Continuing medical education

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Continuing medical education (CME) is 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. [1] However, critics complain that drug and device manufacturers often use their financial sponsorship to bias CMEs towards marketing their own products.

Contents

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. [2] 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).

Requirements

In the United States, many states require CME for medical professionals to maintain their licenses. [3] Within the United States, CME for physicians is regulated by the Accreditation Council for Continuing Medical Education (ACCME) and the American Osteopathic Association (AOA).

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. [4]

Production of CME courses

Continuing medical education activities are developed and delivered by a variety of organizations, including:

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, or online professional communities. [5]

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 [6] of these certified professionals. As of June 2011, the Registry included 320 professionals.

Criticism of industry sponsorship

Critics, such as Morris and Taitsman, [7] 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. [7] 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. [8]

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. [9] 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. [7]

CMEs also work alongside the medical-industrial complex, which describes the connection between pharmaceutical companies, healthcare corporations, and physicians in creating for-profit healthcare products. [10] Physicians who undergo continuing medical education courses can oftentimes be subject to bias due to pharmaceutical companies and healthcare corporations promoting products throughout the course. [11] This can create poor outcomes for patients, who are oftentimes subject to physician bias and potentially detrimental effects. [12]

Related Research Articles

<span class="mw-page-title-main">Royal College of Physicians and Surgeons of Canada</span>

The Royal College of Physicians and Surgeons of Canada is a regulatory college which acts as a national, nonprofit organization established in 1929 by a special Act of Parliament to oversee the medical education of specialists in Canada.

<span class="mw-page-title-main">College of Family Physicians of Canada</span> Canadian professional organization

The College of Family Physicians of Canada is a professional association and the legal certifying body for the practice of family medicine in Canada. This national organization of family physicians was founded in 1954 and incorporated in 1968. Although membership is not mandatory to practice medicine, it currently numbers over 38,000 members. Members of the CFPC belong to the national College, as well as to their provincial or territorial chapters. The CFPC uses both English and French as official communication languages.

<span class="mw-page-title-main">Medical education in the United States</span> Educational activities training physicians in the United States

Medical education in the United States includes educational activities involved in the education and training of physicians in the country, with the overall process going from entry-level training efforts through to the continuing education of qualified specialists in the context of American colleges and universities.

The American Board of Medical Specialties (ABMS) is a non-profit organization established in 1933 which represents 24 broad areas of specialty medicine. ABMS is the largest and most widely recognized physician-led specialty certification organization in the United States. The other certification organizations in the United States are the American Board of Physician Specialties and American Osteopathic Association Bureau of Osteopathic Specialists.

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The University of Cincinnati Academic Health Center (AHC) is a collection of health colleges and institutions of the University of Cincinnati, Cincinnati, Ohio. It trains health care professionals and provides research and patient care. AHC has strong ties to UC Health, which includes the University of Cincinnati Medical Center and West Chester Hospital.

The Accreditation Council for Continuing Medical Education (ACCME) sets and enforces standards in physician continuing education within the United States. It acts as the overseeing body for institutions and organizations providing continuing medical education (CME) activities. The Council's seven founding member organizations are the American Board of Medical Specialties (ABMS), the American Hospital Association (AHA), the American Medical Association (AMA), the Association of American Medical Colleges (AAMC), the Association for Hospital Medical Education (AHME), the Council of Medical Specialty Societies (CMSS), and the Federation of State Medical Boards (FSMB). These organizations established the ACCME in 1981. The ACCME sets standards and certifies that institutions and organizations meet those standards. "CME credit" is part of special programs offered by other organizations and is not the purview of the ACCME. The ACCME's mission is to provide those in the medical field with opportunities to maintain competence and learn about new and developing areas of their field. A voluntary self-regulated system and a peer-review process are used to regulate and accredit medical education providers.

A fellowship is the period of medical training, in the United States and Canada, that a physician, dentist, or veterinarian may undertake after completing a specialty training program (residency). During this time, the physician is known as a fellow. Fellows are capable of acting as an attending physician or a consultant physician in the specialist field in which they were trained, such as internal medicine or pediatrics. After completing a fellowship in the relevant sub-specialty, the physician is permitted to practice without direct supervision by other physicians in that sub-specialty, such as cardiology or oncology.

