When I entered the field of continuing medical education some 35 years ago, I had a clear sense of direction: Keeping up was every physician's personal and professional responsibility, as a means of providing patients with the best possible care. My role was to help physicians keep up. Theirs was to listen and learn, and apply what they had learned.
The world of CME has changed. The measurement of success is no longer how well we deliver up to date knowledge and skills. Instead CME is being measured by changes in performance, and in some instances, participation is being rewarded by increased pay -- whether for performance or not. Governments are also getting into the act. Here are examples of the changing role of CME:
In the UK, the National Institute for Clinical Excellence issues periodic CME guidelines on use of drugs, devices and procedures. A British Medical Journal article (Oct. 30) found that compliance was quite patchy. "Nothing is impossible for the man who doesn't have to do it himself," said one commentator.
In Canada, Dave Davis, renowned CME leader, calls for a national body to develop Canada-wide guidelines and see to their application in practice.
In Belgium, doctors who meet prescribed standards of CME/CPD credits can ask for a 4.5% fee increase and in addition get a yearly premium of some 500 Euro.
The European Union of GPs suggests that if a physician's recorded CPD (CME) is to be taken as evidence of continued competence, then a legislative framework is needed to provide educational resources and a remedial program for those who fail to meet the criteria set.
In a Pittsburgh (US) hospital, after an 18-month intervention to improve hand hygiene, doctors were the worst group in compliance; a 1-hour CME course was required -- and doctors still failed to wash! So new sinks and soap dispensers were added; hand hygiene finally improved.
.The American Medical Assn. in a special report described the pay-for-performance movement as a "tsunami building offshore". Medicare is funding some pilot pay-for-performance programs at hospitals and clinics.
And the AMA has now approved the use of Category 1 CME credit for performance improvement activities that are evidence based and measured for results.
Is it too late to be asking: What has happened to the joy of learning when the physician is handed today's evidence-based guideline and told to follow it? What has happened to the sense of professional responsibility for keeping up when the physician has to be led to the water and told to wash? What do you think? -- Lew Miller, Principal, WentzMiller & Associates
**************************************** ***** Need a "Second Opinion" about your organization's CME endeavors, in the U.S. or globally? Call WentzMiller & Associates! We'll quickly let you know if we can help, through our 5 principals and associates in the U.S., or through our 7 colleagues abroad.
**************************************** ***** Back issues Now Available! You can access these at www.wentzmiller.o rg. An d for more global CME news and information, check the web site of the Global Alliance for Medical Education (GAME) www.game- cme.org
GREETINGS FROM US ALL!
A Joyous Christmas -- and -- A Peaceful New Year
Dennis Wentz and Lew Miller
Charley Baker
Edwin Borman
Len Harvey
John Kelly
Krishnan
Cees Leibbrandt
Hervé Maisonneuve
Helios Pardell
Beverley Rowley
Pedro Vera C.
·Continuing Saga: The Role of Pharma in CME
CME professionals are under pressure not only from agencies that are seeking to relate CME/CPD to physician performance, but also from the principal funders -- pharmaceutical companies. In the U.S. alone, the pharmaceutical industry invests almost $1 billion a year in certified CME. It is likely that an equal amount -- or more -- is spent in the rest of the world.
As reported in these columns in past issues, the U.S., through government agencies and the Accreditation Council for CME, is imposing tougher standards for commercial support, with full disclosure of financial support for CME speakers and resolution of conflicts of interest to insure fair balance.
What is industry looking for? Says Alex Woods, writing for Pharmafocus UK: "If pharma companies are to successfully develop and spark the chain reaction [to introduce a new product], they will need to have established and respected key opinion leaders (KOLs) on board as early as possible. These 'thought' leaders need to champion the product and ensure it gets the right kind of exposure, enabling it to withstand the rigorous tests it will have to undergo on the rocky road to a successful launch.
