This issue is coming at a later date than usual in order to include coverage of mid-November meetings in China and Europe. We also want to welcome a new group of recipients from Asia, courtesy of Dr. Saurabh Jain of Indegene, India. Back issues of the newsletter are available at www.WentzMiller.org.
Some 1000 Chinese, mostly physicians, plus 4 Americans, 2 Europeans and 1 Canadian, attended the First China International CME Conference, held in mid-November in Beijing, Commented Dr. Alfonso Negri of Italy, one of the Europeans and a WentzMiller associate: "Apparently there was little if any discussion of CME until now. Now everybody talks CME!"
CME in China is now mandatory for 6 million doctors, requiring 25 credits a year -- 10 in live events, 10 in self directed learning and 5 for medical journal reading and peer review. The system, part of China's 13th "5-year plan", is controlled by the Ministries of Health and Education, but most of the funding comes from pharmaceutical company grants. (One US attendee was Maureen Lloyd of Pfizer, which is actively engaged this year in global CME grants through US accredited providers.)
Non-Chinese presentations were made by 2 US co-sponsor leaders: Dr. Murray Kopelow of the Accreditation Council for CME, and Jann Balmer, president of the Alliance for CME, and by Dr. Stefan Lindgren of Sweden, president of the World Federation for Medical Education. A number of Chinese leaders of scientific societies and academic institutions described their CME work in medical schools and provinces, where primary care physicians are being trained. An announced objective of the conference was to promote cooperation; it is not clear yet whether this goal will be accomplished.
Localized primary care is being emphasized more than ever in China, which had gone through a a period of proliferation of specialists and a shift to urban facilities. An article in BMC Family Practice describes a joint Canadian-Chinese program to develop the Chinese CHS (Community Health Facilities and Services) Logic Model to strengthen primary care through use of 287 detailed performance indicators to measure activities and outcomes.
Improving CME standards was a major focus of the European CME Forum (ECF) at its mid-November meeting, reports Dr. Alfonso Negri, who traveled from Beijing to Berlin to participate. The work of the Good CME Practices Group parallels what Dr. Negri's Rome CME/CPD Group has done in the past 5 years from the point of view of accreditors, he said. Attendee Karen Overstreet, of the US-based Lippincott CME Institute, felt that the standards in Europe mirror where the US was 10-15 years ago.
European urology leaders are encouraged by participation in pre and post-knowledge evaluation
A battle between the Union of Bulgarian Medical Specialties and the Bulgarian Medical Assn. for control of CME has been resolved, with both groups playing a role
German state accrediting organizations are have their problems in timely credit reporting and other elements of CME
The role of patients in the CME scene has been the subject of considerable debate in the UK
Spain is moving to periodic validation of physician registration, a first in continental Europe
Additional challenges to European CME came at the MedCommns Strategic Forum 2010 held at Oxford University a few weeks earlier, reports Dr. Thomas Kellner, group med ed leader at MSD. The Union of European Medical Specialties (UEMS), he said, is planning major changes to accreditation and commercial support:
Only programs that are funded by multiple sponsors will be eligible for accreditation
New UEMS/EACCME standards will require that providers offer programs either in accredited CME or promotional med ed -- but not both
Provider accreditation, rather than program accreditation, is a likely major change
That's the title of a provocative article just published in Minnesota Medicine. The authors, both at the University of Minnesota Academic Health Center, argue that the existing CME system in the US needs to be redesigned "to better address patient care and quality improvement challenges".
Health professionals need to assume greater responsibility for assessing and meeting their own learning needs, say the authors. The primary role of CME providers should shift from putting on programs to becoming "consultants and facilitators who support physicians as they create and implement their lifelong learning plans". That's the direction of reforms currently underway in Canada and the UK.
A study of physician-industry relationships from 2004-2009 shows a decline among US primary care physicians and specialists, report the authors in Archives of Internal Medicine. Relationships were still high, however, at 83.8% of doctors replying, with drug samples and food and beverage most prevalent.
Participation in speakers' bureaus, a subject of much media criticism, dropped from 16%% to 8%, and the level of doctors reimbursed for meeting travel declined from 35% to 18%. In an interview, one author, Dr. Eric Campbell of Harvard, was quoted: "I think there is a dawning belief that academic physicians should not be part-time drug salesmen."
