CME Spotlight: Restoring confidence
pharmafile | February 25, 2010 | Feature | Medical Communications | CME, CME Spotlight, Eugene Pozniak, ethics
As John Maynard Keynes said: “The long term doesn’t matter very much, because in the long run, we are all dead.”
This memorable line was coined by the famous economist in 1923 and is often misquoted and misinterpreted. It is not the fatalistic shrug of the shoulders it first seems, rather it is a criticism of laissez-faire policies which predicted that economic equilibrium would return of its own accord ‘in the long term’. Keynes was arguing for strong and decisive government intervention.
The popularity of Keynes’ economic theories has waxed and waned in the intervening decades, usually linked to the state of the economy.
In 1978 the quote was seized upon by György Ligeti for his opera Le Grand Macabre, where he ridiculed the political machinery of the day. I was introduced to this biting political parody when it was staged for the first time in London in the early 1980s: a shambolic, demonic, erotic, anti-operatic adventure that revitalised the musical genre for a new generation. It was also fearsomely funny and totally unsuitable for a school boy, as I was at the time.
The line was removed from subsequent revisions of the opera as the statement lost its theatrical impact in the intervening years of economic boom and bust. But we are reminded of it now as Keynesian economics has reappeared with Barack Obama and Gordon Brown looking to solutions to our current economic crisis; one brought about by financial institutions forgetting about the ‘long term’ and crossing the line between bullish optimism to careless profiteering.
One can see a similar kind of crisis in our own field of continuing medical education. The US is now suffering from years of a rather careless approach to CME, with interested parties riding a tide of profits – all within the rules of course – but with poorly upheld controls, be it self-control, or regulatory control and enforcement.
US accreditation body the ACCME is now trying to restore confidence in the system, and deciding just how they will make public information about organisations which have breached their rules.
We have seen how in the past three or four years the number of nationally accredited CME providers has fallen from over 2,000 to fewer than 800, and this number is expected to fall further as more organisations fail to meet the required standards or simply chose to withdraw from CME when their periodic audits for re-accreditation come about. Many of those that are left, are in it for the long term, planning for the future and actively working towards a new approach to CME. They are doing this by embracing the ACCME’s Revised Standards, published in 2006, and looking at more relevant and sophisticated models such as Performance Improvement CME and examining how CME actually affects clinical practice. But it will take time for confidence to be restored.
The CME debate in Europe
The recent conference of the European CME Forum in London demonstrated that in Europe we have enough interest and momentum to proceed with an increasingly coherent and independent approach. The meeting (of which I was one of the organisers) elucidated some interesting points, with ideas being exchanged in a highly discursive and productive environment.
The outputs: abstracts, videos, reports and proceeding are viewable on the website (www.europeanCMEforum.eu) as they become available.
The meeting programme approached CME sequentially, starting with the initial planning stages and the fundamental needs of the learners, moving on to its delivery and then considering the final impact on patient care. A session was dedicated to online learning, with a review of the latest developments in the area of accreditation from the EACCME. Actual examples were presented, as well as a workshop on how to incorporate best practices from adult learning to the e-learning environment. The meeting was reported live on Twitter (using the ‘hashtag’ #2ECF), which nicely demonstrated how this technology can be used to enhance the meeting experience.
The session on event vs. provider accreditation was as lively as expected, as well as exploring the potential benefits of each system with respect to quality and controls. A pragmatic look at how things are currently managed by the CME accreditation bodies is needed, and needs to be reconciled with the growing demand for online education to be accredited. A move to more online learning would generate pressure on the centralised review system – as e-learning becomes a popular and commonplace educational channel for European doctors.
The topic of how pharma supports CME was a recurrent theme over the two days, as all parties considered their appropriate involvement at each stage of the CME process. Whether supporting initiatives that looked at needs assessment, the final delivery, or with their role limited to simply funding programmes, it is now apparent that pharma needs clear rules of engagement. It is interesting to see an overlap in the publication of clinical papers, with many of the same issues addressed in the recent International Society for Medical Publication Professionals’ (ISMPP) updated good publication practice guidelines (GPP2). www.gpp-guidelines.org.
The ABPI’s Andrew Powrie-Smith is leading the UK industry body’s Trust Imperative, and gave an update of the latest findings from the consultation with member organisations. Powrie-Smith is consulting on how the industry can improve and maintain the industry’s reputation among its stakeholders. The initiative clearly demonstrates a desire to build a long-term commitment between the pharmaceutical companies and the healthcare professionals.
These ideas will now be brought into the public arena for further debate, and all aspects of the relationship between pharma and healthcare professionals will be open for review; from the now endangered promotional gifts (such as branded stationery) to the provision of high quality independent education, to what role pharma should play when supporting CPD-approved educational programmes.
Finally, the Good Clinical Practice Group had its inaugural meeting, where a critical mass of education providers (many of which work as traditional agencies in the medical communications arena) – together with support from CME accreditation bodies and some drug companies – came together to discuss appropriate working practices when engaged in CME projects. Some initial ideas were presented and debated on what standards should be required and demonstrated when engaging in CME programmes. This initiative will continue formally in early 2010 with the aim of having a Spring meeting.
There was a positive feeling across the board at the European CME Forum, with people ready and willing to look to the future and to plan for it. The long term does matter, very much.
Eugene Pozniak is managing director of Siyemi Learning and Programme Director of European CME Forum. Email: epozniak@siyemi.org
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