If you work on medical meetings or with a pharmaceutical company, keep an eye out for a large guy with funny glasses and a baseball cap, especially if he’s lurking around your place of work or your meeting with hidden cameras. Yup, according to an article in the Chicago Tribune, Michael Moore plans to hit the healthcare industry for his next movie, tentatively titled “Sicko.” While it doesn’t mention CME specifically, Moore generally likes to hit all moving targets that fall in his range, and it’s hard to imagine CME would escape once he starts shooting from the hip

Now might be a good time for pharmaceutical companies and CME providers–and anyone else in the healthcare industry, for that matter–to train their staff on how to handle the media. While it may not protect you from Michael Moore, this article offers some tips on how to keep us media hounds at bay.

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Post by Anne Taylor-Vaisey

Continuing education: the good, the bad and the ugly

Christensen GJ. J Am Dent Assoc 2004; 135(7):921-924.

Abstract: Dental CE is mandatory for ongoing competency in dental practice. There are numerous methods of obtaining CE, some of which are highly successful and others that are of minimal value. In this article, I have described and prioritized the various methods of obtaining CE according to their effectiveness as I perceive it. CE in dentistry can be enjoyable, will allow dentists to serve their patients at a higher level of competency and will keep practitioners mentally stimulated as they learn new concepts and techniques.

PubMed link

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In a post that begins, “CME has become tainted,” DB’s Medical Rants–a physician-run blog–has lots to say about the new ACCME Standards for Commercial Support:

This rule appears solid on surface review. The problem will be in finding experts without conflict of interest. In many fields, virtually all the experts receive some pharmaceutical support (often for drug trials).



I suspect that we will see a new  specialty arise in CME. Those who have no financial ties will become the truth arbiters. And again on surface review this seems logical.




I worry that these new experts will have another axe to grind. None of us is without bias. Those who accept no pharmaceutical moneys (and I am included here) may have an anti-pharmaceutical company bias. They may tend towards therapeutic nihilism (at least until the evidence is overwhelming).

Uh oh, I posted about the new ACCME Standards for Commercial Support yesterday without reading all the related documents on the Web site. Things have changed since I last perused the document.

This morning I start getting calls from CME providers who have some serious concerns with the Identifying and Resolving Conflicts of Interest in Continuing Medical Education addendum that was released along with the new Standards, and now I realize that the article I referenced yesterday actually did get it right after all. My apologies to the AP reporter, whose story got picked up and is all over the place now.

For example, from today’s Atlanta Journal-Constitution:

Under the proposed rules, doctors with financial ties to a drug company would be told what kind of recommendations they could make during a teaching presentation. Those instructions would be given to the doctor by a third party with no links to the drug company, the AP reported.

I need to read through all this much more carefully before I can make any intelligent comment on it, but my gut is screaming, “First Amendment.” Anyway, I’d love to hear what you think–many of those I spoke with this morning believe this addendum actually rolls the Standards back to the earlier draft, which so many objected to. More later…

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This post is courtesy of Anne Taylor-Vaisey:

Below is is the abstract and full text link for an article published September 29 (!) in BMC Medical Education. Here is the home page for this online journal:

Maziar Abdolrasulnia, Blanche C Collins, Linda Casebeer, Terry Wal , Claire Spettell, Midge N Ray, Norman W Weissman and Jeroan J Allison. .Using email reminders to engage physicians in an Internet-based CME intervention. BMC Medical Education 2004, 4:17 doi:10.1186/1472-6920-4-17

Full text (pdf)

Abstract (provisional)

Background: Engaging practicing physicians in educational strategies that reinforce guideline adoption and improve the quality of healthcare may be difficult. Push technologies such as email offer new opportunities to engage physicians in online educational reinforcing strategies. The objectives of this study are to investigate 1) the effectiveness of email reminders in engaging recruited community-based primary care physicians in an online guideline reinforcement strategy designed to promote Chlamydia screening, 2) the characteristics of physicians who respond to email reminders, as well as 3) how quickly and when they respond to email announcements.

