CE Measure: The Journal of Outcome Measurement in Continuing Healthcare Education

CE Measure is the first peer-reviewed journal dedicated specifically to the art and science of healthcare educational outcomes measurement.

Original manuscripts that address outcomes methodologies, results, practice-based protocols, CE conference highlights and abstracts, and case histories will be published to promote vigorous academic scrutiny of this important subject.

Sample articles (all available free online):

• Changing Performance among Practicing Pharmacists through Comprehensive Educational Initiatives
• Use of Uniform Outcomes Methodologies to Measure Clinical Impact of Large-Scale CME Initiatives
• Measures of Perceived Self-Efficacy as a Method of Evaluating Educational Outcomes
• Case Report: Web-Based Commitment-to-Change Evaluation of an Annual CME Conference
• Taking the Plunge: A CME Provider’s Journey to the 21st Century
• Continuing Professional Education in Athletic Training: Is Knowledge Acquired and Retained?
• Improving Primary Care Management of Joint Pain through a PI/QI-CME Approach

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Continuing Medical Education in Europe: Evolution or Revolution?

This White Paper was published by MedEd Global Solutions in May, 2010:

Continuing Medical Education in Europe: Evolution or Revolution? MedEd Global Solutions, May 2010.

Contributors: Eric Jean Desbois, Helios Pardell, Alfonso Negri, Thomas Kellner, Peter Posel, Thomas Kleinoeder, Bernard Maillet, Hervé Maisonneuve

CONTENTS

i. Introduction and Statement of Need
1.Current Climate and Opportunities in Europe
2. The Impact of CME on Public Health Economy
3. Funding Models of CME and CPD in Europe
4. Identifying Conflict of Interest
5. The Importance, Structuring & Harmonization of CME
6. The Role of the Pharmaceutical Industry in the Continuing Medical Education of Physicians
Closing Statement: 10 steps to evolve CME in Europe

From the introduction:
When we first initiated the writing of this White Paper, our intention was to develop a clear picture of the current CME environment and the objective was to create awareness of it by elaborating on the driving forces and barriers posed to the professional healthcare community. Over time, it has become clear that recognition of the importance of CME from our primary audience is a “critical factor for success”, as stated by Thomas Kellner, one of the authors of this work. Therefore, in an effort to provide you with the most up-to-date information and expert insights, we have the privilege of offering you, by means of this publication, an in-depth look at CME in Europe for 2010!

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Code for Interactions with Companies (CMSS)

In April 2010, the Council of Medical Specialty Societies (CMSS) announced the release of the CMSS Code for Interactions with Companies. The code provides detailed guidance to medical specialty societies on appropriate interactions with for-profit companies in the health care sector:
Council of Medical Specialty Societies. Code for Interactions with Companies. Chicago: CMSS, 2010
 From the press release:
The code includes seven core principles and detailed guidance on implementation. The principles cover the following key areas:

Conflicts of Interest:
Develop and publicly post policies and procedures to disclose and manage conflicts of interest among those who participate in society activities (e.g., medical meetings, clinical practice guidelines, scientific journals).

Financial Disclosure:
Publicly disclose donations and support received from for-profit companies in the health sector, and disclose Board members’ financial and uncompensated relationships with companies.

Independent Program Development:
Develop and make publicly available policies and procedures that ensure that educational programs, advocacy positions, and research grants are developed independent of industry supporters.

Independent Leadership: 
Prohibit society leaders (presidents, CEOs, and editors-in-chief of society journals) from having direct financial relationships with relevant for-profit companies in the health care sector.  

The 28-page code recognizes that CMSS member societies have different organizational structures and may apply its requirements differently based on their unique activities and infrastructure. Further, some societies may choose to adopt policies that are more rigorous than what the code requires.

What some of the bloggers have written:

• The Carlat Psychiatry Blog
• Hooked: Ethics, Medicine, and Pharma
• FiercePharma
• Conversations in CME with Floyd Pennington
• heartwire

CME articles: Academic Medicine January 2010; 85 (1)

The January 2010 issue of Academic Medicine contains a number of articles of interest to CME  providers. The publisher is providing some of these these free of charge (for now).
RSS feed for this issue

