While I m not yet sure what the actual headcount turned out to be, the San Francisco Marriott was jumping last week with attendees of the Alliance for CME s 30th Annual Conference. As Suzanne Ziemnik, director, Division of CME with the American Academy of Pediatrics said at the Specialty Society Provider Section Meeting last Wednesday, “The reason the Alliance is having record-breaking attendance is due to beautiful San Francisco and to [panelist and manager of accreditation services with the ACCME] David Baldwin and his ACCME colleagues.”

Not surprisingly, the hottest of the hot sessions were all ACCME, all the time, as providers still struggle with determining how to implement the new Standards for Commercial Support before the implementation deadline this spring. In fact, most that I tried to go to were beyond standing room only there was serious overflow into the hallways as people strained to hear the latest from both ACCME officials and their peers. Murray Kopelow, chief executive of the ACCME, also did his best to answer questions that at times were pretty heated during a set of two mini-plenaries on Thursday afternoon. Despite a glitch that had the lights going out at inopportune moments, Kopelow did an admirable job, IMHO, of trying to give direct and specific answers to providers questions about the new Standards.

Another white-hot session was the almost four-hour-long panel called, “Pleasures, Pain, Perils, and Pitfalls of Commercial Support.” This session, most of which I attended by literally sitting at the feet of the masters, featured a panel of pharma CME managers. Other than a short presentation by each panelist at the beginning, the rest of the time was spent by lobbing questions at the panelists who, after repeatedly emphasizing that what they said was their own opinion, not that of their employers, did their best to answer honestly–even though some of their answers were not what the audience wanted to hear. Lawrence Sherman, senior vice president of Jobson Education, was a most excellent moderator who kept us laughing and interspersed some interactivity through the long session with an audience-response system.

My biggest beef was that I would see people I wanted to talk to as they were going up the escalator while I was going down, or on the other side of the crowded hallway. But I did get to see some old friends and meet some new ones at our booth in the exhibit hall (great idea to have breakfast in the hall, guys!), and at the networking reception, also held in the exhibit area, on Thursday evening.

Anyway, stay tuned, because as soon as I dig out from being away for a few days, I ll post writeups of the sessions I went to here on the blog. There was a lot of really good stuff even though I m not entirely sure we resolved the “resolve” question of 2.3 of the new Standards!

To comment on this post, click on “comments” below. To receive a weekly update, e-mail Sue.

Physician/healthcare bloggers, start your engines! Grand Rounds, otherwise known as the best of the best medical blogs of the week, are coming to Capsules on Tuesday, Feb. 1. Please send your entries as soon as possible, with a final deadline of Monday night. For submission guidelines, click here. If you have any CME-related posts, this is the perfect week to highlight them!

CME providers and pharma meeting planners, this is a great opportunity for you all to take a peek at what the recipients of all your hard work are thinking about. Check out this week’s Grand Rounds at A Chance to Cut is a Chance to Cure, one of my own personal favorite physician blogs, even if he does include some images on occasion that make me woozy.

Here’s another Q&A from yesterday’s session at the Alliance for CME conference:

Can a non-physician receive AMA PRA Category 1 credit for a CME activity?

1. Only if they’re listed as part of the invited audience.

2. Only if their governing body accepts Category 1 credit.

3. No.

The right answer is #2–AAFP and some nursing organizations also can accept Category 1 credit.

Here’s another one: Can a product manager or other marketing representative be present during a planning committee meeting?

No

Yes

Yes, if they contribute only information about their products.

The audience was pretty split on this one, with 44 percent saying no, 51 percent saying yes (just 5 percent picked the third option). A panelist representing a pharma company said his company leaves this up to the provider to make the call. “It wouldn’t be someone from the marketing department, though,” he said. “It would be someone who could verify that the data was correct.” There was some discussion about the difference between influence and control. An audience member noted that while ACCME says the provider must maintain control of the content, a pharma person’s presence could be construed as an influence over the content, just by being there. But element 1.1 of the Standards states pretty clearly that the issue is control. “The issue goes back to perception,” said one audience member. “Will the faculty be influenced by pharma being in the room? You have to have a policy so the perception of bias isn’t created by pharma being there.”

Here’s another quiz question from today’s forum at the Alliance meeting:

Honorarium received for CME speaking for which commercial support has been received creates a personal conflict of interest.

True

False

The answer, which 77 percent of the audience got right, was false. An audience member said she has had speakers decline to speak because of worries about perceived conflict in this type of circumstance, especially from faculty involved in managed care. Another audience member said that it’s part of the CME provider’s educational process to help faculty understand that the provider is the one getting the grant and providing the honoraria. It doesn’t come direct from pharma. A panelist representing a pharma company added that another way to get around the problem is to tell the faculty member that s/he can donate the honorarium to a specialty society or other interest so the perception of conflict and/or bias doesn’t come up.

Drats! I was looking forward to going to the Commercial Support: Regulations, Ethics, and Relationships forum this morning, but it was so jammed that I could only get a seat in the hallway, until security made us leave because we were a fire hazard.

But I ended up at a great session that used an audience response system to quiz us on our knowledge of both well-known and pretty obscure regulatory points. I’ll post them as I get time to between sessions.

Here’s one: Is there a limit to the amount of honoraria that can be paid?

1. The limiting factor is the amount of commercial support available.

2. It must be reasonable and of fair market value.

3. It depends on the faculty’s negotiating skills ;>

Our audience came up 13 percent for #1, 80 percent for #2, 7 percent (the wise guys, of course) for #3. The audience was right, or at least 80 percent of us were. A panelist who works for a pharma company elaborated that his company sets a dollar-per-year limit, but re-evaluates regularly to make sure it remains a fair and reasonable amount, adding that the OIG mentions that it should be fair market value.

Pri-Med did something interesting in its Southwest Conference & Exhibition at the George R. Brown Convention Center in Houston recently: It offered physicians a chance to experience a “connected office” that featured Hewlett-Packard hardware and eClinical Works, GE Healthcare and WebMD Practice Services software systems designed for

physician practices. According to a press release, it “enables the more than 4,000 attendees to simulate the use of wireless communications and electronic medical records systems in a real-world clinical practice environment.”

In the Practice Solutions Showcase, clinicians participate in demonstrations of systems designed to increase efficiencies and support higher quality care through the use of Electronic Medical Records and mobile hardware such as Tablet PCs and PDAs. Attendees experience how patient records can be electronically retrieved and how new data entered by the physician automatically updates patient files and billing and insurance claim forms.

What a great idea. If nothing else, it gives people a chance to lust for something that works much better, one would hope, than the current EMRs most organizations use, if any. Effective for the manufacturers, too, especially if they can create some “brand evangelists” who go back home and lobby hard for the new systems.

And another one from Anne:

Here is yet another article on portfolios, from the February 2005 issue of Archives of Disease in Childhood:

Davies H, Khera N, Stroobant J. Portfolios, appraisal, revalidation, and all that: a user’s guide for consultants. Arch Dis Child 2005; 90(2):165-170.

Abstract: From April 2005 all doctors in the UK will be expected to be able to demonstrate their fitness to practice as part of the GMC revalidation procedures.(1) The revalidation process is explicitly linked to the consultant appraisal process implemented in 2001.(2) Central to both processes is the development! of a folder (portfolio) of supporting evidence. Many consultants have no experience of developing portfolios and are unclear about how to meaningfully do so and what sort of evidence is suitable for revalidation. Furthermore, they are uncertain about whether there is any evidence to support their use for appraisal or assessment. This paper describes what a portfolio is, summarises the evidence for their use in appraisal and assessment, and provides guidance on the collection of evidence for revalidation purposes. In addition, it explores the distinction between appraisal and revalidation. Some evaluation data on perceived benefits and drawbacks by participants in appraisal in a paediatric setting is also included to inform conclusions and thoughts on planning for the future.

PubMed

Journal abstract

Citation map

I had hoped to do some blogging from the Alliance meeting going on now in San Francisco, but haven’t found the time yet to write up my notes. In the meantime, here’s a post from my co-blogger, Anne Taylor-Vaisey:

From the latest issue of Hastings Center Report:

Verkerk M, Lindemann H, Maeckelberghe E, Feenstra E, Hartoungh R, De Bree M. Enhancing reflection: an interpersonal exercise in ethics education. Hastings Center Report 2004; 34(6):31-38.

Abstract: There are no moral cookbooks–no algorithms for whipping up moral confections to suit every occasion. But more modest and flexible tools might still be useful for practical ethics. One te! am describes how professionals can be taught to use a framework for understanding moral problems.

Excerpt: To adapt to the new environment, a good professional must not only exhibit the technical proficiency that allows her to do things right-she must also do the right thing. She needs to be aware of her own professional norms and values; to be able to express them to her colleagues, her patients, and their families; and to work together with these other actors to provide ethically responsible care. In short, if professionals are to do the right thing, they must develop a refined capacity for moral reflection.

We have developed a tool for practical ethics instruction aimed at helping professionals to do just that. The tool has been designed to be flexible enough to be used not only in medicine, but also in a number of other venues, including business, architecture, journalism, and the like. While resources featuring the idea of reflection have p! roved popular in professional ethics education, (1) ours differs from them in that it is based on an expressive and collaborative conception of morality in which responsibilities are negotiated through narrative.

PubMed

I wonder if this will start to become more common: According to this article in the New York Times today, Eric J. Topol, the chief academic officer of the Cleveland Clinic Foundation, who has had consulting and financial ties with numerous drug and medical device companies including Eli Lilly and Bristol-Myers Squibb, “said in a letter to one company that he had decided to end most of his relationships to ‘maintain my academic credibility.’” But did he jump on his own, or was he shoved?

The decision follows a report in December by Fortune magazine that Dr. Topol, a leading critic of the painkiller Vioxx, was a paid consultant to a hedge fund that had made money betting that shares of Merck, Vioxx’s maker, would fall. Dr. Topol severed his ties with that firm, though he said he had no knowledge of the firm’s investment position.

Either way, it’s pretty interesting. But if all prominent physicians end up cutting their ties with pharma for whatever reason, that could be disastrous for drug and device research. No easy answers for this one.

In my editorial for the January/February issue of Medical Meetings, written just days after the tsunami hit Asia, my mind was on disaster preparedness for our healthcare workers. While we still have a way to go, it’s good to see that CME providers are working hard to make sure physicians and others on the front lines of disasters know how to deal with the unique challenges and pressures.

So I was doubly glad to hear that the Society of Thoractic Surgeons is including a program called “National Disaster Life Support” in its The Society of Thoracic Surgeons 41st Annual Meeting in Tampa, Florida, Mon., Jan. 24, 2005. And it sounds like they’re going to do a very good job of it:

In any kind of disaster situation, difficult decisions must be made in split seconds. Triage can become overwhelming. Communications will be critical to safety and containment. The STS program will begin to prepare cardiothoracic surgeons to implement the all-hazard approach to mass casualty incident preparedness and management. Participants will learn about the skills needed in these situations through a simulation and with dynamic audience interaction…



Every community needs its surgeons to be prepared for the worst. Every surgeon needs to know what to do when disaster strikes. “We can’t wait for disaster to strike to prepare,” says Dr. Gold. “Preparation must begin now and never stop. Today, disaster preparedness has become a lifelong learning commitment.”

Couldn’t say it better if I tried. I wish I could have gotten him to write my editorial for me!

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