<?xml version="1.0" encoding="UTF-8"?><rss version="2.0" xmlns:content="http://purl.org/rss/1.0/modules/content/" xmlns:wfw="http://wellformedweb.org/CommentAPI/" xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:atom="http://www.w3.org/2005/Atom" xmlns:sy="http://purl.org/rss/1.0/modules/syndication/" xmlns:slash="http://purl.org/rss/1.0/modules/slash/" > <channel> <title>Flexer Report – Policy & Medicine</title> <atom:link href="https://www.policymed.com/tag/flexer-report/feed" rel="self" type="application/rss+xml" /> <link>https://www.policymed.com</link> <description>Legal, Regulatory, and Compliance Issues</description> <lastBuildDate>Thu, 03 May 2018 20:02:48 +0000</lastBuildDate> <language>en-US</language> <sy:updatePeriod> hourly </sy:updatePeriod> <sy:updateFrequency> 1 </sy:updateFrequency> <image> <url>https://www.policymed.com/wp-content/uploads/2018/05/cropped-favicon-32x32.png</url> <title>Flexer Report – Policy & Medicine</title> <link>https://www.policymed.com</link> <width>32</width> <height>32</height> </image> <item> <title>JAMA: Reform of Continuing Medical Education – Still Living in 1910</title> <link>https://www.policymed.com/2009/10/jama-reform-of-continuation-medical-education-still-living-in-1910.html</link> <comments>https://www.policymed.com/2009/10/jama-reform-of-continuation-medical-education-still-living-in-1910.html#respond</comments> <dc:creator><![CDATA[Thomas Sullivan]]></dc:creator> <pubDate>Thu, 29 Oct 2009 09:37:14 +0000</pubDate> <category><![CDATA[Conflict of Interest]]></category> <category><![CDATA[Medical Journals]]></category> <category><![CDATA[CME]]></category> <category><![CDATA[Eric Campbell]]></category> <category><![CDATA[Flexer Report]]></category> <category><![CDATA[JAMA]]></category> <category><![CDATA[Josiah Macy Foundation]]></category> <category><![CDATA[NEW]]></category> <guid isPermaLink="false">http://www.policymed.com/jama-reform-of-continuation-medical-education-still-living-in-1910/</guid> <description><![CDATA[<div style="margin-bottom:20px;"><img width="457" height="575" src="https://www.policymed.com/wp-content/uploads/2009/10/0803_retrospect_surgery.jpg" class="attachment-post-thumbnail size-post-thumbnail wp-post-image" alt="" decoding="async" fetchpriority="high" srcset="https://www.policymed.com/wp-content/uploads/2009/10/0803_retrospect_surgery.jpg 457w, https://www.policymed.com/wp-content/uploads/2009/10/0803_retrospect_surgery-238x300.jpg 238w" sizes="(max-width: 457px) 100vw, 457px" /></div>A recent commentary published in the Journal of American Medicine (JAMA) begins its call for reforming continuing medical education (CME) by citing The 1910 Flexner Report, as if Abraham Flexner is alive and well today. Flexner an unemployed school principle had never physically been in a medical school prior to embarking on his […]]]></description> <content:encoded><![CDATA[<div style="margin-bottom:20px;"><img width="457" height="575" src="https://www.policymed.com/wp-content/uploads/2009/10/0803_retrospect_surgery.jpg" class="attachment-post-thumbnail size-post-thumbnail wp-post-image" alt="" decoding="async" srcset="https://www.policymed.com/wp-content/uploads/2009/10/0803_retrospect_surgery.jpg 457w, https://www.policymed.com/wp-content/uploads/2009/10/0803_retrospect_surgery-238x300.jpg 238w" sizes="(max-width: 457px) 100vw, 457px" /></div><p><span style="font-family: 'Arial','sans-serif';"><a href="http://jama.ama-assn.org/cgi/content/short/302/16/1807?home"><span style="color: #800080;">A recent commentary</span></a> published in the Journal of American Medicine (JAMA) begins its call for reforming continuing medical education (CME) by citing <a href="http://www.rienstraclinic.com/info/FlexnerPharos.pdf"><span style="color: #800080;">The 1910 Flexner Report</span></a>, as if Abraham Flexner is alive and well today. <span style="mso-spacerun: yes;"> </span></span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt;"><span style="font-family: 'Arial','sans-serif';"> </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt;"><span style="font-family: 'Arial','sans-serif';">Flexner an unemployed school principle had never physically been in a medical school prior to embarking on his research.<span style="mso-spacerun: yes;"> </span>He claimed to have investigated 69 medical schools during a 90 day period.<span style="mso-spacerun: yes;"> </span>At that time meant train travel throughout the country. </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt;"><span style="font-family: 'Arial','sans-serif';"> </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt;"><span style="font-family: 'Arial','sans-serif';">Abraham Flexner in his research to his own admission failed to utilize standardized research criteria.<span style="mso-spacerun: yes;"> </span>His goal was to reduce</span> <span style="font-family: 'Arial','sans-serif'; mso-bidi-font-weight: bold; mso-bidi-font-style: italic;">the number of physicians</span><span style="font-family: 'Arial','sans-serif';">, <span style="mso-bidi-font-weight: bold; mso-bidi-font-style: italic;">close all non-allopathic medical schools</span>, and <span style="mso-bidi-font-weight: bold; mso-bidi-font-style: italic;">abolished proprietary medical schools</span> (medical schools run as businesses).<span style="mso-spacerun: yes;"> </span>In addition he failed to take into account any of the advances that these private institutions had contributed to medicine.