In the old paradigm, obtaining continuing medical education (CME) or continuing education (CE) credits was an opportunity for travel, vacation, socialization, meetings, dining, wining, and learning. You could arrive at a given conference city, see the sites, graze the exhibits, eat the food, gather the "free gifts" (oxymoron), and attend a few classes of interest to you. And, if you completed the requested attendance sheets, you could claim up to a certain amount of CE or CME credits. Well, today, there is a new sheriff in town-actually more than one! That was then, and this is now.
The new paradigm dictates that the consumers, regulators, accrediting agencies, publishers, and licensure boards look for more evidence-based education, attestations, and outcome-oriented education. In addition, these stakeholders are seeking journal-based CME/CE articles that are used for credit toward satisfying a given sector's needs. For example, when institutions send practitioners to a conference, they want to ensure they receive their money's worth, and licensure agencies want the licensed or credentialed professional holding a given license to acquire new evidence-based and scientific knowledge specific to his/her practice. Currently, at the anniversary of and as part of the license renewal process, the applicant must sign an attestation that he/she has actually met the requisite number of credits in a given category of CME or CE to be eligible for licensure renewal or maintenance of certification. Thus far, this process has followed the "honor system" and, of course, is subject to audit.
Other standards are undergoing dramatic change. Industry support of CME programs has come under strict scrutiny, impacting CME providers and industry as well. This includes, but is not limited to, medical device manufacturers, biotechnology and pharmaceutical corporations, and private and publicly traded companies. Congress is also in the act-evaluating the transactions between the providers of CME and industry. The Accreditation Council for Continuing Medical Education (ACCME) is expecting conference planning boards, members of the planning panels, speakers, journal article authors, and journal staff to disclose any real or potential conflicts that may exist regarding CME activities. On its Web site, the ACCME states its mission: "The ACCME's mission is the identification, development, and promotion of standards for quality CME utilized by physicians in their maintenance of competence and incorporation of new knowledge to improve quality medical care for patients and their communities."1 The American Medical Association, the American Board of Medical Specialties, and other CME-providing entities are following suit.
In addition, the updated PhRMA Code on Interactions with Healthcare Professionals that took effect in January 2009 essentially puts structure around relationships with healthcare professionals and lays out a specific covenant to "inform healthcare professionals about the benefits and risks of our products to help advance appropriate patient use, to provide scientific and educational information, to support medical research and education, and obtain feedback and advice about our products through consultation with medical experts."2 PhRMA aims to have a highly ethical posture and legal accoununordility in its relationships with the medical community. Of course, PhRMA, like wound care practitioners, wants to benefit patients and enhance the practice of medicine. "The code is based on the principle that a healthcare professional's care of patients should be based, and should be perceived as being based, solely on each patient's medical needs and the healthcare professional's medical knowledge and experience."2
Essentially, our CME activities need to mirror the needs of the "voluntary" covenant of PhRMA. Therefore, to measure these activities, we must work with our CME accrediting bodies. It is an ACCME requirement to measure outcomes in all certified CME activities. As in most academic and scholarly activities, there are leaders who help us find the way forward.
In conclusion, I think Moore's principles3 help us with the proverbial Venn diagram, meeting the needs of all the interested parties in the quest to define the tenets of learning. We can refer to Moore's "pyramid" of outcomes measurements in education:
(1) Participation
(2) Satisfaction
(3) Learning
(3A) Declarative knowledge
(3B) Procedural knowledge
(4) Competence
(5) Performance
(6) Patient health
(7) Community health
Keeping these conventions in mind, we can structure unbiased CME activities based on knowledge, evidence, and competency.
"The principal goal of education should be creating men and women who are capable of doing new things, not simply repeating what other generations have done; men and women who are creative, inventive and discoverers, who can be critical and verify, and not accept, everything they are offered."-Jean Piaget
Richard "Sal" Salcido, MD
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