CME Crossroads: A Survey of Continuing Medical Education Analysis, Criticism, Research and Policy Proposals

 Over the past several years, numerous reports and proposals from professional organizations, federal agencies, academic medical centers, medical journals, and states have sought to change the nature of the continuing medical education (CME) enterprise and its stakeholders.

A recent report from Global Education Group entitled “CME Crossroads: A Survey of Continuing Medical Education Analysis, Criticism, Research and Policy Proposals,” analyzed these proposals. The paper was peer reviewed by more than 20 CME professionals representing all key stakeholders, including representatives of the Accreditation Council of Continuing Medical Education (ACCME), American Medical Association (AMA), professional societies, medical education companies, hospitals, academic centers, and grant funding organizations.

The CME Crossroads is a survey of key CME articles, policy papers, consensus documents, and opinions between 2005 and 2010. During the past six months, the authors reviewed more than 100 studies and documents and were able to identify four “CME Policy and Scrutiny Trends” represented in the literature. Those trends include:

–       Incorporate adult learning principles/expertise into CME

–       Produce Better CME Outcomes

–       Heighten CME Regulation/Enforcement

–       Address Conflicts of Interest

After identifying these trends and providing information to clarify the analysis of CME, the paper concludes with several recommendations to positively shape future debate and CME analysis.

According to the authors of CME Crossroads, the survey of reports and committees created a “perfect storm of criticism, analyses, and policy proposals between 2005 and 2010.” The literature called for everything from a restructuring of the CME system to regulatory and accreditation en­forcement reform, to elimination of commercial support representing more than 50% of the fund­ing for CME activities. The CME Crossraods report asserts that much of the discussion and analysis within the reviewed reports “has been charged with emotions, peppered with anecdotal information, and plagued by confusion.” This finding is particularly problematic given the fact that many reports share the initiative of changing CME, and more specifically removing commercial support.

Although the damage to the CME enter­prise these reports have created is difficult to assess, there are concerning trends found in the ACCME Annual Report data. Specifically, when comparing the recently published 2009 annual report to that from 2007, the number of accredited providers of CME fell by 174.

During this same period, the ACCME reported equally troubling data on the number of certified CME activities. The number of CME activities decreased by 17,941 (-15.8%) between 2007 and 2009. Despite claims that CME funding was “approaching $3 billion” in 2008, actual ACCME report data show that it decreased to a total of less than $2.2 billion, of which 39% ($856 million) was comprised of industry grant funding to support CME activities. Despite the rally cry for al­ternative funding, the 29.3% decrease in industry grant funding was not offset by government or other sources.

The direct decrease not only in funding, but the number of CME providers and activities is disturbing, especially for physicians and patients. It is more shocking given the fact that we are adding 30 million more people to our health system, which means we will need more doctors and health care providers to educate, and more CME.

The interest in CME issues and policies however has surged. In the last five years, the authors found more than 100 articles published on assessing and sharing educational outcomes for CME activities and curricular initiatives and a peer-reviewed journal devoted solely to continuing education out­comes analysis has been published since 2006.

Significant changes in the CME enterprise have also taken place over this time frame, including the development of a “Certified CME Professional” (CCMEP) exam and designation in 2008. Further, the ACCME produced updated criteria for assessing all accredited CME providers in 2006, followed by 2007 policy updates and several calls for comment regarding regulatory proposals between 2008 and 2010, including those focusing on the Standards for Com­mercial Support, a rapid response system to address non-compliance, and blueprints for a future CME monitoring and compliance enforcement mechanism.

Given all of the changes and current activities, the authors assert that the CME enterprise “has reached a crossroads.” As a result, the authors examine the available evidence and provide clarification of the analysis, criticism, research, and policy proposals regarding CME. From their analysis, the authors concluded that the “literature surveyed demonstrated clear trends in criticism and a clear reaction from the CME enterprise. It included genuine evidence-based debate as well as unproven CME accusations.”

As a result, the authors recognized that despite the “rational and irrational concerns” in CME, “many stakeholders that comprise the CME enterprise have taken significant steps toward quality improvement.” Accordingly, the authors noted that the “challenge lies within the CME community to speak with one voice when defin­ing certified CME.”

The authors recommend that the CME enterprise needs “to communicate clearly to groups outside of the CME industry exactly what the CME enterprise is, and perhaps more important, what it is not.” In doing so, they acknowledged that CME providers must emphasize their movement toward quality, which will continue to improve healthcare through physician per­formance improvement.

Next week we will provide a summary of the trends found in the Global Education report, as well as their responses and recommendations.

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