</span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt;"><span style="font-family: 'Arial','sans-serif';"> </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt;"><span style="font-family: 'Arial','sans-serif';"><a href="http://en.wikipedia.org/wiki/Flexner_Report"><span style="color: #800080;">The report</span></a> was full of utopian altruism, </span><span lang="EN" style="font-family: 'Arial','sans-serif'; mso-ansi-language: EN;">less known is Flexner’s recommendation that medical schools appoint full-time clinical professors. Holders of these appointments would become “true university teachers, barred from all but charity practice, in the interest of teaching.” </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt;"><span style="font-family: 'Arial','sans-serif';"> </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt;"><span style="font-family: 'Arial','sans-serif';">Compliance to the Flexner report which was embraced by the American Medical Association and state regulatory boards drastically reduced the supply of physicians in the US, and significantly increased the cost of medicine.<span style="mso-spacerun: yes;"> </span>Rural and areas with poorer patients were especially hard hit by the lack of physicians that resulted from shutting down most of the countries medical schools.<span style="mso-spacerun: yes;"> </span></span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt;"><span style="font-family: 'Arial','sans-serif';"> </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt;"><span style="font-family: 'Arial','sans-serif';">The report was particularly discriminatory towards women and African American physicians resulting in the closing of all women only medical schools and reducing the number of African American schools to 2 and in 1964 fifty years later largely as result of his report subsequent regulation less than 3% of students entering medical school were African American’s and we still see extremely low numbers today.</span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt;"><span style="font-family: 'Arial','sans-serif';"> </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt;"><span style="font-family: 'Arial','sans-serif';">The commentary, titled “<a href="http://jama.ama-assn.org/cgi/content/short/302/16/1807?home"><span style="color: #800080;">Reform of Continuing Medical Education: Investments in Physician Human Capital</span></a>,” was written by Eric G. Campbell, PhD who by his own words lasts December received $150,000 for this “research” from the <a href="http://www.josiahmacyfoundation.org/"><span style="color: #800080;">Josiah Macy Foundation</span></a> that would more than likely get published in JAMA (such confidence in his connections).<span style="mso-spacerun: yes;"> </span></span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto;"><span style="font-family: 'Arial','sans-serif';">His “research” is part of a <a href="http://article.nationalreview.com/?q=MDQwZmUwZTZjNzA5MjExY2MzN2NiY2EwOThhMzQ4NTY=&w=MQ=="><span style="color: #800080;">full scale initiative by the Macy Foundation</span></a> which hired Campbell, IOM and <a href="http://www.aamc.org/meded/cme/lifelong/description.htm"><span style="color: #800080;">AAMC</span></a> to write complementary reports on CME.<span style="mso-spacerun: yes;"> </span><a href="http://www.iom.edu/~/media/Files/Activity%20Files/Workforce/HCContinuingEd/Meeting-1-Dec-11-2008/Campbell%20Slides.ashx"><span style="color: #800080;">Eric outlined</span></a> at the <a href="http://www.iom.edu/Activities/Workforce/HCContinuingEd/2008-DEC-11.aspx"><span style="color: #800080;">IOM hearing in December</span></a> how he was going to find a new system of funding for CME.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>In his own words “CME was expendable”(Audio Files of his talk).</span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto;"> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto;"><span style="font-family: 'Arial','sans-serif';">Moreover, JAMA editor Katherine De Angelis, MD is an active participant in several Macy Foundation fully funded initiatives including the <a href="http://www.iom.edu/en/Activities/Workforce/HCContinuingEd.aspx"><span style="color: #800080;">IOM committee on a Planning a Healthcare Continuing Medical Education Institute</span></a>, and was a participant in the Macy Conference held in Bermuda and subsequent <a href="http://www.josiahmacyfoundation.org/documents/pub_ContEd_inHealthProf.pdf"><span style="color: #800080;">Monograph on Continuing Education in the Health professions</span></a>.<span style="mso-spacerun: yes;"> </span>The Director of the JAMA oversight committee Jordan Cohen, MD is a member of the <a href="http://www.josiahmacyfoundation.org/index.php?section=board"><span style="color: #800080;">Macy Foundation Board of Directors</span></a>.</span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto;"> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto;"><span style="font-family: 'Arial','sans-serif';">The results of Eric’s “study” are less than impressive and his subsequent commentary requires a strong response.</span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto;"> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto;"><span style="font-family: 'Arial','sans-serif';">Accordingly, his editorial on CME, which cites only 8 references, (2 news stories, 2 editorials, 1 report based on editorial, 1 survey, 1 review, 1 research paper on GME) is nothing more then a clearly unsubstantiated “opinion paper,” that should be properly disclosed or retracted. </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: 'Arial','sans-serif';">Regardless of this error, Mr. Campbell goes on to make the claim that “CME<span style="color: #231f20;"> should apply new knowledge and skills that directly benefit patient and societal outcomes (e.g. providing high-quality, efficient, and cost-effective care).” Completely disregarding the breakthroughs CME programs have provided to physicians and patients over the past few decades (e.g. how to use new medical devices, instruction on new treatments and medicines), he claims that traditional CME does not focus on these outcomes. One wonders in all of his paid research whether Mr. Campbell even attended a CME program.