As a follow-up to The Money Maze (, March/April 2006), we'd like to reiterate some important messages we've heard from the pharmaceutical industry about commercial support. In preparing for this article, in addition to drawing on our experience over the past few months, we interviewed three CME experts: Walter W. Wolyniec, medical education director, Boehringer Ingelheim Pharmaceuticals, Ridgefield, Conn.; Maureen Doyle-Scharff, director professional services and medical education, Ross Products Division of Abbott Laboratories, Columbus, Ohio; and Suzanne Murray, president of Axdev Global and the Axdev Group, Brossard, Québec, Canada.
First, let us be clear that not all commercial supporters have made the transition to a medical education division that drives decision-making on educational grants. So it is important that you assess potential grantors to determine which camp they are in. But if they haven't crossed over yet, we think they will in the coming year considering the Office of Inspector General and U.S. Senate Finance Committee investigations into the industry.
Here are our observations:
Basic literature searches will no longer suffice for major educational grants. Supporters want to know that their support will truly make a difference in changing physician behavior. They want to get underneath the obvious information and find out where the true gaps exist. Suzanne Murray calls this process “getting to the depth of behavioral and clinical performance needs.” Maureen Doyle-Scharff is more to the point: “Shame on any provider who thinks a lit search is a needs assessment.”
Outcome measurements are now considered fundamental to a good proposal for funding. We are starting to see an average of 10 percent of funding earmarked for outcomes research in multimillion-dollar grants. Wolyniec indicates that he looks for a minimum of a level 3 (self-reported behavior change) evaluation tool in most proposals. For multiyear proposals, he and others interviewed suggested that more complex measurement of performance outcomes was advisable.
All the interviewees agreed that providers shouldn't hesitate to target multiple supporters for a given educational intervention. This may be particularly appropriate in complex, multiyear programs. Doyle-Scharff states that she is “absolutely a fan of that. Selling more product should not be the reason for education. It may be a viable byproduct, but certainly not the main reason for supporting.”
Wolyniec states that partnerships between national specialty societies and other provider types can often create some of the most meaningful opportunities for support of quality education if the CME projects have clearly identified objectives that focus on improving patient and public health. In his view, the national specialty societies, in collaboration with other agencies, should set goals for patient care standards and utilize measurable outcomes to evaluate the impact of educational support.
Our opinion is that all of this comes back to the Alliance for Continuing Medical Education's CME Staff Competencies document (see “New Competencies for the CME Professional,” at meetingsnet.com). CME staff should be evaluated and reevaluated for the staff competencies you need now to perform according to these standards. Is your staff still mostly logistical in nature? Have you hired educators — people with skills in curriculum development, needs assessments, evaluative methods? Have you pursued in-service training to bring staff up to speed in key areas? Have you reevaluated your standards for each new hire that opens up?
We think Maureen Doyle-Scharff put it well: “Get past the woe-is-me attitude, because it won't go back to the old way. If providers want to play in this game, they have to be appropriately staffed to manage the needs of the arena.”
Steven M. Passin is president of the CME consulting firm Steve Passin & Associates LLC in Newtown Square, Pa. He has also served as deputy health secretary for California. Contact him at firstname.lastname@example.org. Susan O'Brien is senior associate, Steve Passin & Associates LLC. Contact her at email@example.com.