by Jennifer Nicole Dienst | July 01, 2008

Continuing medical education, the prime raison d’etre of medical/pharmaceutical meetings, has come under a chorus of criticism lately. The Manhattan-based Josiah Macy Jr. Foundation, a private philanthropic group founded in 1930 to improve the education of health professionals, recently warned that the industry is “in disarray,” and a number of policymakers and physicians alike are voicing concern that CME and its lifeblood, support from pharmaceutical companies, are in an unholy alliance based on bias and commercial greed.

There are other questions surrounding CME, such as whether the accreditation model should be reformed and even if the quality of the education itself is up to par. M&C asked insiders to weigh in on these pressing problems -- and offer possible solutions.

Under a spotlight

Last November, the Macy Foundation held a conference in Bermuda with 36 prominent members of the academic medical community -- professionals hailing from institutions such as the American Board of Internal Medicine, Harvard Medical School and the New England Journal of Medicine.

A report, released by the foundation this past May, summarized the three-day discussion about the quality of medical education, and no punches were pulled (see “A Troubling Report Card”). Among the gripes: CME does not adequately improve clinician performance, relies too much on outdated lecture formats, and blurs the line between education and commercial support.

Meanwhile, according to a U.S. Senate Finance Committee study released in April 2007, commercial sponsors spent more than $1 billion in CME support in
2004, a situation clearly rife for influence-peddling. Senator Chuck Grassley (R-Iowa) states in the report that “separation between medical education and marketing efforts...isn’t clean enough. Medical education funded by drug companies has to be real education, not a soft sell designed to sway treatment decisions.”

“There’s a lot at stake,” says Mindi McKenna, director of CME for the Leawood, Kan.-based American Academy of Family Physicians. “A lot of patients are not getting optimal care, despite the fact that lots of money is spent for education. I think all involved are dismayed that CME is not having as much impact on practice performance and health outcomes as patients deserve.”

Yet, not all in the medical community stand behind the recent criticism. In the wake of the Macy Foundation report, the Birmingham, Ala.-based Alliance for Continuing Medical Education released a statement emphasizing that the Alliance “does not endorse or condone” the report’s recommendations, and that “the Alliance believes the report includes broad generalizations of divisive issues [that have] not been studied and may not be in the best interests of the broader CME community.” McKenna said that despite the report’s clarity on three central issues -- educational methods, accreditation and funding -- she felt that “not all of the conclusions and recommendations are objective or evidence-based.”