Yesterday, the Accreditation Council for Continuing Medical Education (ACCME) announced the publication of two reports addressing important issues in CME: the effectiveness of CME, and the relationship between commercial support and bias in CME activities. The author of the study, Ronald M. Cervero, PhD, Professor and Associate Vice President for Instruction at the University of Georgia, systematically reviewed decades worth of CME studies and found that CME has been shown unequivocally to be an effective learning tool. Furthermore, on the issue of whether commercial support leads to bias, Dr. Cervero notes that not one single study has specifically measured the impact of commercial support and bias in accredited CME.
In fact, the research shows that physicians perceive very low levels of commercial bias in CME activities — 3 to 5% — and they report the same level of bias for activities that were and were not commercially supported.
CME Has a Positive Impact on Physician Performance and Patient Health Outcomes
The report entitled Effectiveness of Continuing Medical Education: Updated Synthesis of Systematic Reviews "demonstrates that CME is a strategic asset," notes Dr. Murray Kopelow, president and CEO, ACCME. The research shows that CME has a positive impact on physician performance and patient health outcomes.
As noted above, Ronald M. Cervero, PhD, Professor and Associate Vice President for Instruction at the University of Georgia and his colleagues systematically compiled and reviewed hundreds of the individual CME studies over a number of decades looking at whether CME is effective.
“We should even stop asking the question because it's settled, and we should be really asking the more important questions,” he notes. For example: “what are the mechanisms of action...What types of CME are effective?”
To this point, his report came to the following conclusions:
- (1) CME improves physician performance and patient health outcomes.
- (2) CME has a more reliably positive impact on physician performance than on patient health outcomes, which Dr. Cervero notes makes sense given that learning happens on a continuum. Changing knowledge is the most basic aspect of a learning program. Connecting this knowledge to in-practice performance is a tougher challenge, and tougher still is connecting the knowledge all the way to clear patient outcomes. That said, CME is effective along the entire continuum, but less dramatically so as it goes along the line.
- (3) CME leads to greater improvement in physician performance and patient health if it is more interactive, uses more methods, involves multiple exposures, is longer, and is focused on outcomes that are considered important by physicians.
Dr. Kopelow notes: “I encourage CME providers to show this research to healthcare leaders and CEOs and tell them: ‘you need to take advantage of accredited CME or you are missing a huge opportunity to drive health care improvement.’”
No Evidence Supports or Refutes the Belief that Commercial Support Creates Bias in CME Activities
"It is a firmly held belief by some in the continuing medical education community that commercial support creates commercial bias in CME activities," states Kopelow. "Our updated literature reviews find that there is no actual evidence to support or to refute that belief."
Is There a Relationship between Commercial Support and Bias in Continuing Medical Education Activities? An Updated Literature Review finds that there simply have been no studies testing what many publications and authors have deemed to be fact.
Dr. Cervero describes the lack of evidence based studies that suggest commercial support is linked with questionable physician practice:
If you were looking at the negative effects of commercial support, you would expect to see more prescriptions for the pharmaceutical company that was supporting that education. That would be the worst outcome, that the physician was not making an independent clinical judgment about how to treat this patient and was unduly influenced by the CME activity because of how it was funded. I mean that would be, to me that would be the trail of action, and there hasn't been anything that could document that.
Dr. Kopelow notes the perpetual cycle he has seen:
Journal articles and national reports make statements that commercial support leads to bias in CME – without any evidence to support those statements. Perception and beliefs are not evidence.
These reports and articles are then cited and quoted. Unsupported statements and unsubstantiated reports are referenced as fact. Proposed policy solutions are based on these assumptions.
We live in an evidence-based environment in medicine. Research about CME should be held to the same standards as scientific and medical research. Articles and reports about CME should be based on evidence.
Practitioner perception of bias is also an important consideration. The research shows that physicians actually perceive very low levels of commercial bias in CME activities — 3 to 5% — and they report the same level of bias for activities that were and were not commercially supported.
The report recommends that if the medical community is serious about the issue of bias, they must develop rigorous scientific studies to address questions about the relationship between commercial support and bias in accredited CME.
“The CME community takes the issues of independence and conflict of interest very seriously," notes Kopelow. "The literature review supports the success of the Standards for Commercial Support: Standards for Ensuring Independence in CME Activities℠."
ACCME has provided two conversations with Dr. Kopelow and Dr. Cervero: