The profession of continuing medical education evolved slowly up until three years ago, when the Accreditation Council for CME released its updated accreditation criteria. Since then it has undergone tremendous growth and maturation. Not surprisingly, the CME world is going through what could only be referred to as long-overdue growing pains.

In the past, CME was bifurcated: There was academic CME that, for the most part, focused on the ongoing education of the physicians within individual hospitals, systems, or institutions. And then there was private (many referred to it as for-profit) CME, which worked on CME activities that were larger in size, scope, audience, and budget. There were many disparities between the two and, in some cases, one tried to invalidate the other. Much of this, in my opinion, was the result of a lack of understanding about the mission of each group.

But there also were many similarities between the two. Members of each were dedicated to the betterment of physician performance and patient care. Organizations in each were expert at collaboration, collegiality, and creativity. And there was the shared need for commercial support within parts of each group. Therein lay some of the problems, which called for improved oversight and control of commercially supported CME activities. Most of these measures were good; some were not. We needed to grow. And we did.

Going Darwinian

ACCME took the lead in examining and evaluating what we needed to improve. The changes resulting in the 2006 updated accreditation criteria served two main purposes: They helped accredited providers to demonstrate clearly that they were indeed educators; and they led to a consolidation in — and reduction in the number of — accredited providers of CME.

While a few high-quality providers will no doubt disappear, the majority of providers that drop their accreditation or don't seek reaccreditation are doing so because they may not be able to function as independent providers of CME (firewall challenges); they may feel that the new criteria impinge on their ability to do business (financial challenges); and they may simply realize that they are not educators as the ACCME defines that term (business-model challenges). Is this the result of Draconian policies? I think not. It is more the result of Darwinian selection — survival of the fittest. In this case, the fittest providers are those without the three challenges noted above (or others that may also exist).

The remaining providers are feeling the growing pains associated with change. Some providers have had to change their entire process, from needs assessment to outcomes measurement. Others need to change their process of filing, either of hard copies or electronic records. Yet others need to staff up or down to survive in the new world of CME. The ACCME calls this new world “Accredited CME.”

I like this new world, despite the growing pains. I like the emphasis on education and competencies, and I like that the ACCME has evolved, along with the profession, and has taken a leadership role. I like that educational activities will need to be educational. I am not happy that some providers will not be able to function in this environment, but I see this as an opportunity for the remaining providers to take a more active role not only in activity design, development, and implementation, but also in leadership, advocacy, and intra-professional education.

We need to learn from each other and share best practices. We need to be open with each other and with all stakeholders. We need to find a common voice that can tout the benefits of Accredited CME when the detractors are vocal about their misperceptions. How can this be done? Who can lead the charge?

Send your thoughts and comments to Sue Pelletier, the editor of Medical Meetings, at Let's start the dialogue.

Lawrence Sherman, FACME, CCMEP, is senior vice president, Educational Strategy, with Omnia Education, Fort Washington, Pa. A 15-year CME veteran, he is a frequent lecturer on topics related to the strategic development, dissemination, and evaluation of CME activities. Reach him at