Continuing medical education
Encyclopedia
Continuing medical education (CME) refers to a specific form of continuing education
(CE) that helps those in the medical
field maintain competence and learn about new and developing areas of their field. These activities may take place as live events, written publications, online programs, audio, video, or other electronic media. Content for these programs is developed, reviewed, and delivered by faculty who are experts in their individual clinical areas. Similar to the process used in academic journals, any potentially conflicting financial relationships for faculty members must be both disclosed and resolved in a meaningful way. However, critics complain that drug and device manufacturers often use their financial sponsorship to bias CMEs towards marketing their own products.
(ACCME) and the American Osteopathic Association
.
In Canada, certification is provided by the Royal College of Physicians and Surgeons of Canada
(RCPSC) and the College of Family Physicians of Canada(CFPC). The RCPSC is responsible for the development and implementation of all certifying examinations in each specialty other than Family Medicine. Specialist physicians who join the Royal College as Fellows maintain their knowledge, skills, competence and performance through participating in the Maintenance of Certification Program. For each five year cycle, fellows of the college are required to document 400 credits, with a minimum of 40 credits obtained in each year of the cycle. Credits are earned at one to two credits per hour, based on the type of learning activity. The CFPC requires 250 credit-hours over a five year cycle. Fifty credits must be obtained for each year of the cycle. To earn and maintain fellowship within the college, an additional 24 credit-hours of higher level learning are also required over each learning cycle. Similarly, each province and territory requires documentation of ongoing CME for licensure.
Activities may be classified as Formal Learning Activities: including live planned programs, enduring materials (such as DVD- and web-based content), Process Improvement CME (or PI-CME, as defined by the American Medical Association), or Informal Learning Activities such as Internet-Point of Care (POC) research and decision making, or journal clubs
whose members evaluate published research for mutual awareness and benefit.
In 2008, professional certification for CME planners was established by the National Commission for Certification of CME Professionals, which is earned by standardized exam, and confers the Certified CME Professional (CCMEP) certificate. NC-CME maintains a registry of these certified professionals. As of June 2011, the Registry included 320 professionals.
Despite ACCME requirements that program content be free of commercial interests, "CME providers can easily pitch topics designed to attract commercial sponsorship," and sponsors can award grants to programs that support their marketing strategies. The Institute of Medicine has said that CME has become too reliant on industry funding that "tends to promote a narrow focus on the products and to neglect provisions of a broader education on alternative strategies," such as communication and prevention.
For example, gabapentin (Neurontin), was approved by the U.S. Food and Drug Administration for adjunctive therapy in epilepsy, but Warner-Lambert sponsored CME activities that encouraged its use for off-label indications. The U.S. Department of Justice brought civil and criminal charges against Warner-Lambert, which Warner-Lambert settled for $430 million, alleging that Warner-Lambert paid kickbacks to doctors in the form of lavish trips to attend presentations about off-label uses. More recently, AstraZeneca PLC has been fined $520 million in the United States for off-label promotion to doctors for their anti-psychotic drug, Seroquel.
Industry-sponsored CMEs can violate federal statutes, according to the U.S. Department of Health and Human Services. "When a pharmaceutical manufacturer rewards high-prescribing physicians by directing a CME provider to pay (or overpay) them as CME faculty, consultants, or members of a speaker's bureau," wrote Morris and Taitsman.
Continuing education
Continuing education is an all-encompassing term within a broad spectrum of post-secondary learning activities and programs. The term is used mainly in the United States and Canada...
(CE) that helps those in the medical
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
field maintain competence and learn about new and developing areas of their field. These activities may take place as live events, written publications, online programs, audio, video, or other electronic media. Content for these programs is developed, reviewed, and delivered by faculty who are experts in their individual clinical areas. Similar to the process used in academic journals, any potentially conflicting financial relationships for faculty members must be both disclosed and resolved in a meaningful way. However, critics complain that drug and device manufacturers often use their financial sponsorship to bias CMEs towards marketing their own products.
Historical context
Continuing medical education is not a new concept. From essentially the beginning of institutionalized medical instruction (medical instruction affiliated with medical colleges and teaching hospitals), health practitioners continued their learning by meeting with their peers. Grand rounds, case discussions, and meetings to discuss published medical papers constituted the continuing learning experience. In the 1950s through to the 1980s, CME was increasingly funded by the pharmaceutical industry. Concerns regarding informational bias (both intentional and unintentional) led to increasing scrutiny of the CME funding sources. This led to the establishment of certifying agencies such as the Society for Academic Continuing Medical Education which is an umbrella organization representing medical associations and bodies of academic medicine from the United States, Canada, Great Britain and Europe. The pharmaceutical industry has also developed guidelines regarding drug detailing and industry sponsorship of CME, such as the Pharmaceutical Advertising Advisory Board(PAAB) and Canada's Research-Based Pharmaceutical Companies(Rx&D).CME Requirements
In the United States, many states require CME for medical professionals to maintain their licenses. For example, Arizona requires an average of 40 hours of CME every two years. For a complete list of requirements by state, see State Medical Licensure Requirements and Statistics, 2006. Within the United States, CME for physicians is regulated by the Accreditation Council for Continuing Medical EducationAccreditation Council for Continuing Medical Education
The Accreditation Council for Continuing Medical Education sets and enforces standards in physician continuing education within the United States...
