There has been a frenzy of activity in recent months with seemingly everyone involved in CME seeking to avoid negative publicity or to assure that their organizations are protected from official sanction from the Accreditation Council for CME, Office of Inspector General, or Food and Drug Administration. In the process, we may have created an exaggerated and inappropriate set of expectations. CME providers are increasingly being held to standards not required of other professions. The legal offices of pharmaceutical and medical education companies have tightened requirements to an extent that they may not be reasonable.

Report Card Requirements

Case-in-point: A few — but growing — number of med-ed and pharmaceutical companies have asked providers to show their ACCME report cards and their certificates of accreditation. It seems that having passed muster with the ACCME does not carry much weight with these companies and that trust between commercial entities and CME providers is decreasing.

The report card requirements ask that providers inform their prospective partners of not only their overall evaluation by ACCME — for example, exemplary accreditation or accreditation with commendation — but also of specific deficiencies noted in their accreditation surveys. For example, they should disclose if they need to conduct better education of faculty on CME guidelines or develop improved methods for internal data retrieval.

Unreasonable Standards

Why should providers be held to this standard of proof? How is it any more possible for a commercial entity to evaluate this information than it is, for example, to determine whether physicians who graduated in the middle of their medical school classes are less competent than those at the top? Why is it acceptable to pursue such an intensive investigation of CME providers when no one would dare ask a physician who is a faculty candidate to disclose where he or she ranked on the board exam or in exactly which areas their answers were incorrect?

The ACCME does not offer provisional accreditation: A provider is accredited or not. Providers accredited by ACCME should be recognized as having conformed appropriately to the Essentials and Standards for Commercial Support and should not be subject to meaningless document review. If supporters have unsatisfactory experiences with providers, that certainly may be the basis for questioning their capabilities and, as necessary, awarding business to a different provider. Document review, however, is not a good yardstick by which to measure provider capabilities.

For example, ACCME may cite a provider for failure to properly record procedures attendant to a CME activity or suggest that disclosure procedures be tightened. In neither instance is the ability of the provider to conduct quality CME diminished. With the amount of documentation required of providers, it is rare that every requirement is fulfilled. If the ACCME requests procedural modifications, that does not necessarily mean the provider's overall performance is substandard or that the organization violates guidelines.

It does not seem reasonable for pharmaceutical and med-ed companies to require that CME providers share private and privileged ACCME status records. ACCME-accredited providers should continue to respect requests for information that improve the educational product and process, but should not be expected to respond to requests for information that is private and privileged and has no effect on their ability to plan and deliver compliant and need-based CME.




Robert F. Orsetti is assistant vice president, continuing education, University of Medicine & Dentistry of New Jersey, in Newark. Orsetti, a 30-year CME veteran, is a member of the AMA's National Task Force on CME Provider/Industry Collaboration. Contact him at (973) 972-8377 or send e-mail to orsettrf@umdnj.edu. For more of his columns, visit meetingsnet.com. The views expressed in this article are those of the author and not of UMDNJ or its CME office.