“Change we can believe in.” That presidential campaign slogan might well have been the mantra for the CME enterprise — providers and regulators alike — over the past few years. And 2009 will require even more change to build belief in and support for certified CME.
From state and federal “sunshine” laws to media reports about institutions and physicians who fail to provide complete disclosure of financial conflicts, “transparency” is now a prerequisite for trust. Take the example of Charles Nemeroff, MD, PhD. As chair of Emory University School of Medicine's psychiatry department in Atlanta, he received both National Institutes of Health research grants and consulting fees from pharma companies for presentations. In its investigation of the reported $2.8 million Nemeroff received from various drug makers between 2000 and 2007, the U.S. Senate Finance Committee is focusing on the alleged $1.2 million that Nemeroff did not report to Emory.
What does this have to do with CME? In short, nothing and everything. Even though Emory attorneys argue that Nemeroff's research was sound and his presentations were not promotional, the fact is that his speaking engagements were not part of a certified CME initiative. They were managed by and paid out of marketing departments. But in response to a letter from Senate Finance Committee ranking Republican Charles Grassley, Emory officials stated that Nemeroff's talks were educational and “CME-like.”
Nemeroff has stepped down as department chair, and the Senate investigation continues.
Don't Fear Transparency
Transparency is the only way to distinguish certified CME from other forms of so called “educational” presentations. We have to be willing to open our doors and be proud of what everyone will find behind them.
Look at our progress. We've strengthened accreditation guidelines, monitoring, and enforcement policies. We've improved our practices related to measuring the effectiveness of our educational activity design and management. We've even embraced partnerships across provider types to deploy performance improvement and point-of-care CME initiatives that benefit both physicians and patients.
But as the Emory example shows, the media and even those involved with CME still confuse certified CME with consulting, sales, and marketing activities. Why? The CME enterprise has kept its bad apples — as well as the recent changes to clean up its act — under cover. We fear transparency, the one thing that will prove our worth and free us from unwarranted scrutiny.
More Debate in '09
Expect several more proposed changes to CME in 2009. Following its November 2008 Board meeting, the Accreditation Council for CME announced that it would take some time to fully review all the responses it received to calls for comments on proposed changes and a possible “new paradigm” for CME. Thestated that it will “continue discussions … as it analyzes the feedback received.” Talks have begun between the ACCME and various pharmaceutical and medical device organizations, and we should expect more information throughout the year.
Two other organizations also will release reports and proposals this year. The American Medical Association's Committee on Ethical and Judicial Affairs has promised to release an updated proposal on CME prior to June 2009. And the federal government-sanctioned Institute of Medicine is expected to release a report addressing CME from its “Committee on Continuing Education” by December 2009.
The discussions and debate will continue. But if we keep our talks and proposals evidence-based and transparent, we will show all stakeholders that the profession CME is leading a change everyone can believe in.
Stephen M. Lewis, MA, CCMEP, is president of Littleton, Colo.-based Global Education Group and president of the North American Association of Medical Education and Communication Cos. Reach him at firstname.lastname@example.org.
Continuing Medical Education Professionals Must Collaborate