Question: Who should be allowed to develop CME?

Hint: The answer depends on whether your mind-set about the CME enterprise is inclusive or exclusive.

For the inclusive folks, the answer is simple. Any individual or organization designing, implementing, and measuring clinically relevant instruction that improves physician competence, performance, or patient outcomes is welcome to participate. The list of Accreditation Council for CME-accredited providers includes all types. In a world where healthcare is becoming increasingly complex, the inclusive bunch has more of an “it takes a village” approach to CME excellence.

The focus is on the quality of the education, not in defining a group of organizations that should or shouldn't participate. We all know that there are A-list academic medical centers, medical education companies, societies, and hospitals developing CME. And as recent media reports have made very clear, there are also D-list organizations among these CME provider types.

Others Need Not Apply

Exclusive folks have a different answer about which organizations should and should not participate in the CME enterprise. They seem to have a short list of those who are qualified to be a part of continuing education and who are therefore welcome under the tent. All others need not apply.

The most recent example of questions about CME exclusivity can be found in the Mayo CME Consensus Conference proceedings. The Mayo conference was held in September 2008 and was co-sponsored by the Accreditation Council for CME, the Mayo School of CME, and the Society for Academic CME. While the proceedings (which are available at each of the sponsoring organizations' Web sites) included good ideas about credibility, integrity, and the need to better articulate the value of CME, a disturbing question was raised on page 13.

After a confusing statement calling for-profit organizations the “800-pound gorilla” of CME, the Mayo proceedings ask the question, “Should CME stay within the realm of academics, societies, etc.” I didn't think that CME was currently under the “realm” of a few types of providers, and I'm not sure what participants intended with the “gorilla” comment. But it seems clear that some individuals questioned whether private companies — and possibly hospitals — should be allowed to be involved in CME.

We've seen these types of “who should be allowed” statements before. The debate over voting rights in America had plenty of them. Instead of broadly interpreting Constitutional guarantees about the right to vote, states at various times excluded those who weren't male, white, property owners, or able to pass certain literacy tests from the polls.

Exclusion from CME should be based on a demonstrated lack of quality, not appearances or business classifications. We shouldn't forget that all accredited providers must abide by the same set of rules.

Supporters of “who should be allowed in CME” thinking should first consider answers to a few other questions:

• What is the motivation or basis for excluding certain organizations from involvement in CME?

• Is exclusive thinking consistent with academic freedom, free expression, and scientific debate?

• Is CME quality determined by the type of organization or the professionals actually doing the work?

We should continue to ask questions, but the answers for our brightest future won't be found in a CME oligarchy. Placing control of medical education in the hands of the few isn't consistent with scientific method.

Let's keep the conversation going. But let's also realize that without the free exchange of multiple evidence-based, clinically relevant voices, innovation in CME would vanish along with its value and effectiveness.

Stephen M. Lewis, MA, CCMEP, is president of Littleton, Colo.-based Global Education Group, and president of the North American Association of Medical Education and Communication Companies. Reach him at slewis@globaleducationgroup.com.