Despite changes to how continuing medical education is funded and administered, pharmaceutical leaders are optimistic that these efforts will lead to more knowledgeable healthcare providers, which will lead to better care and better outcomes for patients. The Golden Age of CME By Denise Myshko The Forum August 2005 VIEW on Medical Education One constant is change. And continuing medical education (CME) has undergone significant changes over the last several years. Pharmaceutical companies are now applying new guidelines — from ACCME, OIG, and PhRMA — for the continuing education of physicians, pharmacists, and nurses. The Internet continues to make inroads and provide CME programs for those looking for an alternative to traveling to meetings. Around the world, healthcare providers are exposed to increased offerings for continuing education and professional development. Executives from leading companies say pharmaceutical support of CME programs will continue to be critical to ensure providers have up-to-date information about treatment options and therapies. In fact, they say this is a time of opportunity for CME providers to make programs more sophisticated in terms of interactive participation and deployment through advances in technology so that ultimately they become integral to quality improvement within the overall healthcare system. Future of CME Now that the dust is beginning to settle after the issuance of several new guidelines, experts expect the integrity of CME to be preserved and thrive, the industry’s commitment to fund CME to continue, and that all the appropriate checks and balances will work to everyone’s benefit. Johansson-Neil. CME is very much dependent on what we, as a society, want it to be. It’s very easy to criticize the pharmaceutical companies, while what we are trying to do is improve the welfare of the patient through education. Within Schering-Plough, all funds for CME have moved from marketing into medical affairs. We are striving for product-unrelated education with the goal of identifying educational needs, as well as educating physicians, nurses, pharmacists, and other healthcare providers beyond the sole prescribing of medications. The hope is that these initiatives will lead to better outcomes for the individual patients. Beebe. The future of CME is intact, and I believe we may even witness more activity. There is skepticism given all the restrictions, the issue of no ROI, and whether CME is something companies want to continue to pursue, yet physicians say they trust CME and they view it purely as educational. In the true sense of CME, programs will continue to increase physicians’ knowledge and give them data based on high science and the most up-to-date clinical information. Saxton. CME will move closer to the point of care and will be viewed as an integral part of quality improvement within the healthcare system. In the future, when we look back at what’s being done today, we will be amazed at how narrow and limited our view of CME was. We will be glad that our family’s healthcare providers are part of a new system that was born from a vision in the early 1990s on the part of some CME leaders, even though it took more than a decade to come to fruition. We will not lament the “good old days,” but will recognize that the golden age of CME and commercial support is dawning. I say, let’s hurry up and get there. Johansson-Neil. The industry needs CME; medical societies need CME; and without the support of pharma, how would they achieve it? An overhaul on the support of CME would be welcomed. Maybe hospitals and insurance companies should absorb some of the funding for CME. Karwath. Healthcare professionals and their patients rely on the industry’s commitment and resources to facilitate CME, a critical component of the healthcare system. I hope that the future will demonstrate that the integrity of CME can be preserved, pharma’s role can continue, and all the appropriate checks and balances will work to everyone’s benefit. Saxton. Commercial support on behalf of the pharma industry is at risk in the future if we do not start recognizing that outcomes are an essential requirement for both compliance and effective education. I envision industry leading the charge in this area by increasingly requiring documentation from providers on outcomes. This will have many positive effects on the CME profession and is long overdue. The Guidances The ACCME’s updated standards for commercial support, issued in September 2004, reinforce previously issued guidelines promoting the separation of education from promotion. Beebe. The updated standards take us back to the original intent of CME, which is to provide good-quality medical education that raises the level of scientific knowledge and ultimately the standard of care for patients. I like to use the analogy that a rising tide lifts all boats. The first boat that is lifted is the physician level of knowledge about a disease state. We have a right, and an obligation, to make sure physicians are educated in the disease state and to educate them on how best to use medications. The second boat that is lifted is the care that is provided to patients because now physicians know how to select the right medication better, and they know how to diagnose the disease better. At Takeda, our boat rises as we meet these objectives. Saxton. We all want to support education based on the best available evidence that matters to patients. We need confidence in the system. The revised standards help, but they are not enough. We need to have confidence that the ACCME’s monitoring and compliance system is rigorous and reliable. If noncompliant and/or ineffective providers are rewarded in the