Wednesday, July 22, 2015

CME, Industry and Outcomes

Recent medical literature describes the challenges of demonstrating the impact of CME on physician learning (with a focus on the lack of impact), and the need to reform the current system.  Writers suggest that it really is not having the impact that it should, given the financial resources provided.  Others have questioned how it is funded, suggesting that it may be biased given the resources provided by industry, and that it should be changed. 

While I admit my own bias as an Associate Dean for CME for a major medical school, I feel that it is important to study the peer-reviewed literature to best understand this important topic.

First, is the industry influence really that significant?  A piece by Cervero discusses this, and found limited evidence of the impact of industry influence on CME.  In the recent ACCME 2014 report (Table 8), only 11% of accredited CME received commercial support from industry.  My interpretation of this is that the commercial support is certainly not an overwhelming part of CME programs (our own institutional data would definitely mirror this finding).

Second, what is the real impact of CME?  The same above author recently published a piece in JCEHP (full disclosure: I am the social media editor for this journal, but was not involved in any way in the creation, revision, or decision to publish this manuscript) that concluded that CME can indeed impact patient outcomes and physician behavior (the former more than the latter).

Third, improvements in how CME is disseminated should occur.  Within this realm, patients should be included, and interprofessional learning should occur in team environments; this is highlighted by the new President and CEO of the ACCME, Dr. Graham McMahon, in a Viewpoint piece in JAMA that came out online earlier this week.


So where should we go from here?  I think there are several things we can consider.  Most importantly, physicians and other healthcare providers should continue to learn in order to provide optimal care of their patients in a changing environment; CME is one way to aid this learning.  Those in the field have been thinking about how to restructure it for many years and have made major strides in focusing on quality improvement.  Second, we should also consider learning healthcare systems as a way to promote learning for those who provide care for patients.  Lastly, we should be diligent about using technology to make our learning more effective.  Examples include online journal clubs and virtual communities of practice.  Given the complexities that abound in medicine in the current environment, anything that can make the process of learning how to "keep up" and best care for our patients easier should be welcomed.  

2 comments:

  1. Wow what a great post. I can't believe no is commenting on this blog. You put a lot of thought and effort into this post and you deserve some feedback.

    With respect to commercial support for CME, I would like to say this: medical education is darned expensive. A huge amount of federal taxpayer money is spent subsidizing the cost of medical school for our future physicians, in the form of support for training grants for residents. How much federal money is available for continuing education for these same physicians 15, 20, 25 years after they graduate? Not much. However the need to stay up-to-date on the practice of medicine has never been greater, especially in the field of oncology where I frequently work. Cancer breakthroughs seem to happen almost annually these days. So I don't think we need to apologize for coming up with alternative funding schemes for continuing medical education that involve commercial support. I think the key is to disclose and manage potential conflicts of interest, so learners can beware of potential biases in the educational programs they choose to consume. Trust me, if the federal government were providing support for CME, there would be people out there who would accuse the feds of bias, too, in terms of the topics chosen for instruction, or the faculty members chosen to deliver the instruction. Commercial support is an important ingredient for our thriving, lively, innovative system of accredited CME. Let's hope it remains that way.

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