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Industry involvement important to maintain high standard of CME
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All agree that practicing medicine at the highest level requires a lifelong dedication to learning. Thus, continuing medical education of physicians and surgeons is essential to the health of the individual patient and of all Americans as a whole. (And, I might add, as the world becomes flatter, all inhabitants of our increasingly interconnected world.)
 Richard L. Lindstrom |
However, this is where the agreement ends, and key stakeholders — including continuing medical education (CME) providers, certifying bodies, licensing bodies, professional societies, academic medical centers, physician educators, industry sponsors, and our state and federal legislators and regulators — are in the midst of a raging controversy over CME. This controversy includes key issues such as who funds it, what is taught, how it is taught, who teaches it and where it is taught. Each of these issues could command a multi-page treatise, but I would like to make a brief comment on each.
Who pays
CME in America is big business. In 2006, a total of $2.4 billion was spent on CME in the United States, and 60% of it was funded by industry. Many believe industry support of CME risks bias and by definition creates a conflict of interest that cannot be mitigated. They argue that all industry support for CME should be eliminated. I believe that total loss of industry support for CME would negatively impact access to vital quality learning experiences for most doctors.
CME paid 100% by the physician would be an extraordinary financial burden for many physicians at a time when many are hard-pressed to sustain an economically viable practice. It would be easy for the legislature to mandate that all CME be paid 100% by the physician, but the end result would be a significant decline in the number and quality of CME opportunities provided. This is a bad idea and needs to be opposed.
What is taught, how it’s taught
Next, what is taught and how it is taught is important. What is taught needs to be diverse, comprehensive, and directed to enhancing practice and patient outcomes. Many agree that CME relies too heavily on the lecture format. More effective, interactive approaches to teaching are needed, and in ophthalmology, our professional societies and other CME providers are leading in the development of a new generation of learning methodology. These innovative approaches are, however, almost always more expensive, again arguing for the need for ongoing financial support from industry.
Who teaches
The question of who teaches CME is also a hot topic. Some want to mandate that no physicians or surgeons who work with companies in any way to develop the next generation of drugs and devices should be allowed to educate their colleagues in their proper use once approved. While these arguments on the surface sound persuasive, they are unrealistic and counterproductive, as they will significantly detract from the quality, diversity and value of CME. We must allow those physicians most knowledgeable and experienced with new drugs and devices to educate the rest of us in their use. As we discussed in a prior issue (Ocular Surgery News, Dec. 25, 2008, page 4), conflicts of interest are ubiquitous in medicine and life, do not in themselves constitute a breach of duty, and can be mitigated by disclosure, program balancing and, in select cases, recusal.
Still, my best educational experiences have been learning new techniques from the inventors, including phacoemulsification from Charles Kelman, posterior chamber lens implantation from Shearing, Kratz, Sinskey and Sheets, and the proper use of new drugs from the company consultants who performed the clinical trials allowing their approval. To take all the innovators and company consultants off the podium would be a tragedy for the type of education we clinicians so desperately need to enhance our patient care and clinical outcomes.
Where it’s taught
There is an issue over where CME is taught — the meeting venue. I remain supportive of retaining diversity of venue. It does not make a CME program better because it is held in northern Minnesota in a poorly designed lecture hall with poor acoustics and uncomfortable seating in January, nor does it make it worse because it is held in Hawaii in a quality lecture hall with comfortable seating in that same month. CME is not intended to be a form of punishment.
In addition, hosting CME is big business, and it would be patently unfair and likely illegal to set guidelines that are biased in favor of or against one location or another. It is important that physicians and surgeons take the time for CME, and if presenting it in an attractive location within a quality educational facility enhances participation, that is a positive.
Quality CME
Finally, how do we define quality CME? Better metrics are needed to assess the quality of a CME program and its impact on patient care. To me, the best assessment is by the consumer of CME — the individual doctor attending the event. Comprehensive analysis by the participant of each speaker in each event for quality of presentation, value to personal practice and perceived presence of commercial bias can and should incrementally enhance the quality and patient-based impact of CME, which is in everyone’s best interest.