"It is essential to analyze groups such as congress boards, scientific journal editorial committees and professional and patient group leaders in as much depth as possible to avoid missing out on the KOLs that could make all the difference to a product," says Wood. Chris Link, field physician for Seroquel at AstraZeneca, says: "Many of the initial prescribing decisions are made in secondary care, particularly for severe enduring mental illnesses, so it is important that, through a partnership of education and sharing of key data and messages, companies develop brand advocates who are influential in defining good clinical practice for the field as a whole."
With an ever-increasing spotlight on the relationship between the pharma industry and the medical professions," Wood notes, "it is almost inevitable that certain skeptics will see partnerships between the two as a cosy arrangement more geared towards drug promotion rather than clinical advancement."
Let's point up the issue concretely. The critical question for the profession is: Does CME provide unbiased evidence-based content that can improve the quailty of care? The critical question for pharmaceutical companies is more likely to be: Does CME change performance in a way that benefits sales of our products?
Are these positions irreconcilable? If so, must government take over the funding of CME, as is the case in Norway and a few other countries?
·Europe Slowly Moving to Mandatory CME
There is a gradual shift towards some form of mandatory CME, based on an overview of the national situation in European countries, reported November 27 at the Annual Meeting of the European Accreditation Council for CME in Brussels. But in nearly half the countries, usually the smaller ones, CME is voluntary. Mandatory CME by law is an exception. Italy and the Netherlands (for some of the specialties only) are examples. Sometimes legal mandatory structures exist, but are not enforced. Losing the license to practice due to non-compliance with CME requirements is a rare event in Europe.
In the major countries mandatory CME is implemented by professional organizations. The penalties include counseling, white lists, loss of membership in professional organizations, financial incentives/restrictions, the loss of contracts with health care insurances and (in Croatia) new exams.
Increasingly CME activities in Europe receive EACCME accreditation, which results in recognized European CME awards. Much time during the meeting was spent on the practical operation of the EACCME. For EACCME accreditation both national and professional approvals are necessary. This assures quality. There is uniform consensus on this issue, but the practical realization is difficult sometimes. For further information see www.eaccme.be or www.uems.net. - - Cees Leibbrandt MD, WentzMiller associate
UEMS Adopts New Policy to Promote Good Medical Care
A critical new policy paper, titled "Promoting Good Medical Care", has recently been adopted by the Union Européenne des Médecins Spécialistes/ European Union of Medical Specialists (UEMS). Its aim is to provide a framework for confirming the good quality of healthcare in Europe, specifically of the contribution of specialists.
The paper provides guidelines that can be adopted for use in Quality Assurance (QA) systems in all European countries. QA is defined as regular review against defined standards of medical care, and can best be achieved when based on valid evidence, which can also facilitate improvements in medical care and justify the provision of necessary resources.
This UEMS policy paper can have a profound effect on current systems of continuing medical education/continuing professional development (CME/CP), says Dr. Edwin Borman, chair of the UEMS committee that prepared the paper.
The paper is addressed to all who have an interest in the quality of healthcare provision: patients, doctors, medical associations, health service employers and hospitals, fund-holders, regulatory authorities, national and European legislators. The UEMS considers that the QA system should consider the individual doctor, the team(s) within which they practise, and their work environment and should be based on the QA cycle: monitoring medical care against standards accepted as medically valid, introducing improvements that are appropriately resourced, reviewing these changes, and ensuring that the system itself is adequately quality assured.
Eastern European countries, recently added to the European Union, have shown strong interest in the paper, Dr. Borman says. He adds that the UEMS sees no evidence to demonstrate any additional effectiveness of mandatory systems over the model described in its policy paper. (www.uems.be)
**************************************** Need a "Second Opinion" about your organization's CME endeavors, in the U.S. or globally? Call WentzMiller & Associates! We'll quickly let you know if we can help, through our 5 principals and associates in the U.S., or through our 7 colleagues abroad.
