“We are living in a world of change—and it seems to be accelerating,” said George Mejicano, MD, MS, keynote speaker at the 20th annual National Task Force on CME Provider/Industry Collaboration conference in Baltimore, October 14–16. Mejicano talked about how continuing medical education has evolved and why providers need to adapt to the new, complex, and varying environment. Survival, he said, depends on it.

Change remained a predominant theme from Mejicano's opening keynote through the closing address by Bernard Lo, MD, chairman of the Institute of Medicine's Conflict of Interest in Medical Research, Education and Practice Committee.

After a decade of transformation, the CME enterprise braces for more with healthcare reform on the horizon and the likely passage of the Sunshine Act requiring disclosure of payments to physicians. On one hand, healthcare reform that insures more Americans will lead to the need for more physicians and more CME, said one speaker. However, with more focus on transparency and bias, the line separating independent CME will become “brighter and darker,” said Mejicano, who is associate dean, University of Wisconsin School of Medicine and Public Health, Madison.

Also, a focus on performance improvement will likely make producing CME more expensive. At the same time, commercial supporters are pulling back and becoming more selective about whom they fund.

With all these changes afoot, it's not so much survival of the fittest, but survival of the fit enough, said Mejicano. He learned that his own program at UW was not fit enough after a recent meeting with the dean. The dean gave the program high marks for quality; however, he said the stringent rules and regulations governing CME at UW made it inaccessible and unaffordable for internal staff. They had been so focused on developing rigorous national programs that they overlooked the needs locally, said Mejicano.

Focus on Quality

Other presenters struck similar chords and offered their takes on the future of CME. Dave Davis, MD, vice president for continuing healthcare education and improvement at the Association of American Medical Colleges, Washington, D.C., said more education will be delivered on site in work environments or at the point of care. Also, more activities will be self-directed and hands-on rather than didactic, and will be delivered to teams, not just individual doctors.

Murray Kopelow, MD, MS, chief executive at the Accreditation Council for Continuing Medical Education, Chicago, said CME activities should be more in sync with the needs of the American Board of Medical Specialties' Maintenance of Certification program, which requires doctors to keep their certification up-to-date through continuous assessments. CME is the vehicle to drive continuous professional development, but to meet the new requirements of MOC, more CME needs to focus on quality improvement.

Davis raised two questions that he believes should be part of the debate that shapes CME going forward. Does CME contribute to improving clinical care? And are we too dependent on commercial support? Davis believes that overuse of commercial support has commoditized CME to an extent and created a situation where there's too much CME in some areas and not enough in others. The other question around commercial support is: Does it lead to bias in CME?

Mitigating Risk

Lo closed out the conference by explaining IOM's most recent report. While stating that good empirical data was not available to determine whether conflict of interest and bias definitely exist in CME, Lo said the IOM would like to see measures in place that mitigate the risk of industry influence. The IOM recommendations seek to limit and manage conflict of interest caused by damaging “constructive collaborations with industry,” he said.

The most-talked-about recommendation calls for the development of a new system of funding CME that is free from industry influence — not necessarily free of industry support. Lo said that the IOM would like to see a consensus solution that includes a cross section of CME stakeholders, including patient advocates.

Lo said it's incumbent upon the CME profession to act on these recommendations because if they don't, the government may step in.

Mejicano summed up what all this means in his keynote address: “Change is inevitable” — but the change is not about change for change's sake. The goal of CME is patient care and optimal health. We have to stop seeing ourselves as victims, he said. “We are vital to America's healthcare, but we have to ride the wave, not let it crash over us.”

Pulse:

  • Dates for ACCME's 2010 Accreditation workshops: April 28-30, August 4-6, December 8-10. For details, brochures, and registration information, go to education.accme.org/Workshops.

  • Chicago recently landed an unprecedented 10-year contract with the American Society of Clinical Oncology for its annual conference.

  • The North American Association of Medical Education and Communication Cos. has endorsed a new Code of Conduct for Commercially Supported CME. For details, go to www.naamecc.org.

  • The American Medical Association House of Delegates sent the Council on Judicial and Ethical Affairs' report on CME funding back to committee for the third time at its November Interim Meeting. It comes up for approval again in June.

Accme to Expose Violators?

The Accreditation Council for Continuing Medical Education is considering making public the activities and organizations that violate the Standards for Commercial Support. ACCME's chief executive Murray Kopelow, MD, told The New York Times in October that it would begin implementing the new policy within weeks. In November, ACCME released a statement saying, “The board of directors will consider how information about the results of the ACCME's Complaints and Inquiries Process might be shared with learners, providers, and the public.” Results of these deliberations will be announced as the board issues its decisions, according to the statement.

The Times article centered on complaints of bias in an online activity on treating major depressive disorder that were lodged by Bernard Carroll, MD, former chairman of psychiatry at Duke University Medical Center. After review by the ACCME, the program was pulled this fall from the activity organizer's Web site. It was commercially supported by AstraZeneca, maker of the antipsychotic drugs Carroll charged the activity was biased toward.

In addition to sending a letter to the ACCME listing 26 points of bias in the activity, Carroll posted eight questions on the HealthCare Renewal blog (hcrenewal.blogspot.com) that he asked ACCME to consider. While it did not specifically mention any of Carroll's points, ACCME did say it also was reviewing “other potential actions that could be required of providers should an activity be found in noncompliance.”

Farewell to Fred Wilson

The continuing medical education community lost one of its leaders with the passing in October of Frederic S. Wilson. Wilson, who was 65, died of complications from stem cell transplant surgery for leukemia and multiple sclerosis.

Wilson was a familiar face and voice at CME conferences, and his thoughts informed many articles in this magazine. He retired last January from his position as director of medical education for the ethical drug division of Procter and Gamble Pharmaceuticals. His 39-year career in industry included being a vocal advocate for pharma's role in ethical CME. His views were summed up in “Ethical Collaboration in Continuing Medical Education,” published in 2003 in Clinical Orthopedics and Related Research:

“Collaboration between the pharmaceutical industry and CME providers can be expected to continue to produce educational activities and materials that enhance physicians ability to care for patients, without undue influence; that is, to not influence prescribers in any way less than the best interest of the patient.”

Wilson also was an affiliate of the American Medical Association, and he served on the boards of directors of the American Osteopathic Family Physicians Foundation and The Global Alliance for CME. He also chaired the American Medical Associations Taskforce on Provider Industry Collaboration for several years.

Wilson leaves his wife of 37 years, Judith, six children, and nine grandchildren. He also leaves behind a legacy of advocacy and a CME community that many believe is richer for his having been a part of it.

International Update: Kuala Lumpur

Kuala Lumpur Convention Centre recently received the Prominent Company Award at the inaugural Malaysia Independence Award 1957 for its role in helping to build the country's reputation as a preferred destination for meetings and events. It has hosted many global medical conferences lately, including the 13th International Congress of Infectious Diseases 2008; and the 20th Video Urology World Congress 2009, which included 11 live surgeries via videoconference from the city's Hospital Kuala Lumpur during the plenary sessions.

Coming soon to the KLCC are the 14th Asia Oceania Congress of Endocrinology and the 10th International Conference on Low Vision.