Is harmonization of continuing medical education possible around the world or around the block? I spent the month of June seeking an answer, especially as I was preparing my presentations for the Global Alliance for Medical Education annual meeting. My first challenge was to understand what harmonization really means. I went in thinking that harmonization meant that CME would be viewed, developed, and provided all around the world with similar goals and approaches. Harmonization could really occur on so many levels, from the 10,000-foot perspective of developing a worldwide definition of CME/CPD to creating similar commercial-support regulations to establishing global reciprocity of credits.

It seemed to me that harmonization should not only be possible, but also be easily attainable. Consider the following: physicians worldwide have ongoing medical-education needs; medical educators follow the same basic tenets globally; commercial support is available in many geographic regions; and as a profession, CME has global key opinion leaders.

Focus Locally First

At GAME, I had the honor of moderating the closing panel of the meeting. Our task was simple: Summarize the meeting on a regional and global level, and opine regarding global harmonization. The panel consisted of thought leaders with experience in developing and implementing CME in the United States, Canada, Europe, and the Asia-Pacific region. As I listened, I began to realize that global CME harmonization was not going to occur as rapidly or as easily as I had initially thought. We really were still focusing on what needed to change within our own geographic regions.

My panelists were far more aware of the challenges than I was … it was time to remove my rose-colored glasses and see the global CME landscape for what it is: disparate without being desperate, wary without being scary. Globally, there are many smart and driven CME professionals trying to make things work within their own regions. Yes, global harmonization isn't possible until local harmonization occurs. And there are challenges. Consider Germany, where CME is mandatory for the country's 307,000 physicians and is overseen by the Federal German Medical Association, 17 separate medical chambers responsible for CME/CPD, more than 500 medical associations and societies, and innumerable commercial organizers.

Many would say that the work of the European Union of Medical Specialists/European Accreditation Council for CME will speed up global harmonization. But they must get the 26 full European Union members, three European Economic Area members, and five associate members into harmonization. UEMS-EACCME is working double time, both accrediting individual activities and working to harmonize European CME. They are on the right track, but they're not finished yet.

One of the next CME conferences I attended, held in London and organized by the Center for Business Intelligence, proved to be a great forum for discussion among European CME organizers and commercial supporters. The challenges of intra-country regulatory differences and guidelines surrounding commercial support were identified. For example, when organizers develop activities for global audiences, should they follow the regulations in the country in which the activities take place or in the countries from which the attendees and faculty hail? There were more questions than answers.

So where does that leave us regarding global CME harmonization? Well, we have a starting point: Harmonize at home before we try to harmonize with others. Collaborate and discuss, find opportunities to work across borders on a small scale, and share the results with others. The only way that we can reach our goal someday is to work together starting today.

Lawrence Sherman, FACME, is president and CEO of Physicians Academy for Clinical and Management Excellence, New York. A 12-year CME veteran, he is a frequent lecturer on topics related to the strategic development, dissemination, and evaluation of CME activities. Reach him at