Back Issues Now Available! The most recent issues of this newsletter are now available on our web site, www.wentzmiller.org. Content may be used freely. We would appreciate attribution. Content is also available on the web site of the Global Alliance for Medical Education (GAME), as well as information about joining GAME. www.game-cme.org
Spotlight on Europe
Will 2005 see an explosion of new approaches to continuing medical education/continuing professional development (CME/CPD) in Europe? We think so, based on the articles in this issue. More countries are implementing formal CME systems, through government or medical association auspices for both specialists and GPs, though both European medical organizations are opposed to mandatory CME systems. We are keeping a close eye on developments on the continent. Let us know if we can help your organization understand the latest trends.
·European GPs Also Push for Improved Quality
General practitioners in Europe, through the Union of European Medical Omnipractitioners/General Practitioners (UEMO), have promulgated a strong stand in favor of continuing professional development (CPD) as "an inevitable prerequisite for the maintenance and development" of quality in health services.
The UEMO paper states that "it is the responsibility of the individual general practitioner to make optimal use of resources (time, finance, etc.) which in the given national system are set aside for CPD." GPs should identify their personal needs and select learning activities accordingly. And professional organizations, the UEMO says, should "cooperate in securing and developing an effective framework" so this can take place.
UEMO warns that activities must be free of influence from "public authorities, insurance systems and the pharmaceutical industry". At the same time, GPs must be accountable, through external evaluation and audit "to ensure that unrecognized educational needs are identified".
Each GP, says UEMO, should be assured of time and money to participate in at least 50 hours of CPD annually. But agreeing with the UEMS, UEMO notes that "obligatory CME does not guarantee quality". (www.uemo.org)
·Netherlands Moves to Uniform CME Accreditation
Representatives of all professional societies in the Netherlands have established a harmonized system of accreditation of CME activities with mutual recognition of credits within the 3 groups of specialties, one for the 28 clinical specialties, one for the specialties in general practice and one for "social medicine" (occupational medicine, insurance medicine and public health). For full implementation ratification is necessary, but already a uniform application form and a uniform assessment procedure will be used. Accreditation will remain the responsibility of the separate professional societies. Establishment of a central national CME authority is not contemplated.
In addition, the 3 Colleges/Registration Committees reached agreement on a common set of requirements for registration and reregistration. Among them will be a requirement for 40 hours of CME yearly on average (5 year period) for all medical specialists in the 3 groups. This agreement has yet to be ratified by the Ministry of Health.
Presently there are legal mandatory requirements for the specialties in general practice (40 hours yearly) and in social medicine (20 hours yearly). For the clinical specialties no legal requirements are operational presently, although the professional societies in these specialties have set requirements. Mandatory implementation awaits a structural solution of the problem of the financing of CME. -- Cees Leibbrandt, MD, WM&A Associate
·Update on U.S. CME Requirements
Last issue we reported that the executive director of the Accreditation Council for CME (U.S.) had indicated that if a proposed speaker had a significant financial conflict of interest in a commercially supported CME program, he might be disqualified from speaking. Subsequently, responding to an uproar of protest, that position has been modified to allow such a speaker subject to advance, independent peer review of his comments -- certainly a more palatable resolution.
One reader, Dr. Robert Barbieri, chair of OBG at HarvardMedicalSchool, commented: "It seems that we are evolving to a situation where CME presenters will tend to have no direct financial relationships with the companies manufacturing products relevant to their presentations. In addition, there will probably be a growing focus on evidence from clinical trials and evidence based reviews. In many ways, rather than an aura of fear, this seems like a rational and conservative approach to a complex situation with many potential conflicts."
"How am I going to tell the 1,500 faculty members at my institution that their future roles in CME are limited?", said the CME dean at one medical school during the September Conference of the National Task Force on CMEProvider/Industry Collaboration in Baltimore MD, USA.
He and many of the 500-plus attendees found themselves perplexed, angry and fearful after listening to regulators from government and professional organizations.