In Canada, a medical school is a faculty or school of a university that trains future medical doctors and usually offers a three- to five-year Doctor of Medicine (M.D.) or Doctor of Medicine and Master of Surgery degree. There are currently 17 medical schools in Canada with an annual admission success rate normally below 7.5%. As of 2021, approximately 11,500 students were enrolled in Canadian medical schools graduating 2,900 students per year.

The basic requirement for pharmacists to be considered for registration is often an undergraduate or postgraduate pharmacy degree from a recognized university. In many countries, this involves a four- or five-year course to attain a bachelor of pharmacy or master of pharmacy degree.

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The American Osteopathic Board of Neurology and Psychiatry (AOBNP) is an organization that provides board certification to qualified Doctors of Osteopathic Medicine (D.O.) and physicians who specialize in disorders of the nervous system (neurologists) and to qualified Doctors of Osteopathic Medicine and physicians who specialize in the diagnosis and treatment of mental disorders (psychiatrists).

<span class="mw-page-title-main">American Osteopathic Board of Anesthesiology</span>

The American Osteopathic Board of Anesthesiology (AOBA) is an organization that provides board certification to qualified Doctors of Osteopathic Medicine (D.O.) and physicians who specialize in the administration of anesthetic agents and perioperative medicine (anesthesiologists). The board is one of 16 medical specialty certifying boards of the American Osteopathic Association Bureau of Osteopathic Specialists approved by the American Osteopathic Association (AOA), and was established in 1956.

The American Association of Clinical Endocrinology (AACE), formerly known as the American Association of Clinical Endocrinologists, is a professional community of physicians specializing in endocrinology, diabetes, and metabolism. AACE's mission is elevating clinical endocrinology to improve global health. The association is headquartered in Jacksonville, Florida, US.

The American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) is a medical society for the medical subspecialty of neuromuscular and electrodiagnostic medicine based in the United States. Members are primarily neurologists and physiatrists—as well as allied health professionals and PhD researchers.

<span class="mw-page-title-main">Medical–industrial complex</span>

The medical–industrial complex is a network of interactions between pharmaceutical corporations, health care personnel, and medical conglomerates to supply health care-related products and services for a profit. The term is a product of the military–industrial complex and builds from the basis of that concept.

The American Board of Pathology (ABPath) is one of 24 member boards of the American Board of Medical Specialties. This organization was assembled in May 1936, under the approval of the Advisory Board for Medical Specialties (ABMS) and the American Medical Association (AMA) Council on Medical Education and Hospitals. It is the duty of the ABPath to grant certification in Anatomic Pathology, Clinical Pathology and/or Anatomic/Neuropathology to qualified Doctors of Medicine and Doctors of Osteopathic Medicine (M.D./D.O.).

<span class="mw-page-title-main">Physicians in Canada</span> Canadian physician

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References

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  5. Trentin G. (Ed) (2014). Network-Based Continuing Medical Education: Social Media and Professional Development. Nova Science Publishers, Inc., Hauppauge, NY, ISBN   978-1-63117-346-2. https://www.researchgate.net/publication/260311473_Network-Based_Continuing_Medical_Education_Social_Media_and_Professional_Development/
  6. "Welcome to www.nccme.org". National Commission for Certification of CME Professionals, Inc. Retrieved 2013-06-28.
  7. 1 2 3 Morris L, Taitsman JK (December 2009). "The agenda for continuing medical education—limiting industry's influence". N. Engl. J. Med. 361 (25): 2478–82. doi:10.1056/NEJMsb0905411. PMID   20018969.
  8. Institute of Medicine, Conflict of interest in medical research, education, and practice. Washington, D.C., National Academies Press, 2009.
  9. Warner-Lambert to pay $430 million to resolve criminal & civil health care liability relating to off-label promotion. Press release of the U.S. Department of Justice, Washington, DC, May 13, 2004.
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