1 A poll by Photosound, a British agency, has found that global healthcare exhibitors will focus more on providing clinical discussion that sales and promotion in the future, Staffing will shift from sales reps to medical staff, to give healthcare providers more value based on scientific information. And 56% of those surveyed expect a drop in budgets over the next 5 years.
2 Another survey, by PCM Scientific, surprisingly reflects eCME in Europe as the second least important source of learning, just above nonaccredited meetings. Accredited CME conferences ranked first, followed by interaction with peers. But looking ahead, the eCME ranking is likely to move upward fast. The forecast is for 50% of CME to be delivered online in Europe by 2016, compared to 9% in 2008.
3 Once again, scandal in the Indian Medical Association (IMA). Says Dinesh Sharma, writing in the Nov. 25 Daily Mail tabloid: "The rot in the country's medical system appears to be deep-rooted." You may remember that the former head of IMA went to jail for corruption -- after proposing (unrelated) a major CME system which hasn't happened. Now the official Medical Council of India (MCI) has urged IMA to scrap its high-fee endorsement of PepsiCo India and Dabur products -- which were never evaluated, and has also suspended the right of the IMA president and general secretary to practice medicine for a period of 6 months. What next?
The difficulty of achieving a global approach to CME is pointed up vividly in a recent report on pharmaceutical company practices in Europe vs North America, presented by Best Practices LLC. Highlights of the report follow, including quotes from respondents:
The average staff supporting medical education functions is twice as large in North America as it is in Europe. "In Europe, there are almost no PhDs in continuing medical education."
About 24% of CME supported in North America is on the web vs 11% in Europe. "Cost-effective way to reach a large audience."
Level of regulation is much higher in US than in Europe. "Europeans do not have a clue about US regulations and try to force their US affiliates to do things which are illegal."
Twice as many European managers (39%) rated dinner meetings as highly effective CME; only 19% of North American managers agreed. "These are effective when evidence-based, interactive and provide opportunity for reflection and discussion."
The majority of benchmark companies do not utilize a globally centralized function for CME management or oversight. Companies employing such centralized structures report significant impact through increased leverage of budgets and headcount. However, decentralized structures are more typical -reflecting the rapidly evolving CME marketplace and need to reflect local market requirements.
The American Medical Assn. (AMA), which awards CME credits for US physicians, is strengthening its recognition that performance change is an important part of CME. In its new edition of the Physician's Recognition Awardmanual, the AMA is requiring CME providers to certify activities in a new manner, effective July 2011:
** An enduring material activity must measure the achievement of the learner with an established minimum performance level, for example, through pre- and post-tests, patient management cases or simulations. Enduring materials include those in print, audio, video, internet, etc.
**A Performance Improvement (PI) activity must assure content integrity of the selected performance measures and must validate the depth of physician participation. PI is a 3-stage process in which physicians assess their practice against specific measures, identify areas for improvement, and measure the improvement. A physician can earn up to 20 credits for a PI activity.
A new benefit to physicians: Specialty certification or recertification now carries 60 credits instead of 25. Since this is not an annual process, it probably won't be a major incentive!
A representative of the Chinese Health Ministry CME office appeared last January at the annual meeting of the Alliance for CME. Now the China National Continuing Medical Education Committee has announced its first conference "to strengthen international communication and cooperation in the field of CME", to be held in Beijing November 12-14.
The event is co-organized by several Chinese medical schools and the Chinese Medical Assn. Liu Qian, vice minister of health of China is the chair. Co-chairs include Jann Balmer, president of the Alliance, Murray Kopelow, chief executive of the US Accreditation Council for CME, and Stefan Lindgren, chair of the World Federation for Medical Education.
Two recent studies point up the effectiveness of Internet CME by comparing the performance of physicians who participated online with those who didn't. In each case, the web students did better.
In an online article in BMC Medical Education, the authors sought to determine the effectiveness of 114 Internet CME activities. They administered case vignette-based surveys to US practicing physicians immediately following participation and to a representative control group of non-participants. Online participants, they reported, were more likely to make evidence-based clinical choices than non-participants.
"Is physician engagement with web-based CME associated with patients' a1c levels?" That's the question answered in another study published in Academic Medicine. The authors found that physicians in practices in the worst quartiles of a1c control among diabetic patients were those physicians who were least engaged in the study website. Physicians with better control levels viewed 1.13 times more pages.
1 The Cleveland Clinic and the American University of Beirut have signed an agreement to collaborate in the development of a large-scale CME initiative in Beirut. Programs will be eligible for AMA Category 1 credit. In addition, Cleveland Clinic is providing credit to British Medical Journal readers who read a research article focused on a clinically relevant topic, and take a followup test.
2 Now accredited CME programs can include oral or written presentations of scientific research conducted by commercial interests and presented by employees of those interests, according to a recent clarification by the Accreditation Council for CME. The ruling came after major specialty societies protested what they considered was a ban on presentations of research by those who conducted the research -- if they worked for a pharma company.
Ukraine is starting a mandatory system of CME for both specialists and GPs/FPs, according to Oleksii Korzh, head of the department of general practice-family medicine at Kharkov Medical Academy of Postgraduate Education. Over a 5-year period, doctors must accumulate points from courses, conferences and submitting papers.
We have consulted with pharmaceutical companies, medical education companies and medical specialty societies regarding their plans for international activities. We welcome your inquiries. Contactlew@wentzmiller.org or email@example.com.
Listening to the myriad of presentations at the annual meeting of the Global Alliance for Medical Education (GAME) in Montreal last month, one might have wondered if the approaches to continuing education of doctors around the world had anything in common -- except for a desire to improve care of patients.
In Canada and the US, speakers discussed the move toward performance improvement (PI) CME (see April-May issue of this newsletter) as the most critical factor in the field. Can providers learn how to restructure their offerings to put the end (PI) first, as CME guru Don Moore says, GAME participants from around the world seemed fascinated by these discussions, but ...
There are many miles to go in Asia and Latin America -- and even in Europe -- before CME providers and doctors are ready to accept a new paradigm. Many countries are still struggling to have an organized CME system (India, for one). Others are debating whether to make CME mandatory, recognizing that doctor participation is poor in a voluntary system. The hierarchical nature of the culture in Asia leads to didactic learning in live courses. Use of the internet is slowly changing that. But the goal in most countries is still earning credits, not changing performance or patient outcomes.
Nonetheless, the content of the GAME session, focused on innovation, opened the eyes of many. Participants interacted in a session on collaboration, fascinating because several of the examples were of US providers working in the Mideast (where the money is better?). Presenters on mobile learning, social media and simulation offered exciting insights into new technologies.
Will the nations and providers come together into a harmonious mosaic, or continue to go their own way? GAME and other organizations (eg the Rome Group) are supporting the former. Join GAME and gain access to most of the presentations.
"How can European CME evolve from its current state?" asks Thomas Kellner MD, global CME leader at Merck, writing in Continuing Medical Education in Europe: Revolution or Evolution? The report analyzes the current status and issues of European CME, and Kellner offers as a conclusion "10 Steps to Evolve CME in Europe".
"A critical factor for success ... is its recognition in public and the professional community," he notes. One step, closely related to the discussions at GAME, recommends introducing "measures related to performance improvement (PI) instead of learning hours." Unfortunately, as another author, Herve Maisonneuve MD, points out, "PI cannot be funded by pharma industries in France when other CME activities can be." In a call for action, Eric-Jean Desbois, head of the company publishing the report, said: "There is a pressing need for more research in the field of evaluation methods" of CME, including testing of models.
As expected, the 2009 analysis of CME activity from the US Accreditation Council for CME showed a continuation of the 2008 decline in commercial support, from 47.5% in 2007 to 39% in 2009. And support from other sources (registration fees, organization support) was also down -- though slightly. Suffering most were professional associations, whose commercial support dropped by 24.7% from 2008, and medical education companies, down by 21%. Medical schools fared better: down about 6%.
The number of CME activities declined, though the number of participants was up slightly, in part because of a sharp increase (85%) in use of internet CME enduring materials (not live presentations). As Tom Sullivan, president of Rockpointe and publisher of the Policy and Medicine blog, comments: The overall decline in funding and activities appears to be a trend that "is especially troubling, considering doctors will need more CME in light of 30 million more people being added to our health care system". [Chart courtesy of Policy and Medicine]
Contrary to the firewalls being erected in the US, Canadian leaders in medical schools and in the Canadian Association of Continuing Health Education (CACHE) are working actively with industry to create guidelines for collaboration. At the CACHE annual meeting this past May, Dr. Bob Bluman, assistant dean of CPD at University of British Columbia, reported that the task force he chairs favors a continued working relationship with industry, with a focus on improved physician performance and better patient outcomes.
Among the recommendations of the group are to seek multiple supporters and to require that physicians pay a learning fee to attend a program. The plan is to establish a CME expert working group including industry, said Bluman. A CACHE position paper on the same topic indicated a need for a balanced approach to CHE involving clinical practice, academia and industry. CACHE, the paper said, "does not adhere to" the positions taken in the US by the Macy Report, the Institute of Medicine report or the report of the Council on Ethical and Judicial Affairs of the American Medical Assn., all of which call for an end to commercial support of CME.
1 -Latest chapter in the continuing saga of the head of the Medical Council of India, now under investigation for a medical scam: The Health Ministry of India is dissolving the council and replacing it with a doctor panel to function until a new law is passed. Plans for a CME system presumably are on hold.
2- At a recent conference in Washington DC, addressing the question, "Should industry fund CME?", a US Senate staff investigator "bluntly told docs to get off their supercilious 'Who, me?' attitude and come to grips with ... conflicts of interest ... that more often than not have been to the detriment of their patients."
3- For the 4th time, the American Medical Assn. House of Delegates has referred a report on "Financial Relationships with Industry in CME" back to its highly regarded Council on Ethical and Judicial Affairs (CEJA) for "further study", even though a reference committee recommended its adoption. The CEJA report recommended an end to industry support of CME -- or at least substantial restrictions on such support. Testimony cited a lack of compelling evidence to support the contention that industry funding leads to bias in CME, reports MeetingsNet.
From the Far East to the Mideast to the West, the growing topic of the day in CME/CPD is performance improvement CME (PI-CME). We have been able to demonstrate knowledge gains from courses, but evidence that the knowledge gains resulted in improved physician performance and improved patient outcomes has been much less available. The pressure is growing on program organizers to emphasize outcomes. Here are some examples.
International Forum on CPD Accreditation, Sydney Some 70 leaders of national accreditation systems accepted the principle that "CME/CPD systems are expected to produce enhancements not just to the knowledge and skills of physicians but to their actual performance in practice, either as an individual or member of a healthcare team," reported Dr. Alfonso Negri of Italy, an attendee and a WM&A associate. Participants were from Asia, Australia/New Zealand, Canada, UK, Italy, Ireland, South Africa and the Mideast. Is it likely that any national accreditation body will impose such requirements?
UK moving in that direction The current appraisal system in the UK is an annual compulsory requirement, and allows clinicians to identify developmental needs and chart progress in order to improve performance. In a recent survey by Finlay and McLaren, many GPs considered that the appraisal process was working. 48% reported it had enhanced their learning, 40% that it had improved their practice and 56% that it had encouraged their CPD.
PI CME efforts in the US The Conjoint Committee on Continuing Medical Education (CCCME), a group of 16 major organizations, has set a 2010 priority to integrate PI into CME, that is, measuring physician practice performance, delivering targeted educational interventions, and re-measuring performance. Dr. Norman Kahn's article in the Winter 2010 issue of the AMA CCPD Report notes that already one member organization, the American Board of Medical Specialties (ABMS), has accepted the PI-CME framework for board recertification programs. And one state, Colorado, recently considered a bill (not passed) requiring all physicians to either go through board recertification or a performance-based metrics program approved by the state board of medical examiners.
Iran promotes CME to improve performance In a recent articlein Journal of Continuing Education in the Health Professions, HM Esmaily et al state: "Since making CME compulsory for all physicians ... in 1991, Iran has been working to meet the demands of appropriate education to improve performance." The authors describe a randomized trial demonstrating that an outcomes-based educational approach can improve rational prescribing among GPs. Those who participated in interactive, learner-centered programs reduced the mean number of drugs per prescription and improved their explanations of precautions compared to a control group who attended didactic programs.
