Abstract

Typical continuing medical education (CME), as delivered via AMA PRA Category 1 Credit ™, is still obtained almost exclusively via passive experience (whether that means listening in lecture, clicking through pages of an online course, watching an online video, or reading a journal/PDF). And funding of CME (and thus the topic priorities) is still 50% related to support from pharmaceutical and device manufacturers. The slow changes in health professional development over the past decade have thus far yielded little in terms of changing the actual experience.

Yet perception of calm or stagnation in the CME field is unwarranted. The foundation for change has been laid by:

• A powerful and consistent literature that has been identifying problems and recommending changes for 15 years,
• Changes in ACCME policy that are moving CME from a knowledge/education focus to a skills/practice focus as well as requiring outcome assessments and more complete disclosure of possible conflicts of interest,
• Increased transparency regarding payments via a Sunshine Law that makes the cash value of payments to speakers and compensation to learners explicit,
• Continued growth and domination of "Internet solutions" based on user participation and input via Web 2.0 functionality,

Change to continuing health professional development (CHPD) is upon us and will proceed rapidly. The new CHPD/CME experience will:

• Be based on user demand and available via multiple devices when the user wants it,
• Focus more on topics based on medical needs (practice gaps) rather than topics related to pharmaceutical and device manufacturer interests (good for addiction professionals),
• Move topic control away from learner choice and more toward public policy requirements set by states, the federal government, and institutions,
• Require effort and attention on the part of the learner,
• Collect outcomes, especially patient outcomes, to determine effectiveness - and thus accelerate change toward highlighting more effective solutions and downgrading less effective solutions,
• Experiment with the potential of technology via use of simulations (deliberate practice) to deliver a more clinically relevant and challenging experiences.

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Key References

1. Accreditation Council for Continuing Medical Education. CME as a bridge to quality: Leadership, learning, and change within the ACCME System [monograph on the Internet]. Chicago, IL; 2008 Jan. Available at: http://www.accme.org/dir_docs/doc_upload/e2843247-7cae-40fe-a0eb-27a982b8fcc0_uploaddocument.pdf
2. Institute of Medicine. Redesigning Continuing Education in the Health Professions. Washington, DC: National Academies Press; 2009. Available at: http://www.nap.edu/openbook.php?record_id=12704
3. Davis D, Galbraith R; Continuing medical education effect on practice performance: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines. American College of Chest Physicians Health and Science Policy Committee. Chest. 2009 Mar;135(3 Suppl):42S-48S. PMID 19265074. Available at: http://chestjournal.chestpubs.org/content/135/3_suppl/42S.long
4. John W. McMahon, Sr., MD, Chair, Financial Relationships with Industry in Continuing Medical Education, REPORT OF THE COUNCIL ON ETHICAL AND JUDICIAL AFFAIRS, CEJA Report 1-A-11, 2011. Available at: http://www.acme-assn.org/imis15/aCME/PDFs/Advocacy/2011_AMA_CEJA_Report_1-A-11.pdf