Mary Riordan of the Office of Inspector General, Department of Health and Human Services, reviewed the recent Pfizer settlement of over $400 million, in part based on "false claims" related to promoting off- label use of the drug Neurontin in CME courses. She discussed the need to separate educational grants from marketing, and CME evaluation from changes in prescribing. And she noted that CME providers could be charged with fraud or so-called "kickbacks" if pharmaceutical company support of their programs indicated any sort of control over content.
The even more upsetting news that the dean had to take back to his faculty concerned a presentation by Murray Kopelow MD, head of the Accreditation Council for CME, discussing the newly adopted Standards for Commercial Support( www.accme.org). Answering specific questions, he noted that anyone planning a program or proposed as a speaker must disclose all recent financial relationships with the pharma company supporter. If these pose a conflict of interest -- defined as minimal amounts of payments -- the planner or speaker may not discuss any aspect of the related product.
Frequently, speakers on a new drug are those best qualified to dfiscuss its benefits and risks, having been involved in clinical trials. The new standards can make this almost impossible, one attendee noted. Will these pressures make pharma funding of CME in the U.S. disappear? Not until government is willing to pay -- and that's not in the immediate future. Meantime, both content developers and commercial funders are fearful of making a misstep.
**************************************** Need a "Second Opinion" about your organization's CME endeavors, in the U.S. or globally? Call WentzMiller & Associates! We'll quickly let you know if we can help, through our 5 principals and associates in the U.S., or through our 7 colleagues abroad.
Back Issues Now Available! The most recent issues of this newsletter are now available on our web site, www.wentzmiller.org. Content may be used freely. We would appreciate attribution. Content is also available on the web site of the Global Alliance for Medical Education (GAME), as well as information about joining GAME. www.game-cme.org
Taking the Professionalism Out of CME
Around the world, continuing medical education has always been a professional responsibility. Every physician needs to keep abreast of changes in diagnosis and treatment -- and most want to do so. But more and more, as the feature article in this issue illustrates, regulation is reducing the role of the individual doctor by imposing one or another form of penalties. What do you think?
·E-CME Continues to Build Around the World
Three new reports stress the growing importance of online programs as one way for doctors to keep up. Data are still limited about the widespread use of such programs, but certainly in the U.S. the number of physicians taking CME credits is rapidly increasing.
In France, 5 medical educators from Nice and Marseilles (contact pascal.staccini@unice.fr) have developed the J@LON Project (Join and Learn On the Net). In a presentation at the International Medical Informatics Association's annual meeting, they emphasized guided learning as opposed to passive learning. Their solution is to offer teachers and learners a Web-based authoring and publishing platform based on sound pedagogical principles.
In Dubai, UAE, a new portal has been launched that will reach physicians throughout the Middle East and Gulf regions. This is a collaborative effort among the Dubai Department of Health and Medical Services, the Institute for International Research and the AmericanAcademy of CME. Mohammed Al Mazourie of the UAE Ministry of Health sees this as a way to help UAE physicians meet the requirement of 12 CME hours per years to maintain their licenses. "No one has an excuse now for not earning enough credit hours," he said. (http://www.iircme.com)
And from Latin America, Dr. Pablo Pulido of the Pan American Federation of Medical Schools told an International e-Health Assocation conference in London that e-learning provides a powerful path to evidence based medical education. Nonetheless, he stressed the need to tailor content to the realities of each region. E-learning, delivered by medical schools and teaching hospitals, can help close the gap between societal expectations and perceived reality, he concluded.
·Mandatory CME Is on Slow Track in France
The French CME system that has been 'relaunched' by a November 2003 decree is progressing slowly, reports WM&A associate Hervé Maisonneuve. The 3 national committees (for private practitioners, for hospital doctors, and for not-practicing physicians employed by different public and private bodies) set up in March 2004 should publish reports by the end of 2004. They have been busy, setting up small working groups, but their reports are delayed. Their objectives are to publish guidelines for providers and for a credit-like system. A coordination committee meets regularly.
A public health law, published on August 11th, states that "CME has the objective to improve the knowledge, the health care quality, and the patient's welfare, especially for prevention and public health priorities". Mandatory continuing education has been extended to other health care professionals.
·Thailand: CME Required for Relicensure
More than 26,000 physicians in the Kingdom of thailand must collect no less than 100 CME credits every 5 years to maintain the right to practice. The system is administered by the Center for CME (CCME), a semi-independent organization supervised by the Medical Council of Thailand.
Live CME is delivered by certified principal institutes. In these, one credit equals one hour. It is possible for Thai doctors to claim credits for meetings attended abroad, on an individual basis. Credit can also be obtained for self-learning, patient-based learning in hospital, and continuing professiona development activities. Award of credits varies for these.
Each certified principal institute must record credits and upload these to the CCME server. A good idea for all countries!
·Lecture Are Fine, Says Reader
Responding to the August article on how doctors learn, Dr. Jeff Susman, head of family practice at the University of Cincinnati, and editor of the Journal of Family Practice, USA, writes:
I think we have thrown the baby out with the bath water when it comes to disowning lectures and journals as effective CME. Physicians regularly change their behaviors as a result of reading articles and hearing lectures. That controlled trials are not very positive says more about framing research questions and the nature of processing information. While I think it is foolish to believe one article or lecture is going to change practice, it is also folly to believe journals and lectures are without merit. For God's sakes, I would still be using theophylline and digitalis on all my patients if this were the case. Finally, changing behaviors within complex systems is rarely a one to one phenomenon. Multiple encounters with new information, with appropriate reinforcement, ultimately change practice. If we don't at least atune ourselves to what physicians want, it won't matter-they will not choose to drink from the trough in the first place!
Is it feasible to develop a global program to improve the competence of primary care physicians, particularly GPs? That question was addressed at an organizing meeting of world leaders in medical education September 7 in Edinburgh, during the annual conference of the Association for Medical Education in Europe.
The idea was spawned after the 9th Annual Meeting of the Global Alliance for Medical Education (GAME) in New York in June, on the theme, "Building the Global CME Community". Conveners of the Edinburgh session were Dr. Pablo Publido of the PanAmerican Federation of Medical Schools; Lew Miller of GAME, and Dr. Honorio Silva, international medical relations VP at Pfizer.
Now that chronic diseases have joined infectious diseases as the major causes of disability and death around the world, there are opportunities to share the latest approaches to prevention, diagnosis and treatment through a lifelong learning plan.
The goals of the global primary care competency program are:
Create an evidence based approach to CME/CPD, with a core curriculum
Develop a global system for accreditation of CME/CPD
Help create certification and recertification of GPs globally
Adapt global CME/CPD to regional, local needs
Develop regional action plans for implementation
The medical education leaders at the meeting voiced unanimous support for the concept. As a result, a Steering Task Force is being formed to identify global leadership, a 12-month timetable and a major follow-up meeting of 30-40 world leaders to build commitment to action. Pfizer's Medical Humanities Initiative has agreed to support the project.
Send Us Your CME News!
You can help make every issue of the WentzMiller Global CME Newsletter more interesting with your contributions. Let us know (lew@wentzmiller.org) what's happening in your country or organization, particularly those CME activities that may become models for others. Or write us with a problem you are encountering. We'll share it with others to see if a solution emerges.
·Will Pharma Companies Move to Global CME?
Pharmaceutical companies "can now limit the length and expense of global clinical development programs by conducting large multinational clinical studies," says Dr. Bruno Delagneau, a pharma marketer. And key opinion leaders around the world can simultaneously gain experience with a new molecule before launch.
But, Dr. Delagneau comments, in an article in Pharmaceutical Executive, global marketing departments "are still not widespread". And that means there is little global planning of continuing medical education activities. Why not? The author suggests that key managers are "reluctant to give up their autonomy and influence".