Frequently not! "Uptake of knowledge does not occur with simple dissemination and usually requires a substantive, proactive effort to encourage use at the point of decision-making," say the Canadian and French authors of a recent analysis. Clinicians may lack the expertise to implement a recommended action, may feel it doesn't apply in their practice setting, or may not have available the equipment or therapeutic alternatives necessary.
The authors recommend evaluating and customizing an existing guideline to meet local or regional circumstances. There is an international initiative, known as the ADAPTE collaborative, that has developed a process for adaptation leading to increased use.
The ADAPTE framework is based on the following core principles:
Respect of evidence-based principles for guideline development;
Reliable and consistent methods to ensure the quality of the adapted guideline;
Participation of key stakeholders to foster acceptance and ownership of the adapted guideline;
Explicit consideration of context to ensure relevance for local practice and policies;
Transparent reporting to promote confidence in the recommendations of the adapted guideline;
Flexible format to accommodate specific needs and circumstances;
Respect for and acknowledgement of source guidelines material.
1 In our last issue, we featured Dr. Ketan Desai, president of the Medical Council of India, speaking in favor of a new code of medical ethics banning physicians from accepting gifts. The tables have turned. Dr. Desai and an associate were arrested in late April on charges of corruption, accused of demanding a bribe for granting MCI recognition to a private medical college.
2 Two major CME meetings are coming up this spring: GAME, the Global Alliance for Medical Education, meets in Montreal, for its 15th annual meeting, June 6-8. The theme is: "Innovation in CME," with speakers from Europe, North America, Asia and Latin America. The Guidelines International Network (G-I-N) Conference 2010, will be held August 25-28, 2010 in Chicago, Illinois (USA). The theme is Integrating Knowledge, Improving Outcomes.
3 The US Council of Medical Specialty Societies (CMSS) has released a Code for Interaction with Companies, covering conflicts of interest, financlal disclosure, independent program development and independent leadership. The goal is to encourage member societies to maintain an arms-length relationship with industry.
Pharmaceutical companies and some doctors in India are in a state of panic over a new code of medical ethics that bans physicians from accepting gifts, including travel and grants for attending CME meetings. The regulations were passed in December 2009 by the Medical Council of India (MCI) and sanctioned by the Indian government. And Dr. Ketan Desai, MCI president, has urged the health ministry to pass legislation "restraining pharmaceutical companies from these types of activities".
The press has had a field day exploiting violations of the new regulations governing professional conduct. Hindustan Timesreported that "Primal Healthcare took 200 doctors from India to Istanbul for a diabetes conference. Dr. Reddy's Laboratories paid for the travel and hospitality of another 200 in Hyderabad".
Under the headline "My name is BRIBE", an article in the Ahmedabad Mirror stated that Emcure Pharma took doctors and their families to a free movie screening; the company denied this and a manager claimed the event was sponsored by him. In another article, Dr. Desai was quoted as saying: "A friend who owns a pharma company ...told me that the MCI had made things difficult by banning gifts. ... they were paying doctors by check but would now have to do that in cash."
There appears to be no penalty if doctors violate the code, which is another reason there is pressure to regulate pharma. And the controversy comes just as the MCI is getting ready to propose a mandatory CME law by year end.
"European healthcare stakeholders can, and must, learn from mistakes made in the USA when developing a robust framework for CME in the region," says theExecutive Summary of the 2nd annual meeting of the European CME Forum, led by Eugene Pozniak. "The future of European CME will depend on how its stakeholders come together and interact," echoes a FirstWord Dossier just published.
Who are these stakeholders, and what must they do? Certainly they include the medical specialty societies, who produce most of the CME -- with or without commercial education company help. They include the National Authorities, who serve as the regulators of what credits are acceptable -- if credits are required. They include the specialty accreditation boards (ESABs) and the European Accreditation Council for CME (EACCME). Certainly the physicians and their patients should also be considered stakeholders. Considering these disparate forces, the FirstWord authors concluded: "European CME may become more dictatorial (i.e., strictly enforced mandatory CME with ... punitive measures for those failing to comply...), or more democratic, needs based, and controlled by the learners with guidance from the regulators."
Is the pharmaceutical industry a stakeholder? The report of the European CME Forum says: "CME without industry support is impossible -- but pharma needs to increase its engagement with CME and understand how it can be used to provide greater value to its customers" by taking on "greater responsibilities as educators".
These are serious challenges for a region with so many stakeholders and no central organization (other than EACCME, whose role is limited) to help develop some central guiding principles. The "mistakes" in the USA depend on definition. Some would say the whole accreditation system, based on very tight rules for providers, is at fault. Others would blame the pharma companies for abuses of education as promotion. Despite these problems, there is a level of uniformity to the US CME system that is lacking in Europe. Who will step up to remedy this?
Italy and the state of Bavaria, Germany, are developing new rules that apply principally to accrediting online learning for physicians. Italy is testing a system of accrediting providers instead of programs -- only for eCME, and the Bavarian Chamber of Physicians has evolved a new contract of cooperation with providers that applies only to eCME (and print).
In Italy, the Health Ministry no longer manages the CME system; it has been turned over to AGENAS, the national agency for regional health services, a body that sits between the Health Ministry and regional health systems. And starting in January, AGENAS is following a provider accreditation model for distance learning only, reports Dr. Alfonso Negri, a WentzMiller associate. He says the idea is to reduce dramatically the number of providers from about 12,000 to 1,000, because of strict new requirements. The annual fee for accreditation of a provider is about $3,500 -- but in addition a fee of the same amount or more is charged for each course, depending on the number of credits and participants. In contrast, the US Accreditation Council charges $8,500 for pre-application and initial accreditation, and $2,500 annually. But there is no course fee.
In Bavaria, the new contract of cooperation requires the provider of online or print CME to have two independent experts as content reviewers, and to set "adequate fees" for the learner if there is no outside sponsor, such as a pharmaceutical company. As yet, there is no guideline regarding the amount of the fee -- it could be as low as $7 per CME credit. The provider must also sign a declaration identifying any sponsors and affirming that there are no conflicts of interest, according to Dr. J. W. Weidringer of the Bavarian chamber.
1 We welcome back as a WentzMiller Associate Dr. Herve Maisonneuve of Paris, where he is associate professor of public health, quality assessment and medical information at Paris Sud 11 Medical School. He is immediate past president of GAME, and active in CME leadership in Europe. Dr. Maisonneuve took a brief sabbatical from our group when he served as medical education director for Pfizer France.
2 Two major CME meetings are coming up in Canada this spring: CACHE, the Canadian Assn. of Continuing Health Education, meets April 28-30 in St. John's Newfoundland. The theme is "Linking CHE to Educational Outcomes -- Closing the Loop". Then GAME, the Global Alliance for Medical Education, also takes participants to Canada -- this time, Montreal, for its 15th annual meeting, June 6-8. The theme is: "Innovation in CME," with speakers from Europe, North America, Asia and Latin America.Registration available on each site.
3 There are opportunities around the world -- but especially in China -- for globally oriented CME providers to improve health and reduce healthcare costs in managing diabetes. The need was emphasized in two recent articles in the American Journal of Managed Care. The first points up the effectiveness of a comprehensive disease management program. The second notes that China is suffering from a runaway epidemic of diabetes, affecting almost 8% of the population compared to 5% around the world. Too many Chinese diabetics wind up in high cost tertiary care hospitals when with better primary care, complications -- and costs -- could be greatly reduced.
There is substantial disparity among systems of CME in Europe in their recognition of the link between CME and Performance Improvement (PI). As reported in our November issue, the French, in their still-nascent plan, have a strong emphasis on practice audits, though not clearly linked to CME. The British see this as part of continuing professional development (CPD) in their revalidation effort. As noted in the article below, the Germans stay away from "improvement" and talk about quality "assurance". The Italian and Spanish systems, the first mandatory, the second voluntary, have no defined PICME programs.