</span></span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt;"><span style="font-family: 'Arial','sans-serif';"> </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: 'Arial','sans-serif';">Instead, Mr. Campbell would rather focus on a century old <span style="color: #231f20;">report that could not have predicted the impact that medical device and pharmaceutical companies would play in creating life saving treatments and breakthroughs. He tries to downplay such breakthroughs so that he can call for “sweeping reform” in CME that provides a “productive means of investing in physician human capital.” What exactly does human capital refer to? He calls this capital, “knowledge and skills.”</span></span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';"> </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';">Such knowledge and skills are inherent throughout all CME because these programs are created by medical professionals, for medical practitioners to educate doctors on ways to better serve society by making people healthier through new research and ways to practice medicine.<span style="mso-spacerun: yes;"> </span></span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';"> </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';">The only human capital Mr. Campbell is referring to is an attempt to remove industry investment, which he believes may be potentially biased. To make such a claim using a century old report and no evidence, is clearly more biased than any industry involvement in CME. <span style="mso-spacerun: yes;"> </span></span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><strong><span style="color: #231f20; font-family: 'Arial','sans-serif';"> </span></strong></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><strong><span style="color: #231f20; font-family: 'Arial','sans-serif';">Excessive Commercialization </span></strong></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><strong><span style="color: #231f20; font-family: 'Arial','sans-serif';"> </span></strong></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif'; mso-bidi-font-weight: bold;">He cites numbers which show that CME </span><span style="color: #231f20; font-family: 'Arial','sans-serif';">has high profit margins (23.5%) which can be attributed to the fact that most CME providers are hospitals, universities and medical societies which attribute all income from CME for accreditation as (profit) and do not include their overhead and staff time in their reports as expenses.<span style="mso-spacerun: yes;"> </span>But in fairness to Eric he would not know this unless he worked in CME which he does not.</span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';"> </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';">He attributes the profit <span style="mso-spacerun: yes;"> </span>to commercial support, which the ACCME annual report does not, which accounts for 58% of income of accredited CME provider organizations.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Of course he uses the 2007 data and not the most current data, which shows a precipitous $200 million drop in CME funding.</span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';"> </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';">If industry did not provide such support then who would? How much would physicians and patients suffer with only 42% support of CME from other non-profit sources? </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';"> </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';">The reality of commercialization is that today, for a new drug or device to become useful to help treat patients is a multi-stage, multi-million dollar, multi-year process that few investors are willing to take the risk of, even when it means saving lives. So then why criticize those companies that take on all the risk, when their sole purpose is to save lives and make people healthier?</span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><strong><span style="color: #231f20; font-family: 'Arial','sans-serif';"> </span></strong></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><strong><span style="color: #231f20; font-family: 'Arial','sans-serif';">Unstandardized Curricula</span></strong></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><strong><span style="color: #231f20; font-family: 'Arial','sans-serif';"> </span></strong></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif'; mso-bidi-font-weight: bold;">As is the case for all highly trained professionals, </span><span style="color: #231f20; font-family: 'Arial','sans-serif';">physicians must fulfill a designated number of accredited CME credits to maintain their licenses in most states. Mr. Campbell’s criticism that “physicians have broad autonomy in selecting course topics types of learning experience, and activity locations” sounds like government controlled medicine.<span style="mso-spacerun: yes;"> </span>His ethical dilemma is Eric’s and JAMA’s editors firmly held belief that physicians should not have broad autonomy that they are unable to think for themselves, that medical practice should be restricted by academia and the government.