The potential advantages of a global department, says Dr. Delagneau, include:
Cost savings at the local level, because HQ bears development costs
Internal efficiency, by avoiding conflicting feedback
Marketing efficiency, in which global can document best practices and share them
Consistency in branding and in the education message in a disease area
Do global marketing programs ignore fundamental differences across countries and cultures? Not if room is left for local adaptation. For example, one CME program in print was adapted and translated to go into 17 countries, with great success. HQ paid the development costs, local managers the implementation costs.
·Malta's CME System -- With No Distance Learning!
The island of Malta does have a structured CME program through the Malta College of Family Doctors. Each college member must gain 27 units per year at meetings organized by the college -- mostly lectures and interactive discussions. Distance learning? Not needed because of the island's small size, says Mario R. Sammut, college secretary for education.
·Is There a Role for MECCs Around the World?
MECCs? These are medical education and communications companies, a common phenomen in the U.S., but less apparent in many other countries. In the U.S., many MECCs are accredited providers of CME; others work closely with medical schools or medical societies.
WentzMiller recently conducted a survey of CME leaders in several countries to determine the present and future role of MECCs in the CME systems.
Question 1: What percentage of CME programs are developed by MECCs, alone or jointly? China, Italy and Mexico -- more than 50% // Spain - 30% // France - 20% // and UK - 5%
Question 2: Over the next 5 years, how will MECCs' role change? It will increase greatly in Mexico and Spain; somewhat in China and the UK, stay the same in France and decrease greatly in Italy.
·Wentz and Miller on the Podium
Dennis Wentz MD and Lew Miller MS have busy speaking schedules in the next few weeks -- in case you wish to see them in person! Here are Dennis' engagements:
Sept. 30 "Collaboration Between Industry and CME: On or Off the Track?" -- National Task Force on CME Provider/Industry Collaboration, Baltimore
Oct. 25 "Globalization of CME/CPD: An Update" - Global Medical Society e-Cooperative, New York City
Oct. 28 - "Accountability and Assessment of physicians: A Future Look" - Center for Personalized Education for Physicians Annual Learning Summit, Denver
Nov. 4 "Investing in Worldwide CME" - Pharmaceutical Executive MedED forum 2004, Philadelphia
Lew Miller's schedule:
Sept. 7 "Primary Issue in U.S. CME: Pharma Financing" - Association for Medical Education in Europe, Edinburgh
Oct. 18 "Is CME Really a SafeHarbor?" - CBI's 6th Annual Off-Label Conference, Alexandria, VA
Contact lew@wentzmiller.org if you are interested in a WentzMiller principal or associate as a speaker for your organization.
Welcome New WM&A Associates: Joining us are Dr. Edwin Borman, UK anesthesiologist and CPD leader in the Britih Medical Association and Union of European Medical Specialists, and Charles Baker, U.S., former head of Medi-Media, an IMS division.
China is the drug market to watch, says IMS, the leading data company in the pharmaceutical field. China was #10 in the world in 2003, and will pass Mexico to the #9 position in 2004. Other positives in the IMS 2003 report:
·Biologics are growing at 25% a year, faster than any other category of medication.
·When Aventis and Sanofi merge this year, the combined company will rank #3 in the world, #5 in the U.S. Aventis is now #11, Sanofi #19.
Some important negatives were also reported:
·It is estimated that 25% of the drugs sold in Mexico are counterfeit.
·Growth has slowed greatly in the number of prescriptions filled.
·The use of Rxs by people with low incomes and poor health status in the U.S. has dropped substantially. Some 66% of these patients fail to fill or refill prescriptions, compared to 40% of those who have better health status and incomes (still not a good statistic!).
·Noncompliance may be the reason that use of drugs for asthma and diabetes is up sharply in hospital emergency rooms.
What do these data mean for those in CME? Major opportunities in China; major opportunities to develop combined physician-patient education programs in the U.S.
