The American College of Cardiology (ACC) will no longer allow other CME organizations to provide certified continuing medical education satellite symposia at its Annual Scientific Session, beginning in 2012. This decision is the capstone of a three-year process the College developed to clearly separate promotional and independent medical education activities and ensure that all independent certified CME held in conjunction with the annual meeting is compliant, of the highest quality, and meets the identified needs of member-learners.

Instead of traditional satellite symposia, which typically have been sessions developed and certified by external accredited CME providers and held outside of the annual meeting’s official conference hours, the ACC plans to use evening hours to provide some in-depth activities of its own. The ACC will still allow off-hour, noncertified promotional activities, but they will be held in a separate venue and handled by the ACC’s business development division, not its CME office. That division is in charge of ensuring its activities are compliant with the Food and Drug Administration, the Office of the Inspector General, and other regulatory entities that regulate noncertified education.

As Rick Nishimura, MD, co-chair of the 2012 ACC’s Annual Scientific Session says, “This move is important because it will allow transparency in the two separate approaches and better meet the educational needs of our members.”

Changing the System
The satellite symposia overhaul began while the College was planning its 2008 annual meeting, shortly after ACC’s chief learning officer, Joseph Green, PhD, came on board. As Green explains, the traditional satellite symposia system needed to be examined. Green, who prior to joining ACC consulted for specialty societies about satellite symposia (among other CME matters), says the way it typically worked was that a specialty society like the College asked those who had provided financial support previously if they wanted to sponsor a symposia, saving the premium time slots for exhibitors, who had first right of refusal. Then the supporters would go in search of accredited CME providers to design, certify, and put on the activity. Since the Accreditation Council for CME criteria don’t allow commercial supporters to control any aspect of the content of certified activities, “This model was out of compliance from the very start,” he says.

“Many presumed,” Green adds, “that since the society isn’t providing the credit, it’s not accountable.” He doesn’t see it that way. “If it’s held under your annual meeting’s umbrella and takes place in your meeting’s hotels, you have some level of control, and therefore some level of accountability.” Recognizing that changing long-held traditions at large organizations can’t be accomplished overnight, the College nevertheless put it high on its priority list. And change it they did: The RFPs that went out in 2007 for the 2008 annual meeting’s satellite symposia went to CME providers, not potential commercial supporters.

There was one other thing that Green felt needed to be rectified immediately. The same staff members handled all solicitations, whether they were asking for dollars for booth space, sponsorship, satellite symposia, or commercial support for certified CME. “All of that was done by one group—and it wasn’t the education group,” says Elizabeth Yarboro, ACC’s associate vice president.

As it was changing its RFP process, the College also created a CME group specifically to handle grants for certified CME activities. This group would be separated to keep it from being influenced by the business development group, which seeks support for non-CME activities. The reaction, says Green, was mostly positive, especially from commercial supporters who appreciated being able to deal with CME professionals who understand all the rules and regulations around commercial support.

Integrating Satellite Symposia
The second year of the satellite symposia renovation project involved getting the annual meeting planning committee—some 75 ACC member experts—to match up the subject matter of the proposed satellite symposia with the annual meeting content, rather than have it be on random topics that might or might not integrate with the annual meeting sessions. In the third year, the ACC made its application process more rigorous, says Yarboro. The proposals were sorted into topics, then the planning committee reviewed the proposals under each topic and ranked them to determine, for example, which proposals for a diabetes symposium were best.

Now in the final phase, the ACC is fully integrating these symposia by replacing the traditional model with in-depth, ACC-developed and –certified, independent education, beginning with the 61st Annual Scientific Session/i2 Summit (ACC.12) in March 2012. The plan is to delve deeper into topics from the annual meeting in three-hour sessions held in the evening at a hotel, giving participants a change of scenery from the convention center where the rest of the meeting is held. These activities will be based on content pathways developed from the College’s own assessment data of competence and performance gaps, will use interactive educational techniques, and will include the assessment of outcome measures.

“There are all kinds of things we can do in a live program with 100 people over several hours that we just can’t do with 15,000 people in 40-minute sessions,” says Green. ACC will be the accredited provider for these activities, but it has not yet decided whether it will partner with other accredited or non-accredited organizations as well or keep it all in-house. These decisions will be made collaboratively with their member committees.

“The ACC’s education leadership took a thorough and comprehensive approach in its review of several options before reaching consensus that the new model is best suited to maintain the ACC’s preeminent standing in the areas of continuing professional development, life-long learning, and complete transparency in relationships with industry,” says Patrick O’Gara, MD, also a co-chair of the 2012 ACC meeting in Chicago.

Funding New Ideas
One concern noticed by both the satellite symposia group and members who were simultaneously looking into how to make the annual meeting more innovative and meaningful was the potential impact on revenue from independent medical education grant funding from pharma.

“There was a fear at first that the change might result in decreased industry support for the annual meeting,” Green acknowledges. “That hasn’t happened yet.” And, while it’s still up in the air whether ACC will seek separate grants to support the new in-depth activities, the hope is that some of the companies that had been supporting the old satellite symposia model might reconsider funding the annual meeting and/or the new activities, says Green, adding, “and my assumption—which has yet to be proven—is that if we can make it more meaningful and impactful in changing competence and improving performance, industry will be more likely to support it.”

Even if eliminating the satellite symposia does have negative revenue repercussions, it still has to be done, says Green. While revenue implications were discussed throughout the process, ultimately, the ACC member committees decided that it was the right thing to do.

While details on how the policy will be implemented likely will be tweaked in coming years, the evolution is now complete, says Green.