marketplace, there will be a major decline in commercial support over time, as the risk of supporting CME increases in direct proportion to the lack of confidence in the system. Nies. When the new standards came out, coupled with the PhRMA code and OIG guidance, pharma companies realized that they had to separate education from marketing. Johansson-Neil. There was a lot of upheaval when the ACCME standards were first presented last year. At the ACCME meeting, there were many discussions regarding the ramifications of the new guidelines, especially about whether providers would be able to use the best-suited CME presenter because he or she might have a relationship with the sponsoring pharmaceutical company or its competitors. This, rather than being an issue for the pharmaceutical industry, is the responsibility of the CME provider. The best providers have already developed policies about disclosure and resolution of conflict. Karwath. The updated standards focus primarily on the issue of conflict of interest. Specifically, they call for the creation of a process to resolve existing conflicts rather than relying exclusively on disclosure. I suspect that the greatest impact has been on the medical education organizations whose responsibility it is to create and implement the conflict resolution process. It’s clear from the updated standards that disclosure is no longer sufficient. There must be a process to resolve any conflict of interest. Johansson-Neil. Honestly, I don’t know how to define conflict of interest. For example, if a presenter received any monetary compensation from Schering-Plough within the last 12 months, he or she, per the ACCME definition, is in a potential conflict of interest situation. There might be other physicians who are in greater conflict of interest situations, albeit without having had any monetary compensation with the company. The key issue of resolving conflicts of interest lies with the chair of the CME program, who is directing all the speakers and the content. We at Schering-Plough have no control over that. Nies. Certainly, resolution of conflict of interest is new, but at Serono Symposia we’ve always had disclosure policies. The difference is that now, if a conflict does occur, we have to show how we resolved it. I think those are all good things. I think everyone should be held accountable. Saxton. The addition of a process to resolve potential conflicts of interest is helpful in resolving perception. We need to move beyond this view of compliance, however, and recognize that the best form of compliance is good education. This is when we can be sure that perception is reality. Conflict of interest is resolved best when education is based on needs and focuses on the best available evidence that matters to patients. Johansson-Neil. Conflict of interest is being addressed/resolved by adding in extra layers of peer review. For example, for a bigger initiative, we advocate the use of a steering committee, which discusses the broad views and the broad topics. Then there will be a content development committee that flushes out the materials. Then a good provider will have an independent review committee. Now there are three layers of peer review that should be able to determine any conflict of interest and ensure a well-balanced program. Nies. There are studies that state, no matter what, physicians are going to be biased by pharmaceutical funding. But I think that doesn’t give the physicians enough credit. Physicians recognize if there is a marketing message buried in the education program. I think they judge programs based on the merits as to whether they are scientifically rigorous, fair, balanced, and credible. Return on Education Talk has turned from return on investment to return on education as related to identifiable needs assessments and outcomes. Nies. Everybody talks about measuring the return on investment and return on education (ROE). I’m not sure we’ll ever be able to measure it. First, it’s an intangible. Second, if a pharmaceutical company tries to measure the return on an unrestricted educational grant, then it becomes restricted. No matter what happens, a better educated physician is going to result in a better educated patient and a better treated patient. And I don’t think anyone can argue with that. Saxton. There should absolutely be a return on investment; we are not charitable organizations. We expect two things to occur simultaneously: the improvement of healthcare provider performance in the direction of evidence that matters to patients; and the improvement of shareholder value. It would be irresponsible to shareholders for us to give grants that did not align with our research interests. It would be irresponsible to patients and society to give grants that did not support improving patient care through the application of best available evidence. The educational return pharmaceutical companies measure should be exactly the same return that good CME providers measure. Therefore, the outcomes we look at depend on what is appropriately measured from the educational objectives. Good providers already do this. Beebe. We do not measure return on investment other than our belief that quality CME raises all boats. What is good for the patient is good for everyone. In evaluating the medical education companies that we use, we examine how effective they are in delivering the education and whether they meet the objectives set forth. Some med ed groups that we partner with now are helping us to evaluate changes in physician behavior, which is believed to be the only way to evaluate a program’s effectiveness. Karwath. Our goal in funding independent education is to help address the unmet informational