Welcome to European Readers
With this issue, we are adding a number of leaders in CME suggested by our associate, Dr. Cees Leibbrandt, former head of the European Accreditation Council of CME. We hope you find the WentzMiller Global CME Newsletter interesting and helpful. Let us know (lew@wentzmiller.org) if you would like back issues, or if you have news for publication. You can also be removed from our list by clicking the button at bottom, or you can forward to others.
·How Doctors Want to Learn -- But Do They Learn?
What do the experts in continuing medical tell us about how doctors learn best? Small groups, interactive learning in multiple media is what we hear. But is that what doctors say? Not many of them. And in any case, how effective are educators in translating research into practice?
·A new survey of 1,000 GPs in the UK by BMRB showed a clear preference for learning from medical journals compared to sponsored meetings or internet/CD forms of education. Publications drew a vote of 33% very useful and 59% quite useful; meetings 21% very useful and 59% quite useful, and internet/CD lagged at less than 10% very useful, 48% quite useful. Results were similar to a 2003 U.S. study by a major pharmaceutical company. The 3,500 respondents, from specialties as well as family practice, rated "a review article in a peer-reviewed journal" highest in ability to influence prescribing habits, followed by original research articles and CME live programs.
·In a much different study in the U.S. (Medical Meetings July 2004), doctors overwhelmingly preferred lectures with Q&A (64%) to any other form of learning. Next was case-based learning (36%), then hands-on interactive learning (26%). Lectures without Q&A were dead last. Journals were not studied.
·It may take 20 years or more -- if ever -- for original research to change practice behavior, according to a new study on translating research to practice (Joint Commission Journal on Quality and Safety 30(5), pp. 235-245).
So what do educators do? Give doctors what they want, even if behaviors don't change? Or give them a format that is based on what works rather than what is preferred? And does anything really make a difference? What's your opinion?
·Progress Toward Harmonizing Medical Education in Europe
Harmonization of scientist training is the theme of the Zagreb Declaration, adopted this spring by representatives of European medical schools. While the conference stressed better use of resources in training future medical researchers, it also built on the expansion of the European Credit Transfer System (ECTS), which provides for exchange of medical school credits throughout Europe.
The Bologna Declaration of 1999 encouraged a compatible system of degrees in undergraduate and graduate education. It also moved a step toward exchangeable modules and credits in postgraduate and lifelong learning. This should result in higher quality in CME across the EU. (Cees Leibbrandt MD)
·Family Physicians Now Have an International CME Certificate
Now there's a truly global CME program for GPs -- the first of its kind to our knowledge. Wonca, the international organization of GP/FP organizations, has announced the Wonca International Certificate in Continuing Medical Education and Continuing Professional Development in Family Medicine. Fortunately, the certificate has a shorter acronym: WIDFM!
The program requires participants to complete 6 out of 8 topics within 3 years:
Women's Health
Stroke
Diabetes Type 2
Palliative Care
Dermatology
Common Cardiological Problems
Hypertension and Heart Failure
Virtual Consulting Room
The last is compulsory, and permits doctors to submit their own cases in areas that may not be covered in "Western" medicine, such as malaria prevention or causes and treatment of diarrhea.
The program is CD based, with video, a pre test, 10 or more case presentations per topic, and a post test. Right now, the program is available only in English and has a tiered pricing system depending on country of residence. See www.globalfamilydoctor.com/widfm/index.htm for details.
·Get a Better Perspective on Your Place in Global CME
If your organization is determining how best to take advantage of the growing trend toward global CME, you can get the help you need from WentzMiller & Associates. The 10 specialists in our group combine more than 1000 years of experience in the field -- and we have contacts in all the world's major markets. Call Lew Miller or Dennis Wentz, or e-mail us today.
Who is paying for continuing medical education? Should CME credits be required of all physicians? What should be accredited: providers or programs? Live programs only? These were among the critical issues addressed at the 9th Annual Meeting of the Global Alliance for Medical Education (GAME) in New York in June, by experts from around the world.
