Life Science Compliance Update

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November 16, 2015

ACCME: Accreditation Rules Safeguard Continuing Medical Education from Commercial Influence

Continuing medical education courses have been under attack lately, with skeptical writers making unsubstantiated claims that CME courses have "become a key marketing tool for increasing clinician receptivity to new products." Those writers make bold claims, but are unable to back their claims up with concrete evidence.

Graham T. McMahon, a physician and the president of the Accreditation Council for Continuing Medical Education (ACCME), has been working diligently to set some of these unsupported claims straight, reminding medical professionals and others that organizations such as the ACCME exist to "set and monitor the standards that, among other goals, ensure that educational programs offered by organizations that we accredit are independent and free of commercial bias."

Dr. McMahon continues to reiterate that promotion and marketing do not have a place in accredited CME courses. Accredited education is designed to offer physicians and health care teams a space to learn, teach, discuss emerging science, and debate ethical or controversial issues without any commercial influence. Non-accredited CME does exist, however, and Dr. McMahon cannot speak to the rigorous standards that might be applied to those courses, but states that if the authors making allegations against CME courses are referring to non-accredited CME being infiltrated with marketing tactics, then they should specify that and not apply such a broad brush against all CME courses.

The authors of the most recent article, including Adriane Fugh-Bermann, a known CME critic and director of PharmedOut, suggest that providers of CME activities have allowed commercial support to include marketing messages to increase awareness and understanding of hypoactive sexual desire disorder, and implies that the ACCME Standards for Commercial Support are either inadequate or ignored by accredited organizations. The authors, however, do not provide any support or evidence of actual courses that have been given accreditation with such "marketing messages."

As we have previously written, the standards that accredited CME courses must follow cover a wide range of topics including "independence from commercial interests; resolution of any personal conflicts of interest; appropriate use of commercial support; and content and format without commercial bias." A course will not be accredited if it does not follow the standards required by the ACCME.

Dr. McMahon reviewed the ten key points the critical authors presented as being "marketing messages," and concluded that all ten points appeared to be "appropriate elements to describe the epidemiology, diagnosis, and impact of an established disorder on affected patients," not "marketing messages" as were alleged.

Dr. McMahon reminds readers that two important functions of accredited CME courses are to both "creat[e] awareness of newly identified diseases and facilitat[e] the translation of new research into practice." He continues on to state that physicians and health care teams need evidence-based disease-awareness education so they can learn how to efficiently and quickly respond to public health priorities, and know how to diagnose and treat their patients appropriately.

In addition to the strict rules the ACCME has in place regarding the management of funds and conflicts of interests for CME providers, the activities of CME providers are subject to routine audit by the ACCME. These audits are performed on a randomized basis and Dr. McMahon also highlighted the fact that only 11% of accredited CME providers receive commercial support.

Dr. McMahon ended his written response by reminding everyone that accredited CME is part of the solution to the health needs of our country, "there is considerable evidence to show that accredited CME has a positive impact on physicians' ability to deliver high-quality care, and is one of the key resources that enables physicians and teams to deliver safe, ethical, effective, cost-efficient, and compassionate care that is based on best practice and evidence – and not on promotion."

Confirming Dr. McMahon's position is a synthesis of systematic reviews, done earlier in 2015 and focused on the impact of CME on physician performance and patient health outcomes. That synthesis identified eight systematic reviews of CME effectiveness published beginning in 2003. Five of the eight reviews directly addressed the question of "Is CME Effective?" by using primary studies that employed randomized controlled trials or experimental design methods, and concluded that CME courses and requirements do improve both physician performance and patient health outcomes.

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