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CME: The "Third Phase" of a Doctor’s Education

Editor-in-Chief, The Oncologist
Clinical Director, Massachusetts General Hospital Cancer Center, Harvard University, Boston, Massachusetts

In an editorial published in the European Journal of Cancer, Dennis Wentz, the American Medical Association’s Director of Continuing Physician Professional Development, described Continuing Medical Education (CME) as the third phase of a doctor’s educational process [1]. Yet that process is coming increasingly under fire from critics like Dr. Arnold Relman, Editor-in-Chief emeritus of The New England Journal of Medicine, and Professor Emeritus of Medicine at Harvard Medical School. Dr. Relman published an article in The New York Times charging that CME programs financially underwritten by industry are actually thinly disguised marketing ploys that undercut physicians’ ability to independently choose appropriate treatments for their patients [2].

Physicians and industry have a shared interest in advancing medical education. Oncologists in particular, operating as we do on the front lines of applied science, are eager for knowledge about the latest advances in diagnostics and treatments to benefit our patients. Much of that information is rapidly disseminated through medical journals, symposia, and CME courses, and many of those CME courses are supported by industry. In 2002, for example, the Accreditation Council on Continuing Medical Education (ACCME) reported that manufacturers of Food and Drug Administration-regulated products were the source of $720 million in income for ACCME-accredited providers [3].

That in itself is not inappropriate—as long as that information is delivered under stringent guidelines. ACCME guidelines clearly state that commercial supporters may not control the planning, content, or execution of the CME activities of the accredited provider. Industry speakers, whose relationships with manufacturers are required to be disclosed, can be a valuable resource for information. Commercial support must be acknowledged and no promotional materials may be displayed or distributed in the same room immediately before, during, or immediately after an educational activity [4]. For CME that is made available online, as is the case with The Oncologist CME Online, banner ads are banished from the entire CME Website.

As an occasional participant and attendee, I am impressed by the excellence of properly accredited and run CME courses, by the speed with which physicians in the cancer field incorporate new advances into their practice, and by physicians’ understanding of the pros and cons of new approaches. Contrary to Dr. Relman’s assumption, most CME courses I have attended present a reasonably balanced discussion of alternatives, and the oncologists in attendance are notably capable of making independent judgments.

Can the CME process be improved? Certainly. Adherence to guidelines can be strengthened to ensure that all CME providers meet the criteria outlined for the third phase of a doctor’s continuing education—a critical element in advancing physicians’ access to timely, new information that directly translates into better patient care. Third party CME course certification from the National Institutes of Health (NIH), for instance, or from other "neutral" parties could also be helpful. The Oncologist CME Online is proud to have the NIH as a joint sponsor of our CME accreditation. Further guidelines could also be developed for assessing the quality and balanced nature of presentations at courses. Companies should be held accountable for excesses in supporting events that emphasize entertainment and travel, rather than meaningful education.

Such improvements would enhance and protect a system that is already critical to benefiting cancer patients, without eliminating commercial sponsorship that makes such educational opportunities possible. Dennis Wentz had it right when he recognized that CME is the important third phase of a doctor’s education.

REFERENCES

1. Wentz D. Lessons from comparing CME accreditation in Europe and the United States. Eur J Cancer 2003;39:2422–2423.
2. Relman AS. Your doctor’s drug problem. The New York Times 2003 Nov 18; Sect A:25(col 1).
3. CME on the Internet: trends and observations. Current Therapeutics Inc. Available at: http://www.currentrx.com, Accessed March 24, 2004.
4. Accreditation Policies: commercial support. Accreditation Council on Continuing Medical Education. Available at: http://www.accme.org/accreditation/sec_acc_pol.asp, Accessed March 29, 2004.

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