Now the Rome CME-CPD Group, an informal organization of CME leaders in Europe and North America, are encouraging development of PICME. In a presentation at the European CME Forum in November 2009, Alfonso NEgri MD, secretary general, said, "Ideally CME programs should have the following Performance Improvement mechanism":
A relevant needs assessment
Pre-evaluation of physician knowledge or competency
Evaluation mechanism of knowledge/competency gained
Clear separation of funding organizations from the CME activity
Indpendent peer review process to verify quality, freedom from bia
System for assessing and managing conflict of interest
Clear process of assessing the results of activities
In the U.S., PICME is slowly gaining acceptance, in part because the Federal agency that pays physicians for Medicare services to patients offers a bonus to those who participate in a program of reporting performance data -- not improvement -- on groups of patients by diagnosis. The government may decide in the future to require improvement measures as well, but that hasn't happened yet.
In an exciting news item from Islamabad, a consultation group, including the Federal Ministry of Health,the Pakistan Medical & Dental Council (PMDC), and WHO, has recommended setting up an "apex body" at PMDC to formulate rules, regulations and accreditation of CPD programs. PMDC has decided to implement the program, probably within the next year.
Among the recommendations are that departments of medical education should be established at medical universities and institutions, that a monitoring and evaluation system should be established, and that institutions allocate funds to support the CPD activities. Prof. Rashid Jooma, director general of health, is spearheading the program, which had been proposed previously in a paper by Prof. Zarrin Seema Siddiqui of the University of Western Australia.
Meanwhile, Nigeria is struggling to implement a CME system developed in 2007. Each medical doctor must obtain 40 credit units in 2 years to qualify for the issuance of a license to practice; failure will result in "appropriate sanctions," according to an article in the Journal of Continuing Education in the Health Professions. However, the authors say the program has not taken off, and licenses are being issued to doctors who don't have the required credit. The problem, they suggest, may the "centralization of coordination by the Medical and Dental Council of Nigeria."
Engaging presentation, peer communication and informal support -- all were important characteristics of e-learning, according to a review of studies among UK physicians and other health professionals. The article in Journal of Continuing Education in the Health Professions offered some fascinating findings:
"Learners who perform less well in a traditional face-to-face learning environment may gain confidence from the time for reflection offered by ... asynchronous discussion groups and on-line group work."
"The ongoing moderating and supporting role" of a tutor enhances "information sharing and reciprocal learning" if the tutor is appropriately trained.
"Use of a variety of [presentation] techniques ... offers 'authentic learning', in which the learning experience is inseparable from the learn's professional reality."
A research report from Best Practices LLC notes that eCME is responsible for delivering 24% of CME content in the U.S. and 11% in Europe. Younger physicians, the report says, are more open to receiving eCME and eventually will increase the market dramatically. And by offering presentation variety, as suggested in the paragraphs above, the learner can enter at his/her appropriate place on the "spectrum of readiness-for- behavioral-change".
1. The term "quality improvement" is not used widely, say the authors of a analysis on "Revalidation of the Medical Profession in Germany", because it is "a notion that would acknowledge failures and weaknesses, runs against professionals' self-image and the public's expectations concerning medical providers." Instead, we "assure" quality, they said, based on the assumption "that quality is already good or excellent." Carrot better than the stick?
2. Pfizer recently has taken 2 steps to dramatically change its image in the funding of CME. First came the report that Pfizer Canada would provide $780,000 to fund new CME programs of the Canadian Medical Association, designed to inform physicians of new developments in medicine. Pfizer would have 2 persons on a board of 6 overseeing the program. A month later, Pfizer USannounced it was making a $3 million grant to Stanford University with "no say on how the 3-year grant would be spent." Makes one wonder what Pfizer's global CME grant policy really is.
3. Should physicians be required to take courses in cultural competency? The state of Connecticut says so. Effective in October, all doctors must get CME credits in cultural diversity to maintain their licenses. The mandate was the result of a survey that indicated that physicians in the state believe that such training would help them deliver better care to patients with diverse backgrounds. Results to be reported!
SEARCHING THIS SITE: PRESS CONTROL F AND ENTER YOUR SEARCH TERM. YOU CAN SEARCH ANY SECTION LISTED TO THE LEFT, ONE SECTION AT A TIME.