Posts filed under ‘ACCME’

CME Professionals Have Performance Gaps Too

From time-to-time I am asked to review grant request seeking support for CME activities. Recently I had the opportunity to review a nine requests seeking support for CME activities in a specific therapeutic area. Applicants could apply for the grants through one of the myriad of online grant application systems we all have come to either love or hate. This particular system asked applicants a series of questions that provides the granting agency information that would be required to meet ACCME accreditation and AMA CME credit requirements.

After asking the applicants the title and proposed target audience for the project they were asked two questions:

  • What is the professional practice gap your project will address?
  • How do you know that your target audience has this professional practice gap?

With the exception of one applicant, the answers showed a definite lack of understanding of what comprises professional practice gaps. The most common response to the questions referred to the prevalence of the medical condition of concern in the patient population in their service area. Not one word was said about the capabilities or lack of capabilities of the target audience in screening, diagnosing, or treating the medical condition. These applicants completely missed the boat regarding what constitutes a professional practice gap. Remember, these applicants are CME “professionals” working in accredited CME provider organizations. These CME providers demonstrate a clear professional practice gap of their own.

The groups providing funding for CME initiatives know the CME requirements imposed on CME providers. They expect CME providers to demonstrate an understanding of these requirements. When we submit funding requests demonstrating a clear lack of understanding of the most basic requirements in our enterprise it is no wonder these projects are summarily rejected. We need to get our individual and collective acts together. We are demonstrating our deficiencies every time we submit proposals that show we don’t get it.

CME professionals must be able to demonstrate a working understanding of what is required of accredited CME providers to offer approved CME activities. For example, as demonstrated in the proposals I reviewed, if we don’t even know what constitutes professional practice gaps and how to measure them we have a huge performance gap of our own. (By the way there were other things that these folks demonstrated they didn’t understand) These gaps absolutely must be addressed. Current CME staff not possessing the basic skill set to operate a CME program in compliance with ACCME expectations need to get the skill sets or get out of the business. There are lots of resources to help us acquire and develop these skills. Use them or we need to lose you.

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August 16, 2010 at 5:46 pm Leave a comment

CME in the News and on the Blogs January 27th, 2010

Here is a report on the dwindling numbers of accredited CME providers. The prediction that this will continue is correct and for a number of the reasons included in the report. It is probably a good trend.

I am off to the annual meeting of the Alliance for Continuing Medical Education. I think I’ll hear about others who are considering doing the very same thing.

ACCME reports industry shrinkage

Medical Marketing & Media, January 26 2010

“In the last 12 months, 142 medical-education providers either lost their accreditation to offer CME or decided not to apply for renewal, said the ACCME in a report issued last Friday. The tally includes med-ed companies, societies, hospitals and other entities which, for a variety of reasons, have found it too difficult to offer certified activities or, in some cases, to remain in operation at all.

The figures, posted on the Accreditation Council for CME (ACCME) website along with a summary of its December 2009 board meeting, show the extent of attrition taking place in the industry. There are now 713 accredited providers (vs. 725 in 2008) and 1,523 providers accredited by ACCME-recognized state and territory medical societies (vs. 1,600 in 2008)…..”

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What do you think? Good trend or bad trend?

January 27, 2010 at 5:34 pm Leave a comment

ACCME Call For Comment – Knowledge Based CME

The ACCME has called for comment on an issue of particular interest to me. Some stakeholders in the CME enterprise are suggesting that the ACCME add the word knowledge to the accreditation Criteria 1. Knowledge is a critical element of competence, performance and patient outcomes. As the ACCME says, “Providers should try to change learners’ knowledge — when knowledge acquisition will serve the goal of improving physician competence, performance or patient outcomes”. I am opposed to any change in ACCME accreditation criteria that would allow CME providers to offer “knowledge only” CME activities. Criteria 1 is fine as it is stated.

