Stakeholders in the CME enterprise could learn a lot from John F. Kennedy. “Let us not seek to fix the blame for the past,” Kennedy once said. “Let us accept our own responsibility for the future.”

The CME world is in a sea change. Grants from industry are down, and scrutiny of medical education is on the rise. But instead of working collaboratively to fix problems, many of us seem content to fix the blame. The recent U.S. Senate Finance Committee staff report stoked the never-ending debate over which organizations have the right to be involved in CME. At conferences and on the Internet, the blamers are fanning their flames.

Mudslinging Mania

One medical education and communication company executive claimed that “the biggest offenders of the Accreditation Council for CME Standards [for Commercial Support] are universities.” A professional society leader suggested that “clean” CME could only be found at, of course, society meetings. And the executive director managing one university's Office of Funded Programs blamed MECCs. In the university's e-mail newsletter, he lamented that all CME wasn't managed by universities: “Although the accredited MECCs are paid through an ‘educational grant,’ it is a business-to-business relationship which the regulators may suspect is more akin to a ‘fee-for-a-service’ rather than a true grant to Harvard, Duke, or Hopkins. Government regulators — the FDA [Food and Drug Administration], OIG [Office of Inspector General], and most recently the Senate Finance Committee — must ask themselves whether CME is a responsibility of the medical profession or a $1.1 billion business opportunity for ‘educational’ companies.”

The problem with mudslinging is that it makes everyone dirty. All CME stakeholders should admit that we are in the education “business.” Universities, MECCs, and professional societies are all incorporated as businesses that require revenue to deliver education services. Blaming others takes the focus off of quality and questions the integrity of pharmaceutical organizations making the grants.

No specific category of accredited provider deserves the blame, said the Accreditation Council for CME's Chief Executive, Murray Kopelow, MD, in the June 2007 issue of Medical Meetings. “The data doesn't support the observation that any provider group is the problem,” Kopelow said. “These are systemwide issues.”

Move Forward

All players in the CME enterprise would do well to admit past mistakes and move forward. Why are we so shocked and defensive about the scrutiny we're getting? Across the board, at professional societies, medical schools, med ed companies, and hospitals, we all know about cases of excessive honoraria, content that favors commercial supporters, biased faculty, and six-figure satellite symposia “room reservation” fees.

It's time to fix what's broken. Let's collaborate with the ACCME to fully enforce all current standards. Let's push for transparency to identify all personal and organizational conflicts of interest. Let's continue to raise the bar on quality and performance improvement. Let's continue to squeeze out the underperforming organizations, whether they are MECCs or universities or societies.

Rotten CME smells bad on the doorstep of any organization. We must demand excellence throughout the enterprise. Each of us offers unique abilities that can benefit CME. It will take all of us to meet the challenges ahead.

Stephen M. Lewis, MA, has more than 10 years' experience in the healthcare education field. He has spoken out at a variety of medical education conferences and CME community forums addressing best practices, compliance, and regulatory issues. Reach him at stephen.lewis07@gmail.com.