(1) FUNDING: In many countries, from Spain to Sweden to Mexico to Malaysia, the pharmaceutical industry funds from 80- 99% of CME programs, in some cases paying doctors' transportation and meals. There is major emphasis on prescribing in several countries; in Malaysia, for example, 25% of each program is devoted to drug promotion, though the balance of the program is intended to be bias-free. On the other hand, some countries, notably the UK and Norway, fund most CME programs through government subsidy. Doctors employed by the British National Health Service get 10 days of paid study leave per year, and reasonable expenses are reimbursed. In Norway, where the state also funds CME, programs sponsored by industry carry no CME credit points, which are required.
(2) MANDATORY CME The Union of European Medical Specialties (UEMS), which oversees the European Accreditation Council on CME (EACCME), has taken a strong position that CME is an ethical obligation of physicians and should not be mandatory. "it's not effective in weeding out bad apples," says Dr. BErnard Maillet, UEMS Secretary General. Some European countries agree, such as Spain and Sweden. But other member states of the European Union have not supported the UEMS position. UK now has mandatory revalidation, with a CME component. Italy requires continuing education credit for all health professionals. Norway, Austria and several other EU nations also require CME, in some cases only for GPs, not specialists. What about elsewhere in the world? China's Ministry of Health, says Howard Ho of EMD Healthcare Communications, Beijing, requires CME, but mostly for doctors under 50. (Maybe older MDs can't or won't learn?) Mexico is mandating CME for some specialists, and for GPs. Canada is undecided. Malayasia is still voluntary, says Dr. P. Krishnan, head of that country's medical association.
_______________________________________________ _______________________________________________ CONSIDERING A GLOBAL APPROACH TO CME? As this report from the GAME meeting indicates, the CME world can be highly confusing -- and changing rapidly. WM&A is on top of what is happening and ready to guide your organization to avoid missteps. _______________________________________________ _______________________________________________ NEED AN OUTSIDE PERSPECTIVE ON STRATEGIES TO SEPARATE EDUCATION FROM PROMOTION? The principals of WM&A have examined carefully the requirements of ACCME, OIG, FDA and PhRMA, and can provide valubale insights on how to stay out of trouble. _______________________________________________ _______________________________________________ Call WentzMiller & Associates toll free at 888 239-9194, to see how we can help -- through our 2 principals and 8 associates in the U.S., Latin America, Europe and Asia. Ask for Lew Miller or Dennis Wentz.
Want more information?
WentzMiller & Associates, consultants in continuing medical education and continuing professional development, bring you a brief report on the highlights of the GAME meeting in New York in June. You can obtain full copies of presentations by joining GAME at www.game-cme.org, if you are not a member.
·CME Issues at GAME: (3) Accredit Providers or Programs?
In many countries, the CME system is organized by the ministries of health, which dictate the rules for the accreditation system. In Malayasia, for example, the ministry empowered specialty societies to register providers, including government hospitals and 105 specialty bodies,and to issue certificates of participation. Similarly, in the UK, the royal colleges, representing specialties, are authorized to carry out CME.
By contrast, in Italy, in the first 2 years of CME, 200,000 events were accredited, with requests coming from 11,000 providers, says Dr. Alfonso Negri, secretary general of the Italian Council for Accreditation in Pneumology. Dr. Negri himself has accredited over 2,000 programs! But the Italian Commission on CME is now planning to accredit institutional providers later this year. Spain also accredits programs, as does Canada and the EACCME.
·CME Issues at GAME: (4) Accredit Only Live Events?
The debate rages as to whether to accredit anything other than live programs. That is the position of the EACCME and has been the practice in Italy until now. But Spain, Germany, China, Canada and other countries also award credits for the Internet, satellite symposia, print and CD/DVD courses. And Italy, Malayasia and some other nations are examining whether to change the rules.
Part of the concern deals with how doctors learn and how CME results can be measured. In Canada, most GPs prefer to attend large lecture courses, though there is little evidence of effectiveness. The same is true in China and many other venues. But in Scandinavia and the UK, small group learning is much more popular. The value of web-based learning is still being discussed.