Continue Reading January 24, 2010 at 7:34 pm Leave a comment

CME in the News and on the Blogs December 10, 2009

ACCME Testing Online System to Collect, Evaluate CME Activity Data: PARS Expected to Go Live in Early 2010

AAFP News Now 12/9/2009

“The Accreditation Council for Continuing Medical Education, or ACCME, is testing an online reporting system designed to improve the transparency, efficiency and accountability of the CME enterprise, as well as to save CME providers time and hassle by streamlining the accreditation process. The Program and Activity Reporting System or PARS, is a Web-based portal that will permit the ACCME to collect and analyze up-to-date, comprehensive data from ACCME-accredited CME providers…………..”

You will want to take a look at the PDF file describing this effort. There is a link to follow in the article.

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December 10, 2009 at 7:56 pm Leave a comment

CME in the News and on the Blogs September 23rd- 27th, 2009

ACCME Board to Consider Disclosure Policy at December Meeting
MeetingsNet Nov 24, 2009

“ACCME board of directors to discuss increasing transparency around its complaints and inquiries process.

The Accreditation Council for Continuing Medical Education’s board of directors will discuss making changes to its process for handling complaints and inquiries about accredited providers at its meeting December 3-4. According to ACCME’s chief executive, Murray Kopelow, MD, “the board is considering the full range of issues involved for both the accreditor and the CME provider” once a complaint has been filed that a provider is not in compliance with the ACCME’s 2006 Accreditation Criteria. This includes whether or not to make public certain information about activities and providers who have been found to be noncompliant. This information currently is released only to the complainant and the provider charged with noncompliance.”

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(Authors Note: It is not only the US that is grappling with the issue of industry relationships with health professionals. Here is an article from our colleagues in Australia.)

Mandatory Disclosure of Pharmaceutical Industry-Funded Events for Health Professionals
Robertson J, Moynihan R, Walkom E, Bero L, Henry D (2009) PLoS Med 6(11): e1000128. doi:10.1371/journal.pmed.1000128

Summary Points
• There are moves internationally to ensure greater disclosure of gifts and educational events for doctors paid for by pharmaceutical manufacturers. However, there is no agreement on appropriate standards of disclosure. In Australia, since mid-2007, there has been mandatory reporting of details of every industry-sponsored event, including the costs of any hospitality provided.
• Examination of the Australian data shows that although expenditure at individual events is often modest, cumulative expenditure is high, particularly in the case of medical specialists prescribing high cost drugs—oncologists, endocrinologists, and cardiologists.
• Although a significant advance, the new Australian reporting standards do not allow assessment of the educational value of sponsored events, and do not include details of speakers or educational content for most events. However, doctors in training are often present at these events.
• At present, the standards of disclosure are inadequate and should not be tied to an arbitrary monetary value of gifts or sponsorship. Reporting standards should require the names of the speakers presenting, whether sponsors played a role in suggestion or selection of speakers or the development of the content of presentations, and the nature of any direct or indirect financial ties between the speakers and the sponsors.

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A useful resource for those investigating the pharma industry
Croakey the Crikey HealthBlog, November 27th , 2009

“The Drug Industry Document Archive contains over 2500 documents about pharmaceutical industry clinical trials, publication of study results, pricing, marketing, relations with physicians and involvement in continuing medical education. It is a publically accessible web site hosted by the University of California, San Francisco Library and Center for Knowledge Management
Most of these previously secret documents were made public as a result of lawsuits against the following pharmaceutical companies: Merck & Co., Parke-Davis, Warner-Lambert, Wyeth, and Pfizer………………….”

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November 28, 2009 at 5:15 am Leave a comment

Recent: CME in the News and Blogs

CME in the Recent News

If you subscribe to the illogical conclusion that the most important things in CME are the things that get press and blog coverage then you will find the most important thing in our industry is the relationship between industry and the healthcare community. Here are some recent examples of what I mean.
U.S. Sen. Grassley: Says drug companies should disclose payments, seek greater transparency

IowaPolitics.com
Friday, October 23, 2009

WASHINGTON — Senator Chuck Grassley is continuing his campaign to establish transparency with the financial relationships between drug companies and medical professionals.