• Bellande BJ, Winicur ZM, Cox KM.  Commentary: Urgently needed: a safe place for self-assessment on the path to maintaining competence and improving performance. Acad Med. 2010 Jan;85(1):16-8.  PubMed – http://www.ncbi.nlm.nih.gov/pubmed/20042814
• Camilleri M, Parke DW 2nd. Perspective: Conflict of interest and professional organizations: considerations and recommendations. Acad Med. 2010 Jan;85(1):85-91.  PubMed -  http://www.ncbi.nlm.nih.gov/pubmed/20042830
• Davis DA, Baron RB, Grichnik K, Topulos GP, Agus ZS, Dorman T.  Commentary: CME and its role in the academic medical center: increasing integration, adding value. Acad Med. 2010 Jan;85(1):12-5.  PubMed  - http://www.ncbi.nlm.nih.gov/pubmed/20042813
• Dubovsky SL, Kaye DL, Pristach CA, DelRegno P, Pessar L, Stiles K. Can academic departments maintain industry relationships while promoting physician professionalism? Acad Med. 2010 Jan;85(1):68-73.  PubMed   - http://www.ncbi.nlm.nih.gov/pubmed/20042827
• Kawczak S, Carey W, Lopez R, Jackman D. The effect of industry support on participants’ perceptions of bias in continuing medical education. Acad Med. 2010 Jan;85(1):80-4. PubMed   – http://www.ncbi.nlm.nih.gov/pubmed/20042829
• Lo B. Commentary: Conflict of interest policies: an opportunity for the medical profession to take the lead. Acad Med. 2010 Jan;85(1):9-11.  PubMed   - http://www.ncbi.nlm.nih.gov/pubmed/20042812
• Steinman MA, Boscardin CK, Aguayo L, Baron RB. Commercial influence and learner-perceived bias in continuing medical education. Acad Med. 2010 Jan;85(1):74-9. PubMed  - http://www.ncbi.nlm.nih.gov/pubmed/20042828

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Professional medical associations and their relationships with industry (JAMA)

This article was published in JAMA in April 2009:

Rothman DJ, McDonald WJ, Berkowitz CD, Chimonas SC, DeAngelis CD, Hale RW, Nissen SE, Osborn JE, Scully JH Jr, Thomson GE, Wofsy D. Professional medical associations and their relationships with industry: a proposal for controlling conflict of interest. JAMA 2009 Apr 1;301(13):1367-72.

Professional medical associations (PMAs) play an essential role in defining and advancing health care standards. Their conferences, continuing medical education courses, practice guidelines, definitions of ethical norms, and public advocacy positions carry great weight with physicians and the public. Because many PMAs receive extensive funding from pharmaceutical and device companies, it is crucial that their guidelines manage both real and perceived conflict of interests. … The recommendations are rigorous and would require many PMAs to transform their mode of operation and perhaps, to forgo valuable activities. To maintain integrity, sacrifice may be required. Nevertheless, these changes are in the best interest of the PMAs, the profession, their members, and the larger society.

The August 19 2009 issue of JAMA includes a number of letters [by subscription only] in response to this article, entitled Industry Support and Professional Medical Associations [scroll down]:

Norman Kahn JAMA. 2009;302(7):737; Peter C. Lombardo JAMA. 2009;302(7):737-738; Walker L. Ray; Robert L. Addleton JAMA. 2009;302(7):738; Robert H. Jackson JAMA. 2009;302(7):738; C. Daniel Smith; Jo Buyske; Mark A. Talamini JAMA. 2009;302(7):738-739; David J. Rothman; Walter J. McDonald JAMA. 2009;302(7):739.

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Elsevier published a fake peer-reviewed journal for Merck

   According to Bob Grant, a blogger for The Scientist,  Merck paid an undisclosed sum to Elsevier to produce several volumes of a publication that had the look of a peer-reviewed medical journal, but contained only reprinted or summarized articles–most of which presented data favorable to Merck products–that appeared to act solely as marketing tools with no disclosure.   Read the full blog post.  (Requires free registration.)  More from The Scientist

The journal in question was the Australasian Journal of Bone & Joint Medicine, an allegedly peer-reviewed journal created primarily to sell Vioxx and Fosamax to physicians. Summer Johnson, PhD, Executive Managing Editor of the American Journal of Bioethics, has written about these “advertorials in her blog:
Merck Makes Phony Peer-Review Journal (May 1)
Elsevier and Its Many “Advertorials” (May 11)
Another blogger writes: Elsevier has an entire division dedicated to publishing fake advertorial “peer-reviewed” journals

You can read the offending issues online:  volume 2(1) 2003 ;  volume 2(2) 2003

This whole issue was well documented during the May 22 CBC radio show, The Current. See  Part 2: Fake Medical Journals and scroll down to listen to the podcast.

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Conflict of Interest in Medical Research, Education, and Practice (IOM)

  The Institute of Medicine’s report on conflict of interest is now available for purchase or viewing on the IOM’s Web site.  In 2007, the IOM appointed the Committee on Conflict of Interest in Medical Research, Education, and Practice to examine conflicts of interest in medicine and to recommend steps to identify, limit, and manage conflicts of interest without negatively affecting constructive collaborations.

This article was published online in the New England Journal of Medicine on May 1; free full text is available.

