THE CME SYSTEM IN THE U.S. is far superior to any in the world. Yet countless hours are spent searching for flaws and developing additional policies to quiet the critics and to perfect the system. CME professionals should be sensitive to these imperfections while assuring regular maintenance. But CME is by and for medical professionals. It should not change direction every time a new negative news report or journal article appears. To do so would diminish its effectiveness, add confusion and misinterpretation to an already complex system, fuel public criticism, decrease funding, and perhaps even discourage faculty participation.
With 1990 as the “modern” starting point for CME, CME planners have had to take into consideration the FDA Education Guidance, the Accreditation Council for CME Essentials, the Pharmaceutical Research and Manufacturers of America's ethical code, the American Medical Association gifts to physicians policy, the Office of Inspector General's draft guidance for pharmaceutical manufacturers, and several other guidances specific to particular medical associations or groups. And now, the ACCME has issued its draft revision of the Standards.
A steady diet of additional and reworked regulations is not the answer. Using existing national CME policy, CME can gain stability and advance its leadership role in keeping pace with the learning needs of physicians in a time of whirlwind change in medicine.
It is time to say what is right and good about CME and to proudly defend our achievements. If privately funded CME is as biased as some would have us believe, then we can only conclude that our superiority in research, medicine, and technology has resulted almost exclusively from the contributions of nonfunded programs and enduring materials. That might be a sustainable argument were not the majority of CME events funded by commercial firms. Do some such programs have defects? Certainly. But so do many produced under the auspices of institutions.
CME is the loser when one group or another is blamed for its faults, instead of seeking a common ground. CME needs the creative thinking, innovation, and scientific method of all contributing players — the medical institutions and associations, the pharmaceutical and device industries, private education and communication companies, and government and regulatory agencies. Working together works.
When the new ACCME Standards become policy, in whatever form, those who value CME should rededicate themselves to making the system work rather than expending more effort on policy development born of negativism.
CME providers must be allowed to take charge of the system and make decisions based on individual circumstances without frivolous critique and inflexible regulation. In this context, providers of any stripe must be allowed to judge whether commercial interests and business relationships are legitimate — without being bound by fiat to suspect or preclude those relationships a priori.
It is also important to recognize that the medical profession, like other great business and industrial entities in this country, has emerged from policies of inclusion, not exclusion. All who have the credentials should be welcomed to the CME process. Many physicians, whether on academic staff or not, have worked with industry in a variety of ways. To exclude such experienced individuals from participation in CME, as some would recommend, creates a system that stifles rather than encourages open participation and exchange of cutting-edge learning experiences.
Robert F. Orsetti is assistant vice president, continuing education, University of Medicine & Dentistry of New Jersey in Newark. Orsetti, a 24-year CME veteran, brings a broad perspective to this column, having served in a variety of settings including pharma companies and education firms. He is a member of the AMA's National Task Force on CME Provider/Industry Collaboration.