and educational needs of healthcare professionals. And we want to do so in a manner that upholds the highest standards. The goal is unbiased, data-driven, quality educational programs. What we measure is the degree to which the program and/or activity meets the identified learning objectives. Johansson-Neil. There are four different levels of measuring the effects of a program. We generally do a level 1 measurement, which is the reaction to a program, and a level 2 evaluation, which determines whether participants learned something. I believe the main question is how to measure level 3, which is changing behavior, and level 4, which is determining a change of outcomes. Levels 3 and 4 we believe, are very important, but no one yet knows how these measurements can be done. Maybe there has to be a link between appropriate behavior of a physician to his or her certification. There is nothing pharmaceutical companies can do about that. Saxton. Measuring the return of an educational program would only be a conflict of interest if a pharmaceutical company or provider is confused about the difference between education and promotion. In fact, for education, outcomes improve compliance by providing the objective evidence to demonstrate grants were appropriately used for education programs that made a difference rather than ineffective education that could be criticized as entertainment only. Many of the educational activities the industry currently supports are not very sound educationally and would probably show poor educational outcomes if measured. Technology Live events and conferences will continue to dominate the CME landscape for the foreseeable future, but advancements in technologies are drawing more physicians to participate online and providing more interactive and interesting programs. Saxton. We need to be sure that technology is a means not an end when it comes to good educational design. As commercial supporters, we are too often asked to be at the “bleeding edge” of technology that is not grounded in good educational design. For example, a didactic lecture is largely ineffective whether it is live or online. On the other hand, educational technology can be a powerful catalyst for providing innovative learning opportunities that are very effective. For example, the integration of electronic medical records with point-of-care learning technologies in the form of practice-based learning and improvement will fundamentally change the CME landscape in the years ahead. Nies. In the future, there will be more CME programs based on interactive participation. I can envision programs that include transmissions beamed in from the operating room. It’s going to be interesting. Beebe. CME will be much more technologically based, and we will be able to reach out to the masses. The traditional definition of CME is live programming. Physicians prefer this format because they can interact and ask questions, which we can now do via the Internet. There will be more opportunities to reach physicians in remote areas who cannot get to a live program because it is not being offered in their community. Karwath. Technology is having the same type of positive impact on CME as it is on the rest of the world. It has created new ways to deliver information — Webcasts, self-directed Internet-based programs, satellite broadcasts, PDA-based programming, and so on. Technology is helping to educate more healthcare professionals in more locations, more efficiently. Nies. Serono Symposia has its own Website. We have about 60 online CME programs for nurses, physicians, and pharmacists; and we get quite a good number of participants. But I don’t think live programs are ever going to be replaced. Live programs give more than just a didactic lesson. They offer opportunities for a dialogue between colleagues, and live events provide an opportunity for younger researchers to meet more established senior researchers. We find that the majority of our Internet programs are attended by nurses. They are looking to obtain their credits in an inexpensive way and as easily as possible. The Grant Process Unrestricted grants for medical education are starting to come under fire, with critics questioning whether they are truly unencumbered. In response, pharmaceutical sponsors are setting up separate divisions to monitor the grant approval process. Karwath. At AstraZeneca, we have a process for submission and review of grants that specifically monitors the independence of grant approval from company influence and reinforces all appropriate guidelines and policies — ACCME, FDA, and OIG. Saxton. It used to be that the term “unrestricted” meant that commercial supporters had no involvement in the content of programs, but the term has taken on a different meaning in recent years. The concern now is that it might be misconstrued as allowing providers to do whatever they wanted to do with the grant, and that lack of transparency and financial accountability would be misunderstood as some form of inappropriate remuneration. Grants are now viewed as restricted in our post-OIG world in terms of the disease area for which the grant is given. Grants are increasingly encumbered with the expectation that they will be applied to effective, educationally sound, independent education. Increasingly, pharmaceutical companies are becoming more involved in identifying the standards by which they will judge grant proposals and implementing grant review committee processes to ensure that those standards are reflected in decisions. Some may view this as more encumbering, but I view it as exercising our social obligation to ensure that grants are given to quality CME providers. The industry is now recognizing