CME must continue but is becoming increasingly difficult to organize

On March 23, the Detroit Free Press carried a very reasoned editorial by W. Douglas Weaver, MD, newly elected president of the American College of Cardiology (Congratulations, Doug), affirming the need for openness and integrity free of bias in all of our continuing medical education activities but also warning of the potential downside of completely cutting out industry sponsorship. No one would disagree that industry bias must not enter into any CME program, but it is inappropriate to conclude that industry sponsorship equals bias. Read the editorial which is available online.

The potential for bias is not my main concern in this blog. I am working my way through an application for a CME package, based on the current Accreditation Council for Continuing Medical Education guidelines. To say it is difficult to complete would be an understatement — although I have no peer-reviewed literature to support my concern.

Item 1 reads, “The planner incorporates into CME activities the educational needs (knowledge, competence or performance) that underlie the professional practice gaps of their own learners. A professional practice gap is the difference between actual and ideal performance and/or patient outcomes.” As a meeting planner I have no way of knowing who will find the planned meeting to be of sufficient interest for them to register, nor do I have a clue about their knowledge, competence or performance.

The item continues, “Based on the definition listed above list the current practice (what it is), the best practice (what it should be), list your intervention to close the gap.” Not infrequently when I am invited to speak to an audience where I don’t know anyone I begin my remarks by saying, “I know what I know, I know what I would like you to know, but I have no idea what you want to know.” But the ACCME form wants me to document that before CME accreditation can be given.

It doesn’t get better!

Item 2 (there are seven in all on the form in front of me): “The gap is in physician-knowledge (familiarity, awareness or understanding gained through experience or study), competence (ability to apply knowledge, skills and judgment in practice), performance (what one actually does in practice).”

We go to CME programs for two noncompeting but compelling reasons. Many states require a certain number of CME credits to be earned each year in order to maintain licensure. One cannot possibly argue with that. The other is even closer to home and more important. We have an obligation to our patients to remain as current with medical care as possible and practical based on our current and expected future practice population. We do that because we care!

Unfortunately there are some physicians who succumb to industry influence, and there are some physicians who are simply no longer competent. That does not represent the American health care system, just a minute fraction. Making CME more difficult to organize and pay for is not the way to health care reform if the goal is to improve things.

Medical knowledge is increasing at an ever-accelerating pace beyond our ability to keep abreast of all things. We need to have the material that is relevant and important to our practice put into context — not by making sure we read every new article but by direct learning from an acknowledged expert who can be there to guide us and patiently answer our requests to clarify what we didn’t quite understand. CME must continue — targeted and free of bias! And without a bureaucracy that makes it nigh impossible.