</span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';"> </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';">CME is voluntary, and no doctor would choose to lose the income from his practice, or the risk of losing a patient if such a program or educational opportunity was not of great importance. Furthermore, there is no way to standardize the practice of each program because every patient is different, and each person requires different sorts of medical attention and treatments. Since this is the case, CME delivered only as a standardized curricula would prevent doctors from the necessary experience to identify complex problems and provide critical decisions for pressing issues that are increasingly a matter of life or death. <span style="mso-spacerun: yes;"> </span>It also limits the </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';"> </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';">Additionally, his call for CME to represent a “mastery of an essential core set of knowledge and competencies” is precisely what CME does. There are numerous professional organizations, associations and medical journals that provide endless scholarship in every area of medicine. CME simply represents another facet for physicians to use to help them master their core set of knowledge and skills. The fact that there are a “diversity of CME offerings that provide benefits to physicians” should reassure patients that physicians are carefully choosing programs that will truly benefit them the most, not because the doctors have a paid trip to a nice hotel. </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><strong><span style="color: #231f20; font-family: 'Arial','sans-serif';"> </span></strong></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><strong><span style="color: #231f20; font-family: 'Arial','sans-serif';">Lack of Effect on Patient Care</span></strong></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><strong><span style="color: #231f20; font-family: 'Arial','sans-serif';"> </span></strong></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';">The idea that CME today is analogous to a century old report is laughable. Programs that discuss the outcomes of clinical studies, show physicians how to use medical devices, and discuss the future and present needs in medicine in an open and experienced forum is nothing like lectures and note memorization in medical school. Perhaps the reason why such programs are held at various locations is for that exact reason: to remove doctors from the classroom experience and provide more practical experiences. </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';"> </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';">Still, Mr. Campbell’s claim that “traditional CME is not adequately focused on improving patient outcomes” is a blatant distortion of the truth. In fact, he uses a <a href="http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hserta&part=A234741">source</a> an AHRQ study that says exactly the opposite of his claim that “there is scant evidence that CME actually improves patient outcomes.” Specifically, researchers in the AHRQ study concluded that:</span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';"> </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="mso-tab-count: 1;"><span style="font-family: Times New Roman;"> </span></span><span style="font-family: 'Arial','sans-serif';">“CME appears to be effective at the acquisition and retention of knowledge, <span style="mso-tab-count: 1;"> </span>attitudes, skills, behaviors and clinical outcomes.” </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><strong><span style="color: #231f20; font-family: 'Arial','sans-serif';"> </span></strong></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif'; mso-bidi-font-weight: bold;">Contrary to this case of academic misrepresentation, Mr. Campbell calls for a new model of CME, one with a purpose to “</span><span style="color: #231f20; font-family: 'Arial','sans-serif';">maintain and improve the quality and efficiency of the US health care system.” What evidence states at present that CME has a different purpose than this? The problems of quality and efficiency in the US health care system are not caused by CME, they are alleviated. Without CME, health care would be in much worse shape. So what changes are needed to give physicians more skills and knowledge (human capital)?</span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';"> </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';">First, Mr. Campbell thinks there should be “financial incentives for more meaningful CME. “ He notes that “currently, most physicians are not paid based on the quality or efficiency of their practice.” This is a problem of the health care system (e.g. reimbursement rates, fee for service, insurance company practices). While the idea of incentivizing CME is important, has assisted in incentivizing CME by providing grants for higher quality education than non funded education.<span style="mso-spacerun: yes;"> </span>The only thing that providers of CME need to refocus is how to avoid burdensome regulations and policies that make it almost impossible to continue staying in the business of educating doctors on how to save more lives.