what many in the CME profession have known for years; there is a very wide gap in quality between CME providers. By raising the expectations on grant quality, the industry is increasingly in a position to drive positive change in a manner that better CME providers applaud. Beebe. If pharmaceutical companies have a good process in place that evaluates educational merit and are moving toward the OIG guidelines, the review, process, and award of educational grants are outside marketing and sales. Almost two years ago, we made that commitment. For us, CME falls under medical and scientific affairs. We don’t evaluate whether doctors are high prescribers in terms of program development; that doesn’t even come into the picture. Johansson-Neil. I don’t believe there is such a thing as an “unrestricted grant.” On all CME programs supported by Schering-Plough, it is stated that the program is supported by an educational grant. Our job is to evaluate the current situation in each therapeutic area in terms of what the educational needs are. We do that based on literature, feedback on previous CME programs, and discussions with physicians. After this evaluation, we discuss those needs with the CME provider. If there is mutual interest in supporting these educational efforts, we can support them. Nies. There are some who would like all pharmaceutical companies to donate a certain percentage of grant dollars to one big pot, because I think we’re at the height of the regulatory scrutiny right now. But I also think the pendulum will swing back a little bit, and the public, physicians, and the pharmaceutical companies will once again be comfortable with how CME is being run. PharmaLinx LLC, publisher of the VIEW, welcomes comments about this Forum. E-mail us at [email protected]. Thought Leaders Christine A. Beebe, Ph.D.-C. Associate Director, Takeda Pharmaceuticals North America Inc., Lincolnshire, Ill.; Takeda Pharmaceuticals North America, a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd., markets oral diabetes, insomnia, and cholesterol-lowering treatments. For more information, visit tpna.com. Erica Johansson-Neil. Director, Medical Services, Schering-Plough Corp., Kenilworth, N.J.; Schering-Plough is a global, science-based healthcare company with leading prescription, consumer, and animal-health products. For more information, visit schering-plough.com. Kevin R. Karwath. Senior Director, Medical Education Grants Office, AstraZeneca Pharmaceuticals LP, Wilmington, Del.; AstraZeneca is an international healthcare business engaged in the research, development, manufacture, and marketing of prescription pharmaceuticals and the supply of healthcare services. For more information, visit astrazeneca-us.com. Leslie Nies. Executive Director, Serono Symposia International Inc., Rockland, Mass.; Serono Symposia develops focused educational programs for scientists, physicians, nurses, pharmacists, and other allied health professionals. For more information, visit seronosymposia.org. (Editor’s note: Serono Symposia is a separate, nonprofit, independent ACCME-accredited organization incorporated in 1991 by Serono Inc.) Michael Saxton. Executive Director, Professional Education Support, Wyeth Pharmaceuticals, Collegeville, Pa.; Wyeth Pharmaceuticals, a division of Wyeth, has leading products in the areas of women’s healthcare, cardiovascular disease, central nervous system, inflammation, transplantation, hemophilia, oncology, vaccines, and nutritional products. For more information, visit wyeth.com. If pharmaceutical companies evaluate educational grants on merit and are moving toward the OIG guidelines, with a sound review, approval, and follow-up process, the awarding of educational grants should be independent of influences from marketing and sales. Dr. Christine Beebe Takeda Pharmaceuticals North America Kevin Karwath AstraZeneca Healthcare professionals and their patients rely on the pharmaceutical industry’s commitment and resources to facilitate CME. I hope that the future will demonstrate that the integrity of CME can be preserved, pharma’s role can continue, and all the appropriate checks and balances will work to everyone’s benefit. Online CME Trends • 444,000 physicians report conducting CME online in 2005. • The main reason physicians prefer online CME to offline CME is convenience. This not surprising, considering physicians report conducting online CME from home nearly two-thirds of the time. • The majority of physicians do not find online CME to be more relevant than offline CME, which is surprising given online CME has the potential to be highly customized based on the unique learning needs of the individual users, for example self-guided learning. • Another challenge is the common physician complaint regarding the lack of a central portal for finding timely, relevant online CME offerings. In other words, physicians tend to go to a handful of CME sites because they do not have an efficient way of searching all online offerings available to them. Source: Taking the Pulse v5.0, Manhattan Research LLC, New York. For more information, visit manhattanresearch.com. Michael Saxton Wyeth Pharmaceuticals CME will move closer to the point of care and will be viewed as an integral part of quality improvement within the healthcare system. In the future, when we look back at what’s being done today, we will be amazed at how narrow and limited our view of CME was. Offline CME Trends New research indicates the buzz created by novel ways to deliver CME programs — Webcasts, online, CD-ROM, and so on — is not matched by the actual preferences of physicians. These less-established, newer CME program-delivery methods have a long way to go before they win over