Let’s Adopt a National Model for Overall CME Program Improvement

ACCME requires all accredited CME providers to “Evaluate the effectiveness of its overall CME program and make improvements to the program” (Element 2.5). So how do we do this improvement stuff? I hear this question asked over and over. I hear interesting variations in the interpretation of what this means. We can change that ambiguity. We can adopt a common approach to program improvement.

Having a systematic, sustainable, repeatable approach to improvement can be done by each of us regardless of the size or scope of our CME program. Doing so would:

• Create a common nomenclature we could use to communicate about our improvement initiatives.
• Develop a common skill set and approach to improvement we could implement in any setting.
• Produce sustainable improvements in our CME operations we could share with colleagues in other settings that would raise the quality bar for everybody.
• Be a systematic way to evaluate the effectiveness of our overall CME program we could use to show value to our organization and report to the ACCME.
• Be a systematic way to continuously make improvements to our overall CME program we could use to show value to our own organization and report to the ACCME.

Such an approach to improvement does not have to be an expensive or extremely time consuming effort. Adopting a simple, systematic, sustainable, repeatable approach to improvement is within our reach.  An increasing number of healthcare settings around the country are engaged in such efforts right now.  Industry has been doing this for decades.

Interested in becoming an early adopter? Contact me at ctlassoc@mindspring.com to learn about getting  started in transforming your CME operation into a culture of improvement and join in the effort to create a common national approach to CME program improvement.

GSK and CME Funding Restrctions

This story has created a torrent of interest in the blogs and news outlets in the past few days. Google “GSK and CME” and you will see what I mean. This is yet another of the great number of stories we have been seeing for a long time related to industry involvement with CME. It seems to be the major topic of interest to writers and bloggers following CME issues.

GlaxoSmithKline Changes Doctor Training Policy
Associated Press – Sep. 21, 2009

RESEARCH TRIANGLE PARK, N.C._British drugmaker GlaxoSmithKline PLC is making major changes in its spending on training programs for doctors, fees paid to doctors for consulting, and even political contributions.

The changes include immediate bans on all corporate political contributions and on using commercial medical education and communication companies to run programs teaching doctors about medical treatments.

Those programs often promote a drug maker’s new, generally expensive drug and give little information about its risks or how well it compares to older, cheaper drugs.

The moves come as congressional investigators, consumer groups and the media ratchet up criticism over the increasing influence drug and medical device makers wield over the practice of medicine.

Reflections on Taking the CCMEP Examination

If you are considering taking the CCMEP examination you might find this  interesting. It is a podcast I did with three people who were successful in earning their certification. They share why they took the exam, how they prepared for the examination, some surprises they encountered and a few other reflections. Download it to you favorite MP3 player or your computer and have a listen. Its about 15 minutes long. I hope you find it useful.

PI CME: The Unintended Outcome?

If you have been following this blog for a while you know I have a particular interest in “Performance Improvement CME”. Recently I have done several podcasts with CME professionals engaged in providing PI CME to their constituents. One striking outcome is being reported almost universally in these efforts. When physicians or groups of physicians engage in an effective PI CME initiative they not only make significant changes in their performance, they report they are learning a systematic approach to improvement they can replicate in other improvement efforts.

Not one of the CME providers I talked with indicated this was an outcome they intended. But to me this is an outcome as valuable as the intended performance changes in patient care. CME providers are teaching skills that are transferable to many different improvement interests. Perhaps we should consider physicians gaining this skill as an intended outcome of our PI CME efforts. It does mean we have to be very deliberate in teaching “improvement science” which may require some professional development of our own.

What do you think?

CS2Day PI CME and Handheld Projects

Interested in learning about four different approaches to PI CME in a smoking cessation initiative? How about a handheld project that prompts heath care providers on next steps to take in caring for the patient who smokes? Listen to my conversation with Dr. George Mejicano as he gives a description of these initiatives. He also describes some things in the outcomes evaluation that will be very instructive when choosing an approach to PI CME.

Be Careful When Addressing Uses for Unapproved Drugs: Lilly Gets Fined

CME provides a safe haven for the discussion of off label uses for drugs. When done correctly, this is a valuable service CME can provide to the medical community. Look at what happened to Lilly. Hopefully no accredited CME provider was unknowingly entangled in the marketing strategies strategies that cost Lilly a huge fine.

Does Pharma Use Common CME Activities to Promote of Off-Label Drug Use?

Here is an interesting article published PLoS Medicine describing ways pharma promote off label use of drugs. One author worked in the industry as a physician in medical affairs, supporting marketing and both authors have current contacts within the industry. The authors disclose that unreferenced material in the article “comes from their personal experience, contacts, or information available in public fora such as industry discussions and presentations at trade shows”. Since CME is a forum for discussion of off label uses of drugs this is worth the read for every CME provider. Four of the five techniques purportedly used by pharma to “promote” off label uses of drugs mentioned in the article are activities engaged in by many CME providers. Heads up colleagues.

For a summary of what is said in the article go here. Here are the five techniques pharma are said to use to promote off label uses of drugs:

• Use of “Key Opinion Leaders”
• “Publication Strategies” to Generate Influential Publications Whose Industry Origins are Disguise
• Bleed-Through from Unaccredited “Drug Talks” to Accredited Continuing Medical Education
• Using Obligations Generated by “Unrestricted Educational Grants”
• Use of Compendia and Drug Indices

In some areas of medicine off label use of drugs is common and necessary. For many health conditions most patients are taking something off-label. Some of this evidence based information is published in peer-reviewed journals. Off-label uses of approved drugs should be discussed by physicians utilizing the best evidence available. Independent, evidence based CME is an essential place to do this. This is where the new initiative to educate CME faculty in how to separate promotional presentations from those made in accredited CME activities is very important.  The issue is how to have the information presented in a fair and balanced way without undo influence from industry. The question is whether faculty can speak from both perspectives and not be conflicted. Some say yes. Some say no.

Mass Law on Gifts to Physicans Goes Beyond Reason?

In a blog on “Policy and Medicine” you’ll find an interesting post on the impact of a proposed law in Massachusetts related to gifts to physicians.

You might find this very interesting and somewhat concerning.