IN THE PUBLIC INTEREST

Now that's a phrase that's crept into the lexicon of CME in the past year. Yet if you look at corporate America's changing image, this development is not unexpected. Consider the November 18, 2003, article by Arnold S. Relman, MD, in the Op Ed section of The New York Times that decries the misguided ethics of doctors and the intentions of commercial supporters in CME (www.nytimes.com/2003/11/18/opinion/18RELM.html).

In the face of such exposés on the influence of pharmaceutical companies on CME, providers — particularly those that are communications-company-based or that jointly sponsor with communications companies — should be proactive in assuring that their CME activities go through a rigorous content-validation process.

Ensure Evidence-Based Content

So exactly what is content validation? First, let's examine the Accreditation Council for CME's value statement on validation of content. In 2002, the ACCME released a policy (2002-B-09) and accompanying value statement on content validation (www.accme.org/whatsnew/sec_new_nw1_230.asp) that includes the following:

• Data must be based on “evidence that is accepted within the profession of medicine.”

• Materials used in CME must “conform to the generally accepted standards of experimental design, data collection, and analysis.”

Activities are not eligible for accreditation if they 1) promote “recommendations, treatment, or manners of practicing medicine that are not within the definition of CME, or are 2) known to have risks or dangers that outweigh the benefits, or are 3) known to be ineffective in the treatment of patients.”

Bring in the Experts

The content validation process is not simply a review of an application for credit, but rather a detailed review of syllabus materials or handouts, including PowerPoint slides. Here are several options for implementing content review:

• Empower your CME committee or advisory board. If your committee comprises content experts that span the breadth of your program, then contract with individual members of that group to perform content review.

• Form your own review panel of specialists. Seek out independent experts in each area of medicine in which you offer CME.

• Use a pre-established expert panel under contract. The University of Wisconsin Medical School, for example, has just announced its new content validation service comprised of a panel of academic experts in all specialties of medicine (www.contrev.med.wisc.edu).

Create a User-Friendly System

As you establish a new validation process for your program, consider these elements:

• Develop an easy-to-use format to document the process. During Wisconsin's pilot of their program, reviewers expressed concerns and suggested changes for about 40 percent of activities. This is important to document as it shows your process is working.

• Establish clear criteria for reviewers. At a minimum, they should ask: Are materials scientifically objective (are studies used as the basis for the content valid and acceptable to the scientific community)? Are the materials balanced and unbiased? Are patient care recommendations acceptable to the scientific community?

Require reviewers to provide rapid turn-around of their report. Wisconsin, for example, promises a maximum five-day return.

Insert a budget line item so you have proper funding for CME content review and to clearly indicate that content validation is a critical value of your program — especially in those activities funded by a pharma firm. (Commercial supporters: Consider requiring this function of any provider with whom you contract.)

For a free content validation format, visit my Web site at www.PassinAssociates.com.

Steven M. Passin is president of the CME consulting firm, Steve Passin & Associates in Newtown, Pa. He has also served as deputy health secretary for California. Contact him at Passin@PassinAssociates.com.