physicians and make the currently preferred options — live meetings and printed reports — obsolete, according to a survey by Rogers Medical Intelligence Solutions. Rogers Medical Intelligence Solutions recently surveyed 2,000 U.S. physicians (cardiologists, oncologists, primary-care physicians/internists, and psychiatrists) to gather data on physicians’ preferences in terms of CME program delivery methods, providers, treatment impact, and patient-care topics of interest. • An overwhelming 93% of survey respondents report that CME programs have influenced the way they treat their patients. But the Rogers Medical Intelligence Solutions survey uncovered that the CME delivery methods physicians prefer are different from the delivery methods that currently generate the most buzz. • The top scorers in terms of physician preference are the two most well-established CME program-delivery methods: live meetings and printed reports — 74% and 61%, respectively, of all respondents. • CD-ROM/DVD and Internet-based programs have established footholds in the marketplace, but their physician support is modest — 26% and 25%, respectively. Physicians appear to prefer the established, tried-and-true delivery methods. Physicians have, after all, had the most exposure to these delivery systems and the most experience receiving valuable content from them. If a survey were made only of younger and more technology-savvy physicians, the less-established and more-novel CME program-delivery methods might well enjoy considerably stronger support, provided the physicians were satisfied with the content delivered through these channels. The survey scores found that Webcasts were the least popular of all CME program-delivery methods. Analysts speculate that there may be two reasons for this: a substantial group of physicians has been dissatisfied with the quality of Webcast CME content, and another group has been frustrated by technology problems involving, for example, bandwidth, installation, or logging onto a live Webcast event. Given time to establish new habits and given relevant and appropriate CME content for these new formats to deliver, these novel methods may well establish themselves and enjoy the same popularity among physicians as live meetings and printed reports. Source: Rogers Medical Intelligence Solutions, New York. For more information, visit rogersmis.com. CME Around the World Africa and the Middle East Jordan. Licenses of physicians are for lifetime practices and no additional education after university is required. Kuwait. The national accreditor is the Kuwait Institute for Medical Specialization (KIMS). South Africa. CME is mandatory. The national accreditor is the Medical and Dental Professional Board under the jurisdiction of the Health Professions Council of South Africa. Asia-Pacific Australia. CME is voluntary. National acceditors include: Royal Australian College of General Practitioners; Royal Australasian College of Obstetricians and Gynecologists as the governing body for reproductive health programs; and Royal Australian College of Physicians for the Neurologists, Pediatric, and Adult Endocrinologists. India. There are no mandatory, statutory requirements for undergoing CME, and there is not a system of certification of CME. CME is provided by medical associations, healthcare communications groups, and pharmaceutical companies through print media, videos, and conferences. In 2003, the Union Health Ministry moved a constitutional amendment making CME mandatory, but the bill was not placed before parliament. The present health minister has vetoed a similar proposal. Japan. CME is voluntary and accreditation is through medical societies. At present, only societies, not the licensing authority, sanction CME credits to renew certificates of specialists. Programs that do not involve any society are not allowed to provide CME credits, although some programs are jointly sponsored by the societies and pharmaceutical companies. Eastern Europe Croatia. CME has been mandatory since 1995 when the Institute of Licensure and Re-license was established. The national accreditor is the Specialist Societies and Hospitals. Czech Republic. CME is mandatory and is similar to the Croatian system. The national accreditor is the Specialist Societies and Hospitals. Hungary. CME is voluntary but had been mandatory. Four medical schools under the control of a supervisory steering committee and pharmaceutical companies (both local and international) are playing a key role in CME. Every activity concerning the credit point system should be done in close cooperation with the Hungarian Physician’s Chamber and the entire Doctors Collegium. Poland. A law exists for CME but doesn’t work in practice. The national accreditor is the Polish Chamber of Physicians and Dentists. Romania. CME is mandatory. The national accreditor is the Romanian College of Physicians. Providers are accredited with the help of scientific societies and professional organizations. Slovenia. CME is mandatory. The national accreditor is the Slovenian Medical Chamber. South and Central America Argentina. CME is voluntary, but there are plans to make CME mandatory in the future. The national accreditor is the National Commission for Board Certification and Re-certification. Brazil. There is no formal CME system in place; the Brazilian Federal Health Council has no rules for CME. Medical societies are playing a major role in establishing standards for certifying and updating their members. There is a trend led by the major schools of medicine to reduce the number of new physicians because of a saturation of the market — 9,000 new doctors every year. The goal is to have better training and CME for board