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Navigating the minefield

The changing face of CME in Europe: have reports of its 'death' been greatly exaggerated?

A minePharma's role in supporting CME is under growing scrutiny as Europe observes the erosion of pharma's reputation around CME through unsavoury practices in America with growing concern. Protecting the industry's positive contribution to high-quality medical education in Europe is today's pressing challenge, as the appetite of doctors for accredited medical education continues to grow apace, spurred on by mandatory national requirements and the anticipated arrival of revalidation. The explosion of online learning technology, punctuated by the recent advent of pan-European accreditation for eCME, has hailed a mass expansion in the volume of education offered to doctors. What can and should pharmaceutical companies be doing?

Paying the price
Over the years, pharma has spent billions of Euros supporting continuing medical education (CME) and other non-promotional projects, with relatively little thanks and much scepticism. CME is here to stay but pharma's role as a major funder for accredited CME programmes is in question and single-sponsored initiatives are increasingly meeting resistance from accrediting bodies. But with a trend towards mandatory CME across Europe, funding needs can only increase. With over half of all CME funding in Europe currently originating from the pharmaceutical industry, how can this situation be resolved to all stakeholders' satisfaction?

Questionable returns?
Is supporting CME still a good investment for pharmaceutical companies? PCM Scientific recently undertook a survey of 300 physicians across four key European markets to ascertain what types of education were of the most value and influence for physicians. The majority of doctors ranked CME as their preferred source for enhancing their knowledge and clinical practice. Attendance at non-accredited meetings, meanwhile, was the lowest priority for most surveyed. Clearly, then, investment in CME is more likely to optimise physician engagement. However, what is the benefit for pharma when product-specific content is off limits?

Dr Chris Chapleo, global director of stakeholder affairs at Reckitt Benckiser Pharmaceuticals, is passionate about the mutual benefits of fair balanced education. "Improving prescriber competence and enhancing clinical awareness of the latest evidence regarding best practice with the whole range of products available, can only improve patient outcomes. When pharmaceutical products are used for the right patients, at the right time and in the right way, everyone stands to gain. On the other hand, poor clinical practice leads to poor treatment outcomes and adverse events, all of which can undermine the perceived utility of any product within any indication". His conclusion is clear: "Before dismissing the benefit of unbiased education, think carefully about what optimised clinical practice would achieve for the industry as well as for patients."

 

Important knowledge sources 

Important knowledge sources

 

Doing it right
Pharmaceutical companies are evolving fast; budgets and responsibility for promotional and non-promotional activities are increasingly separated between marketing and medical departments, respectively. Medical education agencies are also following suit, with responsible companies teasing out content provision by promotional and educational divisions. Taking things to the next level, Pfizer and GSK implemented strict provider-selection policies that include only a handful of academic institutions and exclude traditional medical education companies. Whatever the organisational approach, when it comes to CME content, one thing is clear: today's funders must restrict their contributions to the purely financial. Perhaps the most important thing that companies can do to optimise the educational benefit of their investment is to ensure that they work with high-quality providers for both live and online CME.

Ensuring quality
Quality is about a lot more than just having accurate and unbiased content. The relevance of the content to clinical practice and appropriateness and effectiveness of the teaching methods utilised are all key. Formal needs assessments are critical in ensuring that an activity will address an identified knowledge gap rather than perceived needs. This process should be built in to providers' methodologies for developing CME activities. Long-term follow up to demonstrate lasting clinical impact is of equally obvious importance, but surprisingly few implement this as standard.

Quality in eCME
Although there has always been widespread agreement that CME is a valuable ethical commitment, it is hard for healthcare professionals to set aside study time, particularly if it involves meeting attendance. Little wonder then that e-learning has gained such popularity in recent years.

Surprisingly, PCM Scientific's survey revealed that online resources were generally ranked by physicians as the second least important source for helping them maintain their knowledge on best clinical practice. However, looking ahead, eCME was ranked as being the third most likely to impact on future professional development and enable expansion of quality patient care. Indeed, if current trends in the use of online education continue, forecasts suggest that 50 per cent of CME will be delivered via the Internet by 2016, a dramatic increase over the 9 per cent in 2008.

In preparation, the European Accreditation Council for Continuing Medical Education (EACCME) has recently launched pan-European accreditation for eCME. However, since the quality of the modules can be subject to detailed review, this process will be significantly more rigorous and exhaustive than live meeting accreditation. The costs for submitting online modules for accreditation are therefore correspondingly higher than for live meetings.

Simply putting written content into an online format with a closing test will not suffice. Providers will need to demonstrate excellence in instructional design as well as compliance with rigorous standards in terms of fair balance, transparency and accuracy. Reflecting the rigour of the process, rejection rates for online CME accreditation were initially high, though providers of 'borderline' modules will now be given opportunities to improve their eCME modules in accordance with feedback before a final decision is given.

 

Impact of online CME

Impact of online CME

 

gCMEp – the future?
The good CME practice (gCMEp) group was launched at the second European CME Forum in 2009; it was set up by CME professionals to define good practice in CME, with the aim of converging and optimising standards and practices across Europe. It is hoped that, in the future, benchmarking by gCMEp should offer reassurance to financial supporters that the education provider they have selected will operate appropriate standards in accordance with the core principles of gCMEp (see table above). For now, participation in the initiative is a good signal of commitment to the highest standards in CME delivery. Eugene Pozniak, lead founder of the gCMEp initiative, said: "Mindful of the mantra that, 'When America sneezes, Europe catches a cold', European healthcare stakeholders can and must learn from mistakes made in the US when we come together to develop a robust framework for CME in the region".

 

Good CME practice core principles

Appropriate education

Educational programmes should address pre-identified educational needs

Quality 

Education should be of the highest possible quality, be evidence-based and developed to address specific learning objectives, with systems and processes in place

Independence 

Of education provider/agency, financial supporters and faculty

Fair balance 

Educational programmes should be fair and balanced

Transparency 

Relevant relationships between individuals and organisations, sources of funding, sources and generation of content, should be transparent

Effectiveness 

Programmes should be reviewed and evaluated for their effectiveness

 

Evolution of European CME
In Europe, accredited CME has historically been a national affair, partly due to the complexities of mutual recognition of CME credits between countries. Also, in contrast to the US, CME has not been mandatory across Europe – even today, among major European countries, although CME is mandatory in France, Italy and Germany, it remains voluntary in Spain and the UK. However, as emphasis on the value of CME increases, the UK will be the first to introduce compulsory revalidation to ensure doctors remain fit to practise.

There is little doubt that with an increasing focus on quality in education, future CME will show a more demonstrable impact on healthcare outcomes than ever before. There will be a significant move away from discrete one-off modules or meetings toward ongoing programmes, and this represents a huge opportunity for enlightened pharmaceutical companies to support physician education by funding CME models that provide long-term value.

As John Shaw Billings, surgeon general during the American Civil War and co-worker with Andrew Carnegie to open libraries across the UK and US, said: "The education of the doctor which goes on after he has his degree is, after all, the most important part of his education".

The Author
Dr Alisa Pearlstone is scientific director of PCM Scientific - CME division of PCM Healthcare Group
She can be contacted at alisa@pcmscientific.com or on +44 (0)20 7531 6693.

To comment on this article email editor@pmlive.com

11th November 2010

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