Grassley has conducted oversight and sought disclosure with physicians, especially those involved in influential taxpayer-sponsored medical research; medical journals containing ghostwritten articles; medical colleges; continuing medical education; and the patient advocacy community.

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CME outfitters: Guilty of Pro-Seroquel Bias, According to ACCME

The Carlat Psychiatry Blog
Monday, October 12, 2009

In ACCME’s testimony before the Senate Special Committee on Aging on July 29 of this year, Dr. Murray Kopelow, the chief executive of ACCME, defended the integrity of the embattled organization in part by pointing out that they have beefed up their enforcement of anti-commercial bias policies.
Here is a story that exposes an accredited provider for alleged non-compliance.

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Here is another blog from Health Care Renewal on the same topic
More of the same

ACRE Responds to CEJA Report Financial Relationships with Industry in Continuing Medical Education

Policy and Medicine
October 19, 2009

The Association of Clinical Researchers and Educators (ACRE), recently released their response to the AMA CEJA Report: Financial Relationships with Industry in Continuing Medical Education (1-I-09). Specifically, ACRE recommended that AMA House of Delegates reject the report or refer its recommendations back to committee. The report which includes some light editing from the report rejected by the House of Delegates this past summer needs to be rewritten from the beginning.

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Merck discloses a portion of US speaker fees

Medical Marketing & Media
October 20, 2009

Merck disclosed fees paid to US-based medical and scientific professionals who spoke at promotional medical education programs during the third quarter of 2009.

The first disclosure includes payments made to 1,078 patients between July 1, 2009 and September 30, 2009. Speakers during that period were paid an average of $1,548 per engagement, and participated in two engagements on average, according to the announcement. The company will disclose payments for the third and fourth quarters of 2009 in early 2010, at http://www.merck.com/speakerpayments.

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Extremely Low Rates of Bias Reported in Commercially Supported CME Activities

Policy and Medicine
October 20, 2009

The American Journal of Medicine (AMJ) recently produced a critical study titled: “Low Rates of Reporting Commercial Bias by Physicians Following Online Continuing Medical Education Activities.”

The study of over 1,000,000 physician CME participants, found very little reporting of bias (less than 1%) and no difference between bias reported in commercially supported vs. non supported CME activities.

The study was funded by Medscape, LLC, and written by employees of Medscape, and other authors who give a complete list of their disclosures in the article.

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Drug Companies Used Physician Education to Push Pills

Brian Vastag Science Journalist
October 20, 2009

Article Authors Note: A scientific journal recently commissioned this story from me, but after I reported and wrote it, the journal killed it. I think it’s an important story that serves the public good, so I’m posting it here to get it on the record. BV

Drug makers routinely exploited continuing education seminars as opportunities to market pills to doctors, company documents reveal.

Continuing medical education (CME) has exploded into a $2.3 billion business in the United States, with nearly half of the funds pouring in from drug and medical device manufacturers. Physicians must complete a certain number of CME courses each year to retain their medical licenses.

Today, the large pharmaceutical companies say their CME dollars support only independent education, with no input from the companies. But as recently as 2004, the documents show, marketing personnel played key roles in developing the seminars, treating CME as one element of their comprehensive sales plans.

“It is very clear…that continuing medical education has been used as marketing, and I think it continues to be,” said Allan Coukell, director of the Pew Prescription Project, which seeks to reduce or eliminate conflicts of interest in medicine.

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CME accreditation body plans exposure of courses violating drugmaker influence rules

FierceHealthcare: Daily News for Healthcare Executives
October 21, 2009

To remain certified, doctors must take continuing medical education courses each year. With about half of the $1 billion per year cost of these courses being picked up by pharmaceutical companies, questions have always lingered as to whether such sponsorships unduly influence physicians. That’s particularly the case, critics say, because the nonprofit that accredits course providers–the Accreditation Council for Continuing Medical Education–hasn’t done enough to police drug industry influence on such content.

This week, however, the accrediting group has signaled that it’s ready to take a tougher stand on the issue of pharma influence on CME content. The head of the ACCME said this week that he would soon be revealing a list of classes and companies that already have violated rules against imposing commercial bias on this content.

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October 26, 2009 at 8:26 pm Leave a comment

CME In the News September 2009

Here are a few things about CME that have appeared in cyberspace in the last few weeks. I am sure most of you have seen the last missive frmm the ACCME. If not go take a look at the organizations web page.

Eliminating CME Conflicts Worth the Cost, Says Scully
By Jun Yan

Psychiatry News September 4, 2009
Volume 44, Number 17, page 1
© 2009 American Psychiatric Association

“Regulators may join the already-crowded debate over whether commercially funded CME is beneficial or detrimental to the medical profession and patients’ health.

The fact that the relationship between the industry and the medical profession is facing increasing scrutiny is not a bad thing,” James H. Scully Jr., M.D., APA’s medical director and CEO, told the Senate Special Committee on Aging at a hearing in late July. He was one of the medical leaders who testified at the hearing to express their knowledge and opinions about continuing medical education (CME)—specifically, whether funding from pharmaceutical and device companies, currently accounting for half of all funding for all CME programs in the United States, leads to biased information for physicians.”

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Physicians know FDA-OK’d uses for drugs half the time
Critics say doctors need better information and call for tougher action on off-label marketing.

By Kevin B. O’Reilly, AMNews staff. Posted Sept. 7, 2009.

American Medical News

This article starts by referring to a 2006 study reported in the Archives of Internal Medicine:

“A 2006 Archives of Internal Medicine study of 725 million prescriptions found that about one in five orders was written off-label — that is, for a condition that has not received the Food and Drug Administration’s approval as a safe and effective use of the drug. More than 70% of these off-label prescriptions were for indications in which the drug ordered had little or no scientific support.”

Later in the article you will find this assertion:

“Much of what doctors know about drugs comes from what they learn from the industry because the industry is out there actively communicating with doctors through sales reps or sponsoring continuing medical education programs.” (My emphasis)

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PHARMA GROUP SAYS: No more sponsored golf, other perks for docs
By Dona Pazzibugan

Philippine Daily Inquirer
First Posted 20:25:00 09/07/2009

The concern over relationships between industry and physician is not only a US concern. Read what one group in the Philippines is doing.

“Sponsored golf games and seminars in posh resorts here and abroad for doctors are no longer allowed among drug companies belonging to the Pharmaceutical Healthcare Association of the Philippines as it tried to police its ranks against unethical promotional activities.”

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Merck, Schering-Plough Spent Big on Medical Education

24-7 News
Date Published: Tuesday, September 15th, 2009

“A report says Vytorin makers Merck & Co. and Schering-Plough spent $60 million to fund medical education courses over the past four years. According to The Wall Street Journal, the drug makers made the payments to a small group of medical schools and health groups, including Harvard University and the American Heart Association.
The Merck and Schering-Plough Continuing Medical Education (CME) funding was disclosed in a report released by the Senate Special Committee on Aging. “These documents remove any doubt that, at least in this case, when drug companies fund continuing medical education, they see it as money well spent on marketing their latest blockbuster drug,” said Sen. Herb Kohl, D-WI, chairman of the Special Committee.”

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Here’s one for you. Another expose focused on the influence of pharma in medicine. This time it is on the practice of ghostwriting.

When stories extol drugs, maker may be behind it
By Kris Hundley, Times Staff Writer
St. Petersburg Times
In Print: Sunday, September 20, 2009

“Documents recently released in federal court cases against the drug company Wyeth have exposed one of the dirty secrets in the world of medical journals: the widespread practice of ghostwriting.

While doctors are named as the authors of articles about treatments and diseases, behind the scenes is a paid writer who is largely responsible for crafting the piece. Not only is the ghostwriter on the payroll of a drug company with interests in the topic, the company often reviews the manuscript before the physician sees it.
With publication in a peer-reviewed journal, the physician enhances his reputation and resume. The drug company gets its marketing message across by a supposedly unbiased author.

Meanwhile journal readers — doctors and their patients — have no inkling of the drugmaker’s role in shaping the information.”

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September 21, 2009 at 5:16 pm Leave a comment

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