Having toiled in the vineyards of CME for most of my long career, I am all too familiar with the views of those who find little to like about our CME system, particularly the commercial support process. Charges of bias, promotion disguised as education, special interests, fraud and abuse, and undue influence have taken time and attention away from our ability to do what we do best — educate physicians and the healthcare team for the benefit of patients and the public health.

The recent criticism of CME systems and funding sources suggests that the problems may never be resolved to the satisfaction of everyone. Medical care, the public health, the cost of services, and healthcare professionals' education are crucial quality-of-life issues for many and, hence, constitute inviting targets for criticism. As with any important endeavor, constructive criticism can, and often does, lead to productive change.

The CME profession, however, has had to react to a mounting cascade of commentary, some positive but much negative, over the last several years. In some instances, negative press has caused supporters, academia, and faculty to reevaluate their involvement in the CME process. At the very least, new and more restrictive guidelines have been issued. The end result is that CME professionals are spending a lot of time and effort on systems and processes, and less time on developing methods that truly have an effect on learning, retention, and application.

Exciting Times

These are exciting times for CME. Consider, for example, evidence-based medicine, point of care information delivery, outcomes research and analysis, certification of CME professionals, global interest in for-credit CME, the online grant application process, and shifting industry fortunes and policies. Consider also new and future technologies, such as computer-driven graphics, imaging and animation, webcasts and podcasts, and Internet2.

The potential for these new methods and technologies, although boundless, presents an enormous challenge to those who plan and guide CME. As with the more traditional means of education delivery, not each of these innovations will be applicable in all settings and for all learners. Some will be adopted readily while others will require training and careful positioning for optimal effectiveness. The learning curve will be rapid for some, while for others it may be difficult and slow. New methods and technologies have been adopted into CME with great speed. Now we must be smart enough to incorporate them appropriately into educational and learning models.

Given the somewhat daunting task of using new techniques, models, and skills to the best advantage of health team learners, I think we should shift our attention and energies away from infighting about guidelines and reacting to damaging headlines, and instead focus on developing new CME models, policies, and structures worthy of the available technology. Proper use of these new resources will benefit both learners and patients and will contribute significantly to our abilities to measure educational effectiveness and application. There's no doubt guidelines have their place and serve to maintain boundaries, but do they contribute to better education or patient care? Proof has been elusive.

A whole new technology-based world is now emerging for the delivery of CME content. It's time for more dialogue — and ultimately, decision-making — while always being mindful of guiding procedural and ethical principals.




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 mm.meetingsnet.com. The views expressed in this article are those of the author and not of UMDNJ or its CME office.