We see the Conference as a missed opportunity. This is how the chief executive officers of the major CE accrediting bodies describe the Macy Conference.
Last November a group of 40 academics gathered in Bermuda for four days to discuss the current state of Continuing Education in the Health Professions and their recommendations for the future. In May they published their final conference proceedings:
Continuing Education in the Health Professions: Improving Healthcare through Lifelong Learning.
The Chief Executives of the three major accrediting bodies the Accreditation Council for Continuing Medical Education (ACCME), the American Nursing Credentialing Center (ANCC) and the Accreditation Council for Pharmacy Education (ACPE) issued a response to the Josiah Macy, Jr. Foundation. (Letter to Josiah Macy Foundation)
The CEO’s went out of their way to describe the report as flawed and “disagree with, or take exception to, most, if not all, of the Conference Proceedings.”
This is a reaction to the inflammatory language used in the report which goes out of its way to belittle medical education in the US.
Our concern stems from our observation that neither the Conference, its observations, its assumptions, its conclusions nor its recommendations seem to be based on the facts and circumstances that we know to be extant in our three professions’ continuing education, or continuing education accreditation systems, today.
According to the CEO’s many of the statements made in the report are outdated:
These statements reflect concerns that we, as CE accreditors, had 5-10 years ago. Over this past decade we have made significant changes to our systems to address these concerns. Therefore, we question the reliability and validity of the evidence base from which these statements are made.
Specifically they had issues with several of the key findings of the Macy Conference on the
state of education:
Conference finding #1: Too much CE relies on a lecture format and counts of hours of learning rather than improved knowledge, competence and performance.
The CEO’s found quite the contrary:
Data from our organizations show that the CE accreditation systems have integrated new formats of continuing education and that CE providers are utilizing these formats within their CE programs. For example, almost 50% of the continuing medical education enterprise is not didactic in nature.
Conference Finding #2: Too little attention is given to helping individual clinicians examine and improve their own practices.
Conference Finding #3: Insufficient emphasis is placed on individual learning driven by the need to answer questions that arise during patient care.
Again the CEO’s are firm in that: Continuing education is entirely about answering questions that arise in professional practice as the source of the needs data that drives the education.
Conference Finding #3: CE does not promote inter-professional collaboration, feedback from colleagues and patients, teamwork, or efforts to improve systems of care.
CEO’s take issue with the validity of this statement: It is not valid for the Chairman’s Summary to say “CE does not promote inter-professional collaboration”. Our three organizations have worked productively and collaboratively for many years to bring order and efficiencies to CE accreditation.
Conference Finding #4: CE does not make adequate or creative use of Internet technology, which can help clinicians examine their own practice patterns, bring medical information to them during patient care, and aid them in learning new skills.
CEO’s rightly note that there is a plethora of internet based CME. Published quantitative data, which we know the Macy conference participants had access to prior to the Conference, do not support these statements. For example, in CME since 1998, there has been a reported 24-fold increase in the number of Internet CME activities (to 93,582 in 2006); a 68-fold increase in physician participants (to 2.4 Million in 2006), and a 62-fold increase in non-physician participants (to 1.5 Million in 2006).
Also in this rebuttal includes the total bias of the Macy Conference towards “Point of Care CE”, they correctly pointed out that Up-to-Date, a commercial service that was very involved in the outcome of the conference epically the conference summary.
We find that the Conference Chairman’s Summary, the Conference assumptions along with the Conclusions and Recommendations directly and indirectly specifically promote “Internet point-of-care learning.” We observe that persons in a position to control the content of the Conference and its derivative written products have personal financial relationships with a proprietary entity marketing such product. These financial relationships were not disclosed in the Conference Chairman’s Summary although we note that the Proceedings now have a list of Statements of Potential Conflicts of Interest.
We ask, “Did the Macy Foundation manage this conflict of interest during the conference development process? Were steps taken to resolve this conflict of interest prior to the Conference?”
Conference Finding #4: There is too little high quality scientific study of CE.
We are not sure of the validity of this statement. A “Pub Med” search on ‘continuing education’ produces over 35,000 citations which range through a myriad of relevant topics. We are not aware of a published meta-analysis of all this literature that has drawn the conclusion that “There is too little high quality scientific study of CE.”
Finally, we believe that the Conference presents broad opinions and offers some dramatic changes for the CE enterprise, yet provides little evidence to support the need for, or the desirability of these recommendations. Some of the conclusions and recommendations for the future of CE would be better characterized as expressions of what is already in place.
We find it disappointing that the Conference seemed to be unaware of the current state of continuing healthcare education.
We see the Conference as a missed opportunity.
The Macy Foundation Conference brought together a group of important people without a universal understanding of the current CE delivery system or its outcomes — but with firmly held beliefs about what the deliverables of the system should be.
The CEO’s found that though they disagree with the recommendations, many of the deliverables described by the participants of the Macy Foundation Conference could have useful applications. They could easily be packaged as benchmarks by which we could evaluate and monitor our CE systems. They could provide a future framework for organizational and system self-assessment and improvement.
Our industry benefits from its broad range of participants and providers, the Macy Conference reflects only a small minority of providers (mostly academic faculty, no representation from specialty societies, medical communication companies, state level providers) and therefore the CEO’s were correct in firmness of their response.
The CEO’s belief and position is that everything can be improved.
As we work together to bring about high quality medical education for healthcare providers it is important not to discredit the hard work and diversification that everyone before us has done to make this the best medical education system in the world.
We have written extensively on this issue:
Macy Report — Filled in the Blanks
Macy Report — The World is Flat