CME: Points of view	December 2007

The future of medical education: focus on physicians

By Frank F. Britt and Marissa Seligman
Frank F. Britt is general manager, education programs, Pri-Med (pri-med.com). Marissa Seligman is chief clinical, regulatory affairs and compliance officer, Pri-Med Institute.

In the increasingly regulated health-care environment, some have questioned the value of continuing medical education.  Is CME just another onerous and unnecessary requirement that physicians must deal with, or does it truly benefit practitioners and patients?

According to the ACCME, over the past five years physician utilization of CME has increased by 58%, encouraged by an increase in industry support of 60% over the same period.  There is a reason: the need for CME has never been greater. In the future the health-care industry will deliver ever more personalized medicine, placing new pressures on physicians to expand their breadth and depth of knowledge.  Technological advances are occurring at breakneck pace while more stringent certification requirements, Medicare changes, and greater focus on quality outcomes, among other factors, are making the practice of medicine more complex. Given these dynamics, now more than ever we must concentrate on how best to share new health-care advances and treatment protocols through certified continuing medical education. The question is not whether we need CME, but who should pay for it and how should we work together to improve it.

Pharmaceutical, biotech, and medical device industry role in CME

Industry’s role in supporting education has increasingly become controversial, due to concerns that funding may lead to bias toward a particular therapeutic option or be driven by an industry’s bottom line.  It is critical to address these concerns head on – both to validate the value of industry support and ensure that CME remains independent.

As a leading independent provider of CME educating 350,000 health-care professionals annually, both with and without commercial support, it is our mission to advance the quality and safety of patient care through certified education. In pursuit of that mission, we believe we must recognize the contribution that pharmaceutical, biotech, and medical device industries have made by supporting CME through unrestricted educational grants. More than just an enabler, the pharmaceutical, biotech and medical device industries have helped to make accessible a platform for post-graduate physician training through certified, high quality, un-biased education. Even the Senate Finance Committee, in their recent report on CME, recognized the value of industry support. However, it is clear that CME providers could more effectively communicate both the value of industry support of CME, as well as enabling better transparency in planning and design.

Providers must demonstrate that the education they provide is independent of commercial interests.  Recently, some have claimed that CME providers have resisted transparency; however, the reverse is true. Leading CME providers have proudly embraced the chance to showcase the practices and procedures already in place.  We believe that all CME providers, from independent medical education companies to academic medical centers, should be expected to adhere to the same standards of excellence and transparency.

Physicians at the center of the CME discussion

In clarifying the mechanics of financing CME, we can return our focus to CME’s mission: filling knowledge gaps so doctors can provide patients with better care. Physicians’ needs provide the roadmap for the design of CME’s curriculum, as well as the barometer for measuring impact. Leading CME providers must embrace a broader view of CME in order to address multiple areas of physician competency. CME can help physicians meet quality and performance measures that already exist, such as Maintenance of Certification, Performance Improvement and other health-care quality initiatives. Not only should CME address these areas, it must address them in ways that work with the demands of physician’s everyday lives.

Independent CME providers are also investing in programs to improve performance. Better programs can help with urgent lapses. For example, the American Diabetes Association and American Association of Endocrinologists note that 7% of America’s population has diabetes, but nearly one-third are unaware.  Despite this, physicians meet annual A1c screening guidelines in only 28% of patients, according to the Agency for Healthcare Research and Quality’s report.

Today, there is need for broader-based curricula thoughtfully synchronized  across live, online, and print channels, maximizing the time invested by the physician. This means embracing the concept of self-directed learning, with tasks largely within the learner’s control, which is the core of adult learning theory and the future of CME. Although the concept of personalized curricula is not a novel idea, the contemporary interpretation requires more sophistication and breadth of capabilities to deliver as physician learning and practice behaviors have evolved.

CME: eyes on the prize

CME stakeholders need to keep their eyes on the prize – quality education that enables effective patient care.  Any discussion about CME needs to center on what it means for the physician learner – specifically on how CME providers can create a well-rounded, unbiased learning environment for physicians that fits the realities of physicians’ day-to-day lives. It is imperative that industry support continue to enable the delivery of certified CME. Developing CME to meet the needs of 21st century medicine is a challenge shared by many— from pharmaceutical, biotech, and medical device manufacturers to managed care organizations, state and federal governments and CME providers as well as physicians, and ultimately patients. All these stakeholders must contribute to a common dialogue on how to innovate CME to meet the needs of 21st century medicine. Leading CME providers look forward to working with all stakeholders to meet this extraordinary goal.  Only together will it be possible.