CME providers are generally quite adept at conforming to current requirements for development of compliant activities. Faculty, too, are generally guideline-compliant and when unfamiliar with the rules, they are ready to listen, understand, and comply.

As in any endeavor, however, there are outliers: those faculty who claim they have not been informed about guidelines, or do not agree with them, or simply refuse to comply. That is the problem, one that threatens relationships among faculty, providers, and grantors. For example, some faculty members and attendees refuse to participate in CME activities if they can't bring a spouse or guest and have the tab picked up by the educational grant. Those of us who thought that this practice was a non-issue — one that was addressed years ago — are appropriately surprised by such revelations. Apparently, CME providers, medical institutions, and medical associations have not delivered and reinforced the message adequately.

Slide Scrutiny

While the “all-expenses paid” mind-set is still a reality, a more immediate and frequent problem is potential faculty members insisting on adding slides and other material to their presentations without prior approval of the provider. Faculty who are unfamiliar with the guidelines or who object to them may complain to the provider's education partners or grantors that the provider is being rigid and uncooperative. In these circumstances, the faculty member fails to realize that the provider follows, but does not make, the rules. Accreditation Council for CME, Office of Inspector General, and other guidances are foreign to these individuals. Most — but not all — will agree to comply once informed.

Confrontations among all parties to the CME activity most frequently occur when ill-informed faculty insist on using unapproved slides or other information for presentations. It is common practice for providers to approve a core set of slides, for example, for a given activity, and fewer supplemental slides to give faculty the flexibility to customize their presentations within prescribed boundaries. Conflicts develop when a faculty member wants to modify core and supplemental content ad hoc and doesn't give the provider the chance to review the changes. The situation is compounded when such personal, unapproved content then dominates the presentation.

Speakers certainly are entitled to include content in their talks that reflects personal research and experience. Ideally, providers should have advance knowledge of this material, but in any case, such content must be balanced, objective, scientifically sound, must contribute to the learning experience and objectives, and must not overwhelm the approved content. Providers who forfeit this responsibility do a disservice to attendees and violate a basic tenet of ACCME guidelines: content review and approval.

Keep Control

Providers, medical education companies, and grantors must take a strong stand against those who would wrest control of CME content from those responsible for its validation. We must recognize that all who claim to be educators — whether accredited or not — have an ongoing obligation to train faculty and other CME activity participants in the ethical and regulatory aspects of the profession. As with disclosure, those who refuse to comply should be excused from participation.

Robert F. Orsetti is assistant vice president, continuing education, University of Medicine & Dentistry of New Jersey in Newark. Orsetti, a 30-year CME veteran, is a member of the AMA's National Task Force on CME Provider/Industry Collaboration. Contact him at (973) 972-8377 or send e-mail to For more of his columns, visit