This just in from ACCME: “The member organizations of the ACCME have unanimously approved the 2004 Updated ACCME Standards for Commercial Support: Standards to Ensure the Independence of CME Activities.”

For complete information, click here.

Funny timing: I just came across this article about the new standards. In part, this is what it says:

In the past, a doctor teaching such a course would disclose his or her financial relationship with any drug company, say as a paid member of the company’s speakers’ bureau or a grant recipient. Once that was out in the open, the physician might then talk glowingly about anecdotal experience with that company’s drug.



Now, a third party with no ties to the drug company would have to tell the doctor what kind of recommendations he or she could make. Anecdotal observations would be replaced by results of systematic clinical trials. Any review of journal literature would have to include negative, as well as positive, studies.




“So this whole thing about just saying ‘I’ve got a conflict of interest. And I’ve got a relationship. And I’ve got a personal opinion. And I’m probably biased. But, I’m going to tell you anyways,’ that’s not allowed,” said Murray Kopelow, chief executive of the accreditation council.

This is, of course, a little off from what the Standards actually say, which is that CME providers must identify and resolve all conflicts of interest  but leaves the decisions about how to do that up to providers. It almost seems like this reporter was looking at the previous draft Standards, which raised a huge wave of discontent because it did appear to imply that any faculty with industry ties should be disqualified from speaking. The latest proposal only says that CME providers must identify and resolve conflicts of interest–not disqualify faculty out of hand if they have ties to industry.

For the most part, CME providers I’ve spoken with seem to think the new Standards are an improvement, though some remained worried over that “resolve” part.

We’ll have to wait and see how it all shakes out now that the new version is in play.

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I am so pleased to be able to welcome our new co-blogger, Anne Taylor-Vaisey, MLS.

Anne, a Canadian librarian with years of experience in continuing health education and librarianship, and in Internet training at all levels, is with the CMCC Health Sciences Library, Canadian Memorial Chiropractic College, in Toronto, Ontario. She also is a tireless seeker of the latest CME-related academic research and reporting, which she is willing to share with us here on Capsules.

Here’s the first of what I hope will be many of her contributions to Capsules:

From Medical Education Online:

Bradley P, Herrin J. Development and validation of an instrument to measure knowledge of evidence based practice and searching skills. Med Educ Online [serial online] 2004;9:15.

Abstract: The aim of this study was to develop and validate three instruments which measure knowledge about searching for and critically appraising scientific articles (evidence-based practice-EBP). Twenty-three questions were collected from previous studies and modified by an expert panel. These questions were then administered to 55 delegates before and after two international conferences in EBP; the responses were assessed for discriminative ability and internal consistency. Five questions were discarded and three instruments of six questions each were developed. Finally, the instruments were re-validated in a randomized controlled trial comparing two educational interventions at the University of Oslo, Norway by 166 of 175 eligible medical students. In the re-validation, the instruments showed satisfactory level of discriminate validity (p<0.05), but borderline levels of internal consistency (Cronbach s a 0.52-0.61). More research is needed to develop a suitable instrument which includes questions on searching for evidence.

Free full text

PDF version

In part due to the abusive prescribing habits of some doctors outlined in this article from signsonSanDiego, California soon will require its doctors to take CME in pain management. “By 2006, all doctors in the state must prove they have taken a continuing education course in pain management before their licenses can be renewed.”

That could help with the incompetence angle, but that s only one of the top three reasons docs overprescribe pain meds, it says. The other two are greed and deception, and I don t know of any CME activity that can change those behaviors once they re ingrained–that goes more to character than education.

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First Nebraska develops a telenetwork for CME, and now, according to an article on sunnetwork.org, so is India.

About a week ago, India launched Edusat, the country s first theme-based satellite (it s theme being education), which will be operational in about a month. “In the first phase, there would be 1,000 terminals with two-way interactive facility,” with 9,000 more coming in the next three years to link the country s educational institutions.

& the programme of linking Kerala’s medical colleges with district hospitals to promote continuing medical education and expert consultation would be commissioned in three months.

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Here’s another interesting article on the topic I posted about earlier:

Visible Simulation in Medical Education: Notes and Discussion from Sage Publications.

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