Report from the Alliance for CME annual conference

The continuing medical education community suffered another blow to its credibility when, in January, just several weeks before the Alliance for CME annual conference, the Josiah Macy Jr. Foundation released a scathing report. Stating that the field was “in disarray,” the report criticized everything from CME's overuse of lecture formats to its failure to promote teamwork among healthcare professionals.

Macy's most controversial conclusion was that commercial support creates an unavoidable conflict of interest that cannot be eliminated by strengthening firewalls between pharmaceutical/device companies' marketing and education divisions. CME providers received about $1.2 billion in pharma industry grants, representing about 50 percent of their total income in 2006, according to the Accreditation Council for CME data report. The Macy solution: phase out commercial support over a five-year period. The report also recommends that accreditation should be restricted to academic institutions and medical societies, as well as a few other groups.

The report is the result of a conference the foundation held in November 2007 in Bermuda, which brought together 36 leaders from the academic healthcare education community to discuss their concerns. The document that was released in January, “Continuing Education in the Health Profession: Improving Healthcare through Lifelong Learning,” is actually only an executive summary. The full report, complete with background papers supporting its findings, is due out later this year. Before the report, many CME professionals had never heard of the New York-based foundation, which was founded in 1930 to improve healthcare education.

Coming less than a year after the April 2007 U.S. Senate Finance Report on CME, which also concluded that pharmaceutical industry funding compromises CME's independence, the Macy paper generated great anxiety among CME professionals. It became the talk of the Alliance for Continuing Medical Education's annual conference, held January 19 to 22 in Orlando, right up until a heated session on the last day.

The Macy View

While attendees thought the report raised important issues, they criticized it for providing no data to support its conclusions and no practical solutions for how to implement its recommendations. It also failed to acknowledge recent improvements in the CME system, such as the Accreditation Council for CME's updated accreditation criteria and new commercial support policies. And, they faulted the process, pointing out that only academic professionals were invited to the conference, and that other sectors, such as medical education and communication companies, were excluded.

The highly anticipated hot-topics session on the closing day of the conference gave attendees a chance to hear from CME professionals who had participated in the Macy forum and to respond.

Although some Alliance attendees had expressed disbelief that their colleagues who participated in the Macy conference really agreed with its conclusions, Macy representative Ellen Cosgrove, MD, senior associate dean, education, University of New Mexico School of Medicine, Albuquerque, explained that the report's findings were reached by consensus during the November conference. “We all stand behind the report,” she said.

Refuting comments that the Macy conference was convened in reaction to the Senate Finance Committee report, Cosgrove explained that the conference took 18 months to plan and therefore was not a response to the SFC.

Speaking to the commercial-support issue, Cosgrove said that while industry has done a good job of strengthening firewalls, too much time and too many resources go into proving a negative — that CME is not biased — when the focus should be solely on education. “We share the concerns about what it will mean to fundamentally change the structure of how CME is funded,” she said. “That is a question that is as scary for [the Macy participants] as it is for many of you.” The five-year time frame proposed by Macy, she said, is intended to give the profession the time necessary to alter the funding model.

Acknowledging that some in the community felt hurt by the report, Macy representative David A. Davis, MD, vice president, continuing healthcare education improvement, Association of American Medical Colleges, Washington, D.C., said that the proposed ban on pharma funding should not be construed as an attack on CME professionals for not doing their jobs. In fact, he said, it's a criticism of the healthcare profession for not supporting CME as it should. Macy calls on academic health centers, healthcare organizations, group practices, and other stakeholders to step up and foot the bill. “It's not so much about demonizing [the pharmaceutical] industry as it is a call to action to the healthcare community for the professional development of CME,” said Davis.