CMSS Response to IOM – Perhaps No Need for Redesigning Continuing Education in the Health Professions

In response to the Institute of Medicine’s recently published report titled “Redesigning Continuing Education in the Health Professions”, the Council of Medical Specialty Societies (CMSS) asserted that a Continuing Education Institute accountable to the federal government is unnecessary.

In asserting their position CMSS, which represents 32 major medical specialty societies with an aggregate membership of more than 580,000 physicians in the US, noted the organization could not support the new proposed institute for various concerns.

CMSS acknowledged that the IOM’s report, which used “five broad messages,” made no mention of two recent innovative developments in continuing medical education (CME), Point of Care CME (POC‐CME) and Performance Improvement CME (PI‐CME). Instituted in 2005 these two new forms of CME are beginning to revolutionize the life‐long learning of physicians.

As CMSS describes, POC‐CME takes place when a physician is confronted with a question about the management of a patient currently receiving care. The physician accesses an evidence‐based source, either live on the internet or downloaded, then armed with the new knowledge implements a change in his/her practice behavior toward that patient, which is linked by evidence to improved patient outcomes.

PI‐CME, as defined by the American Medical Association, is an activity that is a “structured, long‐term process by which a physician or group of physicians can learn about specific performance measures, retrospectively assess their practice, apply these measures prospectively over a useful interval, and re‐evaluate their performance.” Physicians review their current practice, engage in learning activities to improve practice based upon nationally accepted performance measures and then re‐evaluate their practice to assess improvement. Repeating this procedure regularly creates a “Culture of Improvement” in practice. Currently, more than a dozen medical specialties offer PI‐CME, with more programs in development.

CMSS also pointed out that the IOM incorrectly states the role of “pharmaceutical and medical device companies in financing the provision of and research on CE.” The reality is, “accredited CME providers determine CME programming through needs assessment, and produce CME under recently revised criteria.” Moreover, data from the Accreditation Council on Continuing Medical Education (ACCME) reveal that less than half of financial support of CME comes from commercial support.

Another problem with the IOM report is that it does not recognize that certification requirements were recently standardized by the American Board of Medical Specialties in March of 2009. Moreover, the Federation of State Medical Boards recently released for public comment its report on proposals for Maintenance of Licensure through state medical boards.

In addition, the report does not consider the importance of the Conjoint Committee on Continuing Medical Education (CCCME), convened by CMSS in 2002, with the original charge to “re‐position” CME. In 2009, CCCME adopted the goal of using the CME system to improve the performance of the US health system, as measured by international benchmarks (such as World Health Organization measures). To do so, three strategies were proposed:

–    The integration of performance improvement into CME;

–    Consideration of the development of curricula for CME, at the system, specialty and practice levels; and

–    Convening the national dialogue on the financing of CME to assure the absence of influence of commercial support on the content of CME

Conclusion

As evidenced by all the concerns from CMSS, it is clear that the IOM committee has not recognized, nor taken into consideration significant recent changes in the accreditation and delivery of continuing medical education, as well as its use by certifying and licensing boards. In fact, the report did not fully consider the Standards for Commercial Support: Standards to Ensure the Independence of Continuing Medical Education, which were revised and promulgated by the ACCME in 2004, with enforcement strengthened in 2008. These standards have been adopted by all three accreditors of CME in the US (ACCME, AOA, AAFP) and by all three CME credit systems (AMA PRA, AOA, and AAFP).

Accordingly, because the report lacked evidence and a vision, the recommendation for an Institute for Continuing Education which is either accountable to, or managed by, the federal government is unwarranted. CMSS recognizes that the profession of medicine is accepting responsibility for transparent, voluntary self‐regulation of continuing medical education in many ways not reflected in the IOM report. The profession is actively accepting accountability for its part in facilitating the evolution of life‐long learning for physicians, with the goal of measurably improving patient outcomes, through facilitation of a new culture of improvement in medical practice.

Consequently, we agree with CMSS that the profession of medicine should be responsible for professional voluntary self‐regulation of continuing professional education, not governmental regulation. Ultimately, “continuing education is a professional responsibility, and one in which the profession is leading.”