THE 2004 SOCIETY for Academic CME Fall Meeting, November 5 to 7 in Boston, may have been relatively small, but it was powerful. One hundred fifteen participants gathered at the Hynes Convention Center to learn the latest on the Accreditation Council for CME's new Standards for Commercial Support and news from the CME research front, and to share best practices with their peers.
The main educational day of the meeting, which was held in conjunction with the 115th Annual Meeting of the Association of American Medical Colleges, started off with a bang: a panel on “what constitutes a conflict of interest” that included Murray Kopelow, MD, chief executive of the, and other CME luminaries. But rather than the usual presentation followed by a Q&A session, the panel posed seven scenarios, then asked the audience to vote via different colored strips of paper whether or not they felt the scenarios depicted conflict.
For example, one of the scenarios read: “Dr. Alistar Writer has spent the last five years of his spare time developing a point-of-care system, My-OwnSurgiConsult, to help busy clinicians check their most frequently asked questions with current evidence. As an effective presenter, he is routinely invited to be part of the surgical review course. The primary reference he uses is the MyOwnSurgiConsult system. He offers all attendees a free one-month trial, with no further obligations.”
SACME attendees voted heavily that the doctor in the scenario did have a conflict and that they would not use him for a CME activity. (For all seven cases, the audience's responses, and a chance to vote, click on “Capsules” on mm.meetingsnet.com, and do a search for “SACME conflicts of interest.”)
News from the Research Front
There were a number of excellent research papers presented, including a study conducted by the Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, on the variation in how eight specialties participated in the Royal College's maintenance of certification program.
This study, a work in progress, involved looking at members of seven groups of specialties and subspecialties (surgery, medicine, laboratory medicine, pediatrics, psychiatry, radiology, and community medicine) who participated in the Royal College's maintenance of certification program in 2002 and 2003. The point was to compare the influence of the size of the community they practice in, gender, year they graduated from medical school, and university affiliation to the credits earned in each year in the six sections of CPD options. These sections included accredited group learning activities, nonaccredited group learning activities, self-assessment programs, structured learning projects, practice review, and scholarly activities.
Overall, the presenter concluded that demographics does influence the pattern of participation in CPD, albeit in different ways. For example, pediatricians were found to have less participation in group CME activities and were more active in self-assessment programs. Psychiatrists weren't all that active in group CME or self-assessment, but they liked their structured learning projects. Pathologists showed increased use of self-assessment programs, and surgical specialties used more practice review than did medical specialties.
The population of the area in which the docs practice also made a difference. Specialists in large population centers used less self-assessment, while those in more rural areas liked self-directed learning.
Another bit of research came from Robert Morrow of the Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, N.Y., which used a multimedia approach to get community health centers in the New York area to increase their use of best practices in asthma management. Post-test results showed that participants had improved their knowledge, and data from the insurance companies showed that patient hospitalizations and emergency department visits decreased. Quarterly costs for the patients also dropped dramatically.
Still Conflicted About Conflict
The opening panel wasn't the only place this white-hot topic came up. Robert E. Kristofco, MSW, director, Division of CME, University of Alabama School of Medicine, Birmingham, ended the day with another highly interactive session on conflict of interest and the new ACCME Standards for Commercial Support.
One participant said she mostly heard from her own staff, who were “freaking out” about it. “We are going to look at this in a systematic way,” she said. “It's unclear how the variation between different providers and how they resolve conflicts will affect. We've already had speakers come back to us and say that the specialty societies don't have a problem with [the way they handle a potential conflict],” implying the academic provider was being overly stringent. Another said, “A lot of people are saying that they just won't do accredited CME anymore.”
Another participant didn't think it would be a big issue for her. “Look at the disclosure forms for the past year and see how many conflicts there are that you would have had to deal with. Is it really as big a problem as we make it out to be?” Another replied that it all depends on the level of conflict that exists. “Is the speaker a consultant versus a speakers bureau member versus someone who's done research for only one company?”
And the last word was: “It's ironic that the exact same physician who can't speak to docs can go in and talk to medical students who are less equipped to determine bias than practicing physicians.”