Graham T. McMahon, MD, MMSc, president and CEO at the Accreditation Council for Continuing Medical Education (ACCME), published a recent article in the Journal of the American Medical Association on the guiding principles behind the New Standards for Integrity and Independence in Continuing Medical Education (CME).
In the article, Dr. McMahon discussed the importance of trust, noting that physicians, health care professionals, patients, and the general public need to be able to trust that accredited education is “delivering scientifically accurate content that is free from industry manipulation and influence,” while also acknowledging that collaboration between health care professionals and industry can advance patient care.
Dr. McMahon went back to 1992, when the ACCME initially released standards governing interactions between CME and Industry in response to concerns from both the government and physicians about the “inappropriate influence of industry over education.” He also referenced the 2004 revisions that included more stringent requirements (with particular regard to the disclosure of conflicts of interest). Over the course of time, the ACCME Standards have been adopted by other accrediting bodies, representing multiple health care professions throughout the United States.
The adoption of the ACCME Standards by other accrediting bodies, in addition to recognition by international accrediting and regulatory bodies, “suggest that the standards have been effective in preventing commercial bias in CME without constraining the dialogue that facilitates discovery.” McMahon notes that “studies show low rates of perceived commercial bias for accredited CME activities and find no evidence that industry funding, when present, influences content or introduces bias in accredited activities.”
Turning to the present, McMahon notes that “the health care ecosystem has changed considerably” since the 2004 revisions, which prompted a two year process of communication and work to “streamline, clarify, and modernize the standards and ensure that the accredited CME system delivers on its promise to facilitate quality and unbiased education to the profession in a changing health care environment.”
ACCME issued a draft set of Standards in early 2020 and finalized them in December 2020. Since the new Standards have been finalized and published, six accrediting bodies have adopted them, including those who oversee the continuing education environment for nurses and pharmacists. All accredited CME providers must comply with the new ACCME standards no later than January 1, 2022, and compliance will be monitored via ACCME’s existing audit, remediation, and accountability framework.
In his article, Dr. McMahon outlined some of the key changes in the updated Standards, including discussing content validity and disclosure expectations. He notes that “issues related to content validity are more important than ever” and because of that, content validity is now the first standard in an attempt to emphasize its importance. Under the content validity standard, all recommendations for patient care in accredited CME must be based on current science, evidence, and clinical reasoning and also give a “fair and balanced view of diagnostic and therapeutic options.” The new standard also clarifies that accredited CME is “an appropriate and important place to discuss, debate, and explore new and evolving topics,” that should be identified as such.
Additionally, a key principle in the standards has long been disclosure – all individuals involved in CME must disclose financial relationships with industry to the accredited provider and their learner colleagues. The new standards include a more rigorous disclosure process as planners, faculty, and others involved in creating the educational content are all required to disclose all direct and indirect financial relationships with industry to the accredited provider of education. The CME provider is responsible for determining which relationships are relevant, which is a contrast to the prior standards where the responsibility for determining relevance was with the individual planners or faculty.
Dr. McMahon concludes his article by reiterating that the “fundamental principles of independence and integrity in the name and text of the new standards are intended to convey their critical importance in ensuring that accredited CME serves the public trust” and highlighting the fact that “each individual involved in CME has a role and responsibility in upholding these core principles.”