certification. Chile. CME is voluntary. The national accreditor is the National Council for Medical Specialties Certification (CONACEM), which was established in 1985. Certification is provided through a diploma of CME issued by this council. Government health authorities, CONACEM, and Chilean Academy of Medicine are now considering implementation of CME and board certification standards for all specialists. The pharmaceutical industry is playing a major role in education by delivering both print and online CME programs. Costa Rica. CME is voluntary for almost all medical specialties, but mandatory for public health employees. Board certification and recertification is ruled by the committee for medical certification of Costa Rica’s national medical college. Recertification is required by six specialties every three years. Mexico. CME has been mandatory since 2002. In April 2003, a reciprocity agreement was made with the U.S. AMA. There are currently 51 boards of certification; most of them recertify their members every five years. CME providers have to fulfill national standards. Types of providers include: government institutes of health, hospitals, postgraduate medical schools, colleges, academies, medical societies, pharmaceutical companies, and medical publishing companies. Peru. In 1998, the national system for board certification and recertification was established under the rule of the Peruvian College of Medicine. The implementation process is starting. There are many CME activities and programs sponsored by pharmaceutical companies. Western Europe Austria. Since 2001, CME has been mandatory. The national accreditor is the Austrian Medical Chamber. Belgium. CME is voluntary, but incentives exist for accredited doctors (they can ask for higher fees). CME in Belgium is regulated by an organization within the State Institution for Insurance against Disease and Invalidity and is monitored by the profession, the universities, specific organizations, and the insurance organization. Cyprus. CME is voluntary. Cyprus recognizes credits from all over the world. Denmark. CME is voluntary. The national accreditor is the Danish Medical Association (DMA) in conjunction with national scientific societies. Registration and documentation of CME activity is up to each individual doctor on the Internet, and only he or she has access to it. The system is designed for each doctor to compare his or her own CME profile with the average peer colleague and supply the DMA and societies with statistics on the level of activity. Currently, 24 of 40 societies participate. Finland. CME is voluntary. The national accreditor is the National Evaluation Council for CME, which was established in January 2002. France. A legal regulation for CME has been introduced, but execution and assessment have not been implemented. Germany. CME became mandatory Jan. 1, 2004, for ambulatory care physicians; it will be mandatory for hospital-based physicians beginning in 2006. Postgraduate education is regulated by regional medical associations. There is increasing competition in the online CME market by a growing number of CME providers. Greece. CME is voluntary and is offered separately by universities, scientific societies, and hospitals or doctors. There is no coordination of monitoring or evaluation of quality at a national level. CME is considered an ethical obligation of doctors. Credits also are used when submitting applications to universities or for promotions. Iceland. Existing CME is controlled by the profession. Ireland. CME is moving toward a mandatory system. In January 2003, 50% of physicians were required to participate; the remainder by 2004. In 2005, the first half have to participate in audit and peer-reviewed activity; the other half will be required to do the same in 2006. The national accreditor is the Irish Accreditation Board, which was set up in October 2002. Luxembourg. Plans to start voluntary CME. The Netherlands. CME is mandatory. If a doctor falls below a preset quality standard, he or she must attend CME activities. CME is accredited by 28 scientific societies. Norway. CME is mandatory for general practitioners and voluntary for other physicians. Most medical specialists in Norway participate in some CME activities. Portugal. CME is voluntary. There is no structured format, but this is an issue under discussion by both the Ordem dos Medicos (the national accreditor) and Portuguese Pharmaceutical Companies Association based on EFPIA and U.S. CME rules guidance. Spain. CME became mandatory beginning in April 2003. The national accreditor is the Spanish Acceditation Council for Continuing Medical Education. Each autonomous region has its own commission for continuing education that is responsible for CME in that region. Sweden. CME is voluntary. The national accreditor is the Swedish Medical Association. There are plans for a national authority on CME. Switzerland. CME is mandatory. The national accreditor is the Foederatio Medicorum Helveticorum (FHM). Differences exist in the requirements of the various medical societies. If CME requirements are not met, specialists can lose membership in the FHM, making it difficult to get insurance. United Kingdom. Continuing professional development is mandatory. The national accreditor is the Royal College of Physicians. Source: Global Alliance for Medical Education (GAME), Houston. For more information, visit game-cme.org. Erica Johansson-Neil Schering-Plough The industry needs CME; medical societies need CME; and without the support of pharma, how would they achieve it? An overhaul on the support of CME would be welcomed. Maybe hospitals and insurance companies should absorb some of the funding for CME.

Download PDF