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Taking the next step

CME is well established in the US but in Europe many remain sceptical. Now is the time to jump on board if we are to reap the global rewards

Med ed is changing. Increasing regulation, stricter corporate compliance, the perennial aspects of restricted budgets, shorter product lifecycles and competition have made communicating with the target audience more difficult. So, pharma marketers are under pressure to find new communication strategies.

CME activities
One approach that has stirred debate is the role of Continuing Medical Education (CME) activities in communicating with the target audience. While CME is firmly established in the USA as an integral element of communication, in Europe it remains in its infancy, leading many to doubt its importance. But, the question is `Can I afford not to sponsor CME activities?' rather than `Can I afford it?'

Health services research consistently demonstrates a sizeable gap between research-based best clinical practice and what doctors actually do. In reality, physicians interested in changing their practices may encounter organisational and peer-group pressures at the same time as they face information overload and increased patient expectations. So, physicians must acquire the skills and knowledge, not necessarily by working harder, but by learning smarter.


USA and Europe
To achieve this continuous learning, CME systems have been established in many countries to provide a structured platform for the acquisition of new skills and techniques. Accredited programmes apply evidence-based adult learning principles to facilitate self-directed learning, to translate learners' needs into measurable objectives, and to provide interactive learning and opportunities to practise acquired skills. The importance of CME was reinforced in 2002 when the Conjoint Committee on CME in the USA reached the conclusion that CME should enhance quality care, support professional activities, assess professional/educational needs, evoke professionalism, motivate learners and produce measurable outcomes. But, while CME has gained importance, its application has varied from country to country.

The USA has one of the most established CME systems, that began in the 1920s when the mediocrity of initial medical training was recognised. Medical schools identified the need to provide continuous learning practices for physicians and created a classical system of continuing education. The first mandatory programme was initiated in urology in 1934. Today, all CME programmes in the USA are overseen by the Accreditation Council for Continuing Medical Education (ACCME). The mission of the ACCME is `the identification, development, and promotion of standards for quality CME utilised by physicians in their maintenance of competence and incorporation of new knowledge to improve quality medical care for patients and their communities'. The ACCME fulfills its mission through a voluntary, self-regulated system for accrediting CME providers and a peer-review process responsive to changes in med ed and the healthcare delivery system.

By contrast, CME in Europe has been perceived as complex. It has been developed on a country-specific basis that has made European-wide consulting difficult to achieve. But, this is now changing. A growing trend towards mandatory CME, together with the creation of the single European market, has meant that there is an increasing need for European exchange of CME credits, obtained by individual doctors outside their own countries. In 1999, the European Union of Medical Specialists (UEMS) decided to establish an International body which, much like the ACCME, would facilitate access to quality CME for European doctors, contribute to the quality of CME in Europe and make exchange of CME credits in Europe possible. Based on this recommendation, the UEMS established the European Accreditation Council for Continuing Medical Education (EACCME) in 2000.

Right from the start of the EACCME, it was clear that the national professional regulatory bodies would approve a structure, allowing European exchange of CME credits only if they retained control of events in their own country. So, the EACCME does not function as a supranational body, but as a link and clearing-house between the national regulatory bodies.

Increasingly, CME is becoming a mandatory requirement for EU physicians, eg, in Germany, CME is now mandatory for ambulatory care physicians, with probable expansion to hospital-based healthcare professionals, and penalties have been considered for physicians who do not obtain the required 250 credits by 2009. This, together with the recognition by the ACCME of the EACCME points (making it possible for physicians to transfer points) and the increased harmonisation and improvement of quality of CME across Europe, attendance of accredited events has been seen to rise. Indeed, the momentum for CME can be clearly observed at International Congresses, most of which now offer EACCME accreditation for delegates.


Pharma involvement
So, CME represents an important opportunity for the pharma industry to engage with healthcare professionals. Accreditation assures not only educational value, but also fair balance. So, physicians are highly motivated to attend CME-accredited programmes in order to obtain info and be updated on the latest developments; to be reassured that their practice behaviour is within accepted guidelines; to hear from and interact with leading thought-leaders; and, sometimes, just to satisfy licensure requirements. While, traditionally, investment in CME has focused on the US market, where total CME spend is estimated at around $900 million, the growing importance and political momentum in Europe for CME will see rising levels of investment. Indeed, in the UK alone, it is anticipated that support for CME activities will reach £40 million this year.

However, there is increasing concern about direct pharma industry involvement in CME and the related conflict of interest. In 2004, the ACCME issued new regulations to ensure that CME promotes improvements of quality in healthcare and not a specific proprietary business interest of a commercial interest (from the 2004 ACCME). As a consequence of the new guidelines, companies can no longer use the same medical education agency for both promotional and educational (CME-accredited) activities within the US domestic market. This has resulted in many agencies developing specific CME specialist divisions. It is anticipated that similar guidelines will be enforced across Europe.

Even though CME is very regulated, it offers considerable opportunities for increasing collaboration between the pharma industry and medical education professionals. A well-structured, fair-balanced, high-science and measured accredited programme ensures that the healthcare profession has the requisite understanding, knowledge and skills to decide which patients would benefit most from a treatment and, in consequence, to advise, prescribe and treat them.

While many may dismiss this as a US-specific need, the increasing harmonisation and mandatory applications of CME in Europe will ensure that it becomes a global communication channel. Faced with this growing momentum, do you still want to consider the value of not supporting CME?

The Author
Paul Archer
is director of Educational Services for Infinity, a division of medical action communications. He can be contacted at

2nd September 2008


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