</span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';"> </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';">Second, Mr. Campbell asserts that “making maintenance of certification a mandatory requirement for licensure should be strongly considered.” This point is already accomplished by CME programs which do “embody continual engagement with the process of professional improvement through accredited programs. Interestingly, the editorial calls for more CME credits, calling the current minimum of 20-50 CME credits per year “too low.” More CME is exactly what will provide patients with better care and physicians more knowledge and skills. Since Mr. Campbell, as do most critics, offer no way in which the additional programs and courses will be offered and funded, surely industry and providers will gladly foot the bill, not because of the profits but for the lives they will change. </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';"> </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';">Campbell</span><span style="color: #231f20; font-family: 'Arial','sans-serif';">’s third idea to use health information technology (HIT) has already been discredited numerous times. Enhancing physician learning from their routine clinical duties means having more meaningful interactions with patients, and attending more programs where physicians can interact with researchers and scientists to share experience. Using electronic health records will reduce the amount of time doctors have to see patients, and will result in no cost savings. Furthermore, the training of staff, potential for error, and privacy issues all outweigh any potential gains. Finally, “CME activities that include clinical problems encountered in day-to-day practice” already exist.</span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';"> </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><strong><span style="color: #231f20; font-family: 'Arial','sans-serif';">Financing the New CME</span></strong></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><strong><span style="color: #231f20; font-family: 'Arial','sans-serif';"> </span></strong></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';">While claims like CME are “too reliant on industry funding” and “tend to promote a narrow focus on products,” once again, what is the alternative source for money? To create a broader “education on alternative strategies for managing health conditions and other important issues” without industry is highly unlikely. If Mr. Campbell wants to reorient CME away from “marketing drugs,” what system of funding will he use?</span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';"> </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';">His idea that physicians should personally invest in their own CME is already the case: although required by most states to maintain their license, doctors choose which programs to attend often giving up large amounts of personal time and traveling great distances to meetings and conferences at their own personal expense. How would we reward physicians for “practicing high-quality, efficient medicine” or “performance-based incentives?” Who would determine such rewards?</span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';"> </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';">How is the use of specialty boards, also accredited organizations, any different than accredited CME providers? Having a large infrastructure to operate and enforce large-scale maintenance-of-certification programs guarantees nothing (e.g. AMA’s CEJA Report is on round three).</span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';"> </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif';">The use of funded and provided by medical schools and teaching hospitals should be highly valued and increased in use but, where is the money coming from? <span style="mso-spacerun: yes;"> </span>Will this shift the current focus from therapy and treatment to diagnostics and referral from local physicians for high end procedures?<span style="mso-spacerun: yes;"> </span>How many physicians in Montana have access to a program only offered in one place, as is the case for many rural states? Physicians need CME to come to them, and medical schools cannot provide such a service.</span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><strong><span style="color: #231f20; font-family: 'Arial','sans-serif';"> </span></strong></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><strong><span style="color: #231f20; font-family: 'Arial','sans-serif';">Conclusion</span></strong></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><strong><span style="color: #231f20; font-family: 'Arial','sans-serif';"> </span></strong></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif'; mso-bidi-font-weight: bold;">There is only one problem with CME today: there are not enough programs to address the growing needs of patients and physicians. The continued use of commercial support to fill in this gap is necessary to help physicians treat patients. The suggestions outlined by Mr. Campbell suggest a complete misunderstanding of the significance of CME today. <span style="mso-spacerun: yes;"> </span></span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif'; mso-bidi-font-weight: bold;"> </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif'; mso-bidi-font-weight: bold;">Mr. Campbell and other “reformers” pride themselves on repeating Abraham Flexner’s accomplishments; proposing to limit the choices of physicians.<span style="mso-spacerun: yes;"> </span>Perhaps they should also consider theirs and Flexner’s shortcomings at the same time.</span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif'; mso-bidi-font-weight: bold;"> </span></p> <p class="MsoNormal" style="margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #231f20; font-family: 'Arial','sans-serif'; mso-bidi-font-weight: bold;">Perhaps he should focus less on 1910 and more on 2010 and read some of <a href="http://www.policymed.com/cme/">our stories here on the success of CME.</a> <span style="mso-spacerun: yes;"> </span></span></p> <p> </p> <p> </p> ]]></content:encoded> <wfw:commentRss>https://www.policymed.com/2009/10/jama-reform-of-continuation-medical-education-still-living-in-1910.html/feed</wfw:commentRss> <slash:comments>0</slash:comments> </item> </channel> </rss>