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which CME supports physician continuing profes- sional development (CPD).

Drawing an analogy to the law of natural selection, he explains: “In Darwinian terms, this is the time for evolution, not adaptation. The system (enterprise) needs to evolve. System changes will occur, and are occurring, at the people and organizational levels. Some people will move on to other professional pur- suits. Some organizations will stop being accredited providers. New people will be drawn to the CME en- terprise, and new organizational types will emerge as providers. Data and information about organization- al success, driven by the ACCME requirements, will guide this evolution. Emerging CPD systems and the expectation that physicians will improve their prac- tices will drive this evolution.”

The ACCME has been fostering a survival-of-the- fittest mentality via a host of policies and proposals, at the center of which is transparency.

“The provider, the public and those to whom AC- CME stands accountable need access to reliable and valid data and information, at the activity level, that describes CME as something that matters to patient care and, in fact, free of bias,” says Kopelow. “The ACCME is going to get that data and information through its monitoring efforts.”

The CME mix by participation, 2003-2007

67%

2003

24%

10%

54%

2005

27%

19%

46%

2007

20%

34%

0

10

20

30 40 50 % of CME Registrants

60

70

80

Meetings/Conferences

Home Study

Online

Sources: Pri-Med Annual Tracking Study, June 2007; ACCME Annual Report 2006

Long- running no more

Postgraduate Profes- sional Services (PPS) will complete its last CME activity in August. PPS, which has held national accreditation since 1991 (longer than any other MECC) is ceasing operations due to a “strategic decision,” said Jon Bigelow, president and CEO of PPS’s parent company, Knowl- edgePoint360. The company is launching a new entity, Clinical Bridges, to conduct non-certified, disease- state educational activities.

“Our feeling is the CME enterprise has gotten bogged down in disputes, mispercep- tions and misguided regulatory initiatives, and in this environment neither supporters nor providers can plan effective activities to meet the long-term needs of busy practitio- ners,” he explained.

PPS is not alone. Societies, hospitals and medical schools are rethinking CME programming due to a tighter funding market and tougher accredita- tion criteria. It’s likely the coming months will see others decide to opt out of CME, adopt non-certified education or explore different routes.

CME Overview

An enhanced monitoring system, slated to be in- troduced this year, will include an expanded data- base of CME activities and participation, which Ko- pelow says will make accessible “information about each and every educational activity occurring in the nation.” The data may help ACCME parry thrusts from legislators and groups that have called the integrity of CME accreditation into question. An- swering the call of Sens. Max Baucus (D-MT) and Chuck Grassley (R-IA), who scolded the acceditor in the past for ineffectual enforcement, the group also plans direct observation of CME activities by volunteer monitors and has pledged to publish on- line more information about the kinds of activities and funds accepted by providers, although it won’t release specific dollar amounts.

ACCME, along with SACME, is also co-sponsor- ing the so-called Mayo Proceedings to drive toward consensus on an agenda for the evolution of re- search and strategic management of CME that will positively impact the integrity and effectiveness of the whole enterprise.

A matter of degrees “From ACCME’s perspective it is mission critical that CME be about improving quality and safety, be content valid and be developed in a manner that is independent of the influence of commercial inter- ests,” adds Kopelow. “ACCME remains committed to the fulfillment of these elements.”

The profession stands equally committed. Fewer meeting planners are coming into the field, in favor of more people with training in adult education.And an effort is under way to professionalize providers— the National Commission for Certification of CME Professionals CCMEP designator (52 CCMEPs were credentialed last January, bringing to 157 the total number who have earned the credential).

As far as technology, “You will see a lot more in terms of online activities that engage the physician,” Schaffer says, “more just-in-time CME, especially with newly minted medical-school grads entering practice and using their PDAs.”

For now, physicians still need quality education that bridges the gap between clinical quandaries and patient care, and grantors are still willing to fund non-product specific educational initiatives.

Says Schaffer: “I think we’ll still go through a lot of pain and suffering and wringing of hands, but in terms of the future of CME, this is a very exciting time to be in this field.” n

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