence. Though they may be heading toward the same place, the joint presentation highlighted the different roads AAFP and ACCME are taking to get there.

AAFP, which accredits activities, not providers, launched an optional evidence-based CME accreditation process in January this year after completing a pilot program in 2001. The new criteria came into being, said Davis, in part because of increasing concerns about complementary and alternative practice (CAP) topics in CME. The AAFP system uses graded levels of evidence, from systematic review and randomized control trials at the top, to expert consensus statements at the lower end. “We recognize that there isn't evidence for everything,” she said. “But we need to be able to present the best evidence we have available currently.”

While the original intention was to offer complementary and alternative practice topics for prescribed credit if providers could meet the evidence-based criteria, it was difficult to determine what constitutes credible evidence. For now, activities about CAP are eligible for only elective, not prescribed credit, but that may change. Davis said AAFP is developing a database of acceptable CAP evidence sources to make the process more doable for CAP CME in the future.

Kopelow explained that, unlike the AAFP, the new ACCME policy's three “value statements” are not something that CME providers need to document as part of the accreditation process; they are designed to move CME providers toward adopting the principles until they become “shared values” within the CME community. (For more, see page 12.) “Having both of these accrediting bodies singing from the same hymnal helps to get the message out,” said Davis.