WE HAVE BECOME accustomed to waiting. We wait for public transportation, wait in endless lines of traffic, wait to see physicians and other professionals, and wait at checkout counters. At times, even our most sophisticated electronic systems make us wait.

But in terms of CME, waiting can be a source of confusion, indecision, inactivity, inappropriate action, postponement, and cancellation. A case in point is the long time required to issue the Accreditation Council for CME's final revision of the Standards for Commercial Support, based on comments received several months ago in response to the draft document. Those in CME were given a relatively short window of opportunity to respond to the draft without knowing when to expect the final document. Secrecy has surrounded the processing of comments, and little has been said publicly. Most recently, the ACCME Council failed to approve the revised Standards for release. It will likely be well into 2004 before the final version of the new Standards for Commercial Support is issued.

Lame Duck Standards

We must find a way to condense the review process and make it more open to those most affected by the decisions. The Standards for Commercial Support is the core document in CME, the one that drives program development and funding decisions at several levels. Other CME guidelines and policies defer to the Standards as the centerpiece and are weakened in the presence of lame duck Standards.

Some might argue that it should be business as usual under the guidance of the current Standards. But with legal departments controlling much that happens in supported CME, that approach is unrealistic. Knowing that change is inevitable, legal advisors adopt draft concepts as fact or delay the CME process until regulations are issued. The consequences can be severe.

Don't Let Draft Standards Drive Decisions

Consider the directives given by some leading pharmaceutical companies that disqualify fully accredited medical education and communication companies as sources of CME credit because they have relationships with faculty or industry that could be perceived as inappropriate. Certain industry leaders have also stated that they will not do business with organizations that have both educational and promotional operations. The distinction between promotion and education has long been accepted in CME, but such separation should result from policies and procedures as currently defined for accredited providers and should not be the result of misinformed, aggressive, or exaggerated interpretation of draft policy. The inherent danger in the latter approach is that supporting organizations each create customized and often unique CME policy, whether it is based on correct or incorrect extrapolation of draft Standards, and they thereby create confusion among providers, faculty, and participants.

Providers have a difficult enough time understanding and managing the CME process in a world of multiple, ever-changing guidelines. It is a disservice to the process when decisions are reached on the basis of draft policy and in the confusion of varying opinions and interpretation. Let's set policy based on the final ACCME document and work together to find creative means to speed the review process.

Robert F. Orsetti is assistant vice president, continuing education, University of Medicine & Dentistry of New Jersey in Newark. Orsetti, a 24-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.