Steinbrook R. Controlling Conflict of Interest — Proposals from the Institute of Medicine. N Engl J Med 2009 May 1.

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Physician / Pharmaceutical Industry Relationship: Open Access Articles

The following articles are available free online from the CACHE Open Access Library:

• Steinbrook R. Online disclosure of physician–industry relationships. N Engl J Med 2009;360:325-327.
• Steiner TJ.  Ethical issues arising from commercial sponsorship and from relationships with the pharmaceutical industry–report and recommendations of the Ethics Subcommittee of the International Headache Society. Cephalalgia 2008 Sep;28 Suppl 3:1-25.
• Gagnon MA, Lexchin J.  The cost of pushing pills: A new estimate of pharmaceutical promotion expenditures in the United States. PLoS Med 2008 Jan 3;5(1):e1.
• Fisher JA.  Practicing research ethics: Private-sector physicians & pharmaceutical clinical trials. Soc Sci Med 2008 Jun;66(12):2495-505.
• Haines IE, Olver IN.  Are self-regulation and declaration of conflict of interest still the benchmark for relationships between physicians and industry? Med J Aust 2008 Sep 1;189(5):263-6.
• Ross JS, Lackner JE, Lurie P, Gross CP, Wolfe S, Krumholz HM. Pharmaceutical company payments to physicians: Early experiences with disclosure laws in Vermont and Minnesota. JAMA 2007 Mar 21;297(11):1216-23. 
• Campbell EG, Gruen RL, Mountford J, Miller LG, Cleary PD, Blumenthal D. A national survey of physician-industry relationships. N Engl J Med 2007 Apr 26;356(17):1742-50.
• Chimonas S, Brennan TA, Rothman DJ.  Physicians and drug representatives: Exploring the dynamics of the relationship. J Gen Intern Med 2007 Feb;22(2):184-90.
• Kennedy SP, Bormann BJ.  Effective partnering of academic and physician scientists with the pharmaceutical drug development industry. Exp Biol Med (Maywood) 2006 Dec;231(11):1690-4.
• Wofford JL, Ohl CA. Teaching appropriate interactions with pharmaceutical company representatives: The impact of an innovative workshop on student attitudes. BMC Med Educ 2005 Feb 8;5(1):5.
• Brody H.  The company we keep: Why physicians should refuse to see pharmaceutical representatives. Ann Fam Med 2005 Jan-Feb;3(1):82-5.
• Wazana A.  Physicians and the pharmaceutical industry: Is a gift ever just a gift? JAMA 2000 Jan 19;283(3):373-80.  

Funding of Continuing Health Education: Open Access Articles

The following articles are available free online from CACHE’s Open Access Library:

• Council on Ethical and Judicial Affairs (CEJA). American Medical Association. Report 1 of The Council on Ethical and Judicial Affairs: Industry Support of Professional Education in Medicine.[2008]
• Mamdani B. The ethics of industry support for professional education in medicine. Indian J Med Ethics 2008 Oct-Dec;5(4):177-80.
• Sears J. Implementing the Recommendations of the AAMC Task Force on Industry Funding of Medical Education: A Selected Policy Language Compendium. Washington: Association of American Medical Colleges, 2008.
• Industry Funding of Medical Education: Report of an AAMC Task Force. Washington: Association of American Medical Colleges, 2008.
• Cervero RM, He J. The Relationship between Commercial Support and Bias in Continuing Medical Education Activities: A Review of the Literature. June 2008.
• Continuing Education in the Health Professions: Improving Healthcare Through Lifelong Learning. A Conference Sponsored by the Josiah Macy, Jr. Foundation. New York: Josiah Macy, Jr. Foundation, 2008.
• Hebert PC. The need for an Institute of Continuing Health Education [editorial]. CMAJ March 25 2008;178(7):805-806.
• Letters in response to Hebert. 2008.

Ethical issues arising from commercial sponsorship and from relationships with the pharmaceutical industry

  Just published in Cephalalgia [subscription required]:

Steiner TJ. Ethical issues arising from commercial sponsorship and from relationships with the pharmaceutical industry–Report and Recommendations of the Ethics Subcommittee of the International Headache Society. Cephalalgia. 2008 Sep;28 Suppl 3:1-25.
 
Preface: These recommendations, the second set developed for the International Headache Society (IHS) by its Ethics Subcommittee, evolved over 3 years. This extended period allowed time for public consultation, an important part of the formulation process, and for consequent revision. The recommendations were presented in this final form to IHS Council in late 2005, and approved for publication in Cephalalgia. The delay from then until now would have been better avoided. The reasons for it, which did not lie with the Subcommittee, are not of current interest. What matters is that these recommendations remain entirely relevant to their purpose. In one area – the registration of clinical trials – matters have moