Are MECCs On the Way Out of Continuing Medical Education?

The long awaited AMA CEJA report is out along with its companion piece from the MA Council on Medical Education. Overall, not too bad. Some tough love in parts. Some issues still need to be clarified. Here is one the MECC community will find interesting I am sure.

“The Council on Medical Education acknowledges that some of the CEJA recommendations are aspirational and there may not be existing guidelines or regulations to guide physicians and the CME community on how to demonstrate compliance. Additional interpretations, time, and experience will be needed before clarity in application and eventual compliance with these recommendations can be demonstrated. Specifically, the CEJA recommendations and terms requiring clarification are as underlined below:(fcp: one of the items in the list)

……the CME provider is not overly reliant on funding from industry sources.”

For those MECCs that are completely reliant on industry funding does this complete the wake up call many of you think has been coming? Regardless, there will surely be some interesting fireworks between now and the time the AMA takes this up as a policy decision.

Stay tuned.

Pharma Influence in Continuing Medical Education: One Welcome Contribution

“Pharma influence in CME? What!! Are you out of your mind?”

“Well, no not really. And here is why I don’t think so.”

Where (How) Can We Make a Difference in the Current CME Environment?

I was talking to a colleague who happens to work in pharma asking for some advice on an issue of concern to my organization. In the conversation we wandered off to talk about the current state of our CME enterprise. He asked me an interesting question. It went something like this. Floyd, if you could position yourself in the CME world where you could make the greatest impact for positive change, where would that be? Here is my response. How would you respond?

Sure. Go Ahead. Ban Pharma Money From CME.

Banning commercial support for CME appears to be a moral crusade for some, but at what cost? Ask, “Where the money will come from to allow physicians to have access to CME at a price they think they can afford or are willing to spend? Why me of course. The patient. Priceless.

From My “For What It Is Worth Musings” About PI CME

A thought.

There is a need for serious conversation about what we mean by PI CME and what is required of PI CME to have any lasting impact in improving the delivery of healthcare. It is no longer enough simply to consider how physicians learn – an emphasis promulgated by the adult educators (and I am one) far too long. While an understanding of how physicians learn is important, it is not enough. The end product of learning – knowing- is not enough. Physicians know how to do far more than they actually do in providing care.

The more important question is where physicians learn. Physician learning takes place at three levels. First, it occurs in the physician-patient interaction where care is being provided. Second, it occurs in the organizational systems and work processes that comprises practice settings. And third, it occurs in the socio-political-economic systems that frame healthcare delivery. These are each sub-systems of our larger, very complex healthcare system. Change occurring in one subsystem requires change in other subsystems. That is how systems work.

If structured in a way that acknowledges learning occurs in these subsystems PI CME can have a major role in effecting change in physician competence and performance in complex health systems. I believe this. I also believe that CME professionals need to understand improvement theory and the tools used to effect improvement in complex health systems. PI CME offers the CME professional a way to add tremendous value to their organization. We need to step up and take advantage of this opportunity.

Can PI CME Effect Permanent Change? Maybe- Maybe Not!

For permanent change to occur in the practice of medicine there must be a change how the work of patient care is done. Performance improvement and systems based thinking are two sides of the same coin. KNOWING IS NOT ENOUGH.

JAMA Special Communication On Professional Association Relationships With Industry

If you work in a professional society you need to read the special communication released by the JAMA with policy recommendations for relationships with industry. The recommendations cover general budget support, conferences and meetings, funds for research fellowships, and training programs, committees that formulate guidelines or outcomes measures, industry support of publications, product endorsements, affiliated foundations, conflict if interest among society elected officers and board members, and guidelines for members.

I am not sure where the AMA stands in these recommendations or where this fits in the deliberations of CEJA. We will have to wait to find out.

Their conclusions – “Enacting these recommendations will require PMAs to transform their mode of operation and perhaps even give up activities of considerable value.The proposals are rigorous: PMAs should work toward a goal of $0 contributions from industry; they should not collaborate in or profit from industry marketing activities; PMA leaders and executive staff should be free of conflict of interest and, in time, so should the entirety of the board and the members of the practice guideline committees.”

This is a very sweeping set of recommendations that require special attention by those of us working in professional medical associations. A must read. My suggestion? Make a list of all of the recommendations. Have the leadership of your society examine each recommendation carefully and, using facts, determine what, if any impact each recommendation will have on your society. Then respond to JAMA accordingly.

CS2Day PI CME and Handheld Projects

Interested in hearing about four different approaches to PI CME? How about the use of handheld technology to support physician patient care. The CS2Day collaborative smoking cessation program includes these types of activities. Listen to Dr. George Mejicano describe these activities and some of the design features put in to measure the effectiveness of these efforts.

Wisconsin CME Ties to Pharma Makes the News

The Chronicle of Higher Education news blog on march 30th includes a story on CME practices at the University of Wisconsin. The headline, like many reporting on industry support for CME, is a bit sensational – “U. of Wisconsin’s Industry-Backed Courses Mislead Doctors and Could Hurt Patients”. A little disappointing for this publication. The article picked up by the Chronicle was published by a Wisconsin newspaper the Milwaukee Journal Sentinal. That article contains several inaccuracies but it is worth the read.

Another pharma/CME bashing. If this doesn’t stop soon say bye bye to pharma funding for CME. Some may think that is a good idea. Soon pharma may agree. Your thoughts?

Physican Awareness of Commercial Support Regulations in CME