(ACCME) and the American Osteopathic Association
American Osteopathic Association
The American Osteopathic Association is the representative member organization for the over 78,000 osteopathic medical physicians in the United States...
.
In Canada, certification is provided by the Royal College of Physicians and Surgeons of Canada
Royal College of Physicians and Surgeons of Canada
The Royal College of Physicians and Surgeons of Canada ' , French: Collège royal des médecins et chirurgiens du Canada, is a national, private, nonprofit organization established in 1929 by a special Act of Parliament to oversee the medical education of specialists in Canada...
(RCPSC) and the College of Family Physicians of Canada(CFPC). The RCPSC is responsible for the development and implementation of all certifying examinations in each specialty other than Family Medicine. Specialist physicians who join the Royal College as Fellows maintain their knowledge, skills, competence and performance through participating in the Maintenance of Certification Program. For each five year cycle, fellows of the college are required to document 400 credits, with a minimum of 40 credits obtained in each year of the cycle. Credits are earned at one to two credits per hour, based on the type of learning activity. The CFPC requires 250 credit-hours over a five year cycle. Fifty credits must be obtained for each year of the cycle. To earn and maintain fellowship within the college, an additional 24 credit-hours of higher level learning are also required over each learning cycle. Similarly, each province and territory requires documentation of ongoing CME for licensure.
Non-CME (Promotional Education) Programs
Non-CME activities, also referred to as Promotional Medical Education, encompass a variety of industry sponsored educational programs for medical professionals. Several things serve to distinguish these programs, which are typically aimed at promotion of a given product or therapy, from accredited CME programs:- Lack of accreditation
- Direct Industry Sponsorship
- Specific Product or Therapy Focus
- Strict regulation against off-label promotion
Production of CME Courses
Continuing medical education activities are developed and delivered by a variety of organizations, including:- Professional Associations
- Medical Education AgenciesMedical education agencyMedical education agencies are a specialty subset of advertising agencies that develop educational content for the Healthcare, Life Science and Biotechnology industries...
- Hospitals
- Educational institutions, including universities, medical and nursing schools
Activities may be classified as Formal Learning Activities: including live planned programs, enduring materials (such as DVD- and web-based content), Process Improvement CME (or PI-CME, as defined by the American Medical Association), or Informal Learning Activities such as Internet-Point of Care (POC) research and decision making, or journal clubs
Journal club
A journal club is a group of individuals who meet regularly to critically evaluate recent articles in scientific literature. Journal clubs are usually organized around a defined subject in basic or applied research. For example, the application of evidence-based medicine to some area of medical...
whose members evaluate published research for mutual awareness and benefit.
In 2008, professional certification for CME planners was established by the National Commission for Certification of CME Professionals, which is earned by standardized exam, and confers the Certified CME Professional (CCMEP) certificate. NC-CME maintains a registry of these certified professionals. As of June 2011, the Registry included 320 professionals.
Criticism of industry sponsorship
Critics, such as Morris and Taitsman, would prefer that the medical profession eliminate commercial support for CME.Despite ACCME requirements that program content be free of commercial interests, "CME providers can easily pitch topics designed to attract commercial sponsorship," and sponsors can award grants to programs that support their marketing strategies. The Institute of Medicine has said that CME has become too reliant on industry funding that "tends to promote a narrow focus on the products and to neglect provisions of a broader education on alternative strategies," such as communication and prevention.
For example, gabapentin (Neurontin), was approved by the U.S. Food and Drug Administration for adjunctive therapy in epilepsy, but Warner-Lambert sponsored CME activities that encouraged its use for off-label indications. The U.S. Department of Justice brought civil and criminal charges against Warner-Lambert, which Warner-Lambert settled for $430 million, alleging that Warner-Lambert paid kickbacks to doctors in the form of lavish trips to attend presentations about off-label uses. More recently, AstraZeneca PLC has been fined $520 million in the United States for off-label promotion to doctors for their anti-psychotic drug, Seroquel.
Industry-sponsored CMEs can violate federal statutes, according to the U.S. Department of Health and Human Services. "When a pharmaceutical manufacturer rewards high-prescribing physicians by directing a CME provider to pay (or overpay) them as CME faculty, consultants, or members of a speaker's bureau," wrote Morris and Taitsman.
External links
- Practicing Clinicians Exchange, NP & PA Continuing Medical Education
- The Society for Academic Continuing Medical Education
- Continuing Professional Development, University of British Columbia (website) Provider of accredited CME (CFPC Mainpro M1, RCPSC Section 1, AMA Category 1)
- CME Conferences by Medical Education Resources, Inc., a non-profit medical education company.
- Vindico Medical Education Vindico Medical Education is an accredited provider of CME, CE, and CNE activities in live, print, and online formats.
- BMJ Learning online CME BMJ Learning is an accredited provider of online CME courses based within the UK.
- Doctors Aiding Doctors CME (DAD) is an online community of physicians dedicated to CME and the betterment of medical practices.
- The Institute for Advanced Medical Education (IAME) is an accredited provider of continuing medical education, providing practice-changing experiences for physicians, nurses, technologists and other health care professionals. IAME is accredited by the Accreditation Council for Continuing Medical Education.