AAMC Reporter: January 2009

A Word from the President: "Why Think About Continuing Medical Education?"

As 2009 begins, academic medicine faces extraordinary challenges, from developing a more seamless and effective continuum of medical education, to assuring institutional integrity, to working to improve our nation's health care system. While we may already feel overwhelmed by these pressing issues, increasingly I have become concerned about an activity that lies at the epicenter of all three challenges: continuing medical education (CME). Why, in a time of extraordinary challenges and unprecedented financial struggle for our institutions (and our nation), should we focus on this issue?

Rethinking CME is key to addressing all three of the above challenges. By answering some of the tough questions that have long surrounded CME, we also will help learners develop skills to use throughout their professional lives, develop new financial models of support that affirm our integrity, and address many of the clinical care gaps that stand in the way of a sustainable health care system. Therefore, instead of asking "why focus on CME at all?" we instead should focus on the strategies and innovations that will hasten its reinvention.

In previous columns, I have discussed the need to break free from our compartmentalized view of medical education and our tendency to view each stage as disconnected from one another. I believe this is especially true of the way we regard CME. We struggle to find the same energy, academic rigor, and cohesive thinking that we have applied to undergraduate medical education (UME) and to graduate medical education (GME). As a result, learners have viewed CME as a peripheral experience that follows training, instead of as a meaningful, practice-based, and "natural" continuation of their learning and development. Further, as medical educators, we have missed opportunities to improve upon the kind of knowledge transfer and information delivery methods that work best for each generation of doctors. For example, given the technological savvy of today's students, residents, and young practicing physicians, and the enormous potential offered by information technology (IT) for innovative CME, we must redouble our efforts to build greater IT capacity.

Until recently, the AAMC itself had reflected the lack of focus on CME by not having a high-level, professional leader dedicated entirely to this critical area. That issue was addressed in 2007 with the addition of Dr. Dave Davis to our staff. Just as Dave has been working internally with AAMC staff to integrate CME into our thinking about medical education (as well as linking CME to research and clinical care), we also must develop parallel efforts at the institutional level.

To guide us in these activities—and in identifying a unifying theory for CME—we can look to other parts of the medical education continuum. In UME, the Medical School Objectives Project has helped us reach general consensus on the skills, attitudes, and knowledge that graduating medical students should possess. And in GME, the six core competencies defined by the Accreditation Council for Graduate Medical Education (ACGME) have served to guide resident education and training.

What is the parallel for CME? One possibility is to emulate the fourth-year capstone course in medical school. By regarding CME as the ongoing "capstone" of learning that helps practicing physicians sharpen their clinical care and integrate new skills, perhaps we can start building the foundation for lifelong learning. Another possibility might be to follow ACGME's lead, and re-engineer CME from its conference-based mode to one that incorporates the principles of practice-based learning and improvement.

Even if we achieve this kind of innovation, the question remains how such efforts will be funded. Clearly, no single area will more sorely test our ability to manage potential conflicts of interest than will CME. The majority of CME support in medical schools continues to be derived from commercial sponsorship. However well-intended the prevailing model—and despite efforts to manage potential conflicts—corporate sponsorship has an inherent risk of skewing content toward new therapeutic agents or medical devices and away from other important topic areas (e.g., prevention and quality improvement).

As we transition to a new financial model, we must encourage innovative strategies that will enable our schools to become less dependent on industry support. The guidelines set forth in the 2008 AAMC report, Industry Funding of Medical Education, provide an important first step. Additionally, many of our institutions have been exploring a range of options such as using "blind trusts" or even prohibiting commercial support for CME altogether. Others have been seeking alternative funding sources driven by the value that CME brings to the table (e.g., medical school funding to couple faculty development and CME programs, or state and federal grants to support regional clinical and research-to-practice networks).

Still another option under exploration by some academic medical centers is the incorporation of CME as part of ongoing health care quality improvement efforts. This last approach holds enormous potential not only for reconfiguring CME, but also for closing clinical care gaps. All the articles that lament the state of American health care focus on the gap between what we know we should do, and what doctors do in practice. Integrating and linking CME and quality improvement within our academic medical centers creates a "win-win" situation for educators, students, clinicians, and our patients.

In many ways, these important challenges in medical education, institutional integrity, and quality of care form the impetus for a more thoughtful and rigorous examination of CME and its critical place in the lives of physicians, faculty, and institutions. As a community, we must develop mechanisms for sharing our experiences in dealing with these challenges and ensure that these efforts are widely examined and modeled. I encourage you to visit www.aamc.org/cme for more information, and suggest we all resolve to make CME a priority in the coming year.

Darrell G. Kirch, M.D., AAMC President and CEO

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