The Case

Sara Bellum, MPH, is vice president of education at Medical Education Outcomes Work Inc., an accredited medical education company. MEOW is conducting a satellite symposium at the Society of Psychiatric Illness Problems' annual meeting. During the conference, Sara takes advantage of the wealth of educational sessions offered by other providers and decides to sit in on an activity, which is sponsored by an accredited medical school.

When reviewing the disclosure statements in the syllabus, she notes that all faculty members have reported no financial relationships with the commercial interest funding the activity. As the course begins, the chairwoman announces that one of the faculty is being replaced because the scheduled speaker's flight was canceled. When the replacement speaker begins her presentation, Sara is stunned to see that the slide template uses the supporter's product branding and logo. And there is no attempt by either the chairwoman or the speaker to share disclosure information with the participants. Glancing around the room, Sara notices that these omissions have gone unnoticed. What should she do?

Now this is Awkward

Parochka: As providers, we are sometimes faced with emergency situations needing split-second decisions. Is it better to cancel the activity, omit some of the content, or go on with the show? As continuing medical education professionals, our obligations are to the participants and to the patients they treat.

Overstreet: I agree. The provider should make every effort to comply with all relevant guidelines, but sometimes in emergencies, it is hard to think clearly and creatively. Ideally, the provider and course chairperson should have determined how to address the issue, and the provider should have obtained disclosure from the new speaker and reviewed her content before the activity began.

Parochka: Mixing promotion with education is serving a dangerous cocktail. In this era of blogging, tweeting, and e-mail, CME professionals need to be mindful that news of negative occurrences and perceptions of bias can be routed around the world in an instant. As professional colleagues, we need to find ways to put out the fires before they begin and avoid newspaper front pages.

Overstreet: It would be wise for the provider to document what happened and quickly put a plan in place to address it, even if only after the fact, in order to prevent it from happening again.

The Provider's Ethical Obligations

Parochka: Sara should begin by placing herself in the shoes of the other provider. How would she want to be treated? Would she appreciate a call from another CME professional who offers suggestions to avert such occurrences in the future? Should she write a letter to the provider noting the violations and ask for a reply? Should she contact the Accreditation Council for CME? Or should she look the other way?

Overstreet: I don't think CME professionals can look the other way any longer. Critics of commercially supported CME certainly aren't. But squealing to the ACCME may not be the answer either. The provider may be very aware of the issues but not able to find a way to address the problem in the heat of the moment. A collegial exchange to offer suggestions to resolve the issues after the fact might be appropriate. One possible solution would be to obtain disclosure information from the new speaker immediately after her presentation and have the chairperson provide that information to participants. Also, the provider could work with the new faculty member to revise the slides after the event and send them to participants.

Karen Overstreet, EdD, RPh, FACME, CCMEP, is president, Indicia Medical Education LLC, North Wales, Pa. Reach her at

Jacqueline Parochka, EdD, FACME, is president and CEO, Excellence in Continuing Education Ltd., Gurnee, Ill; and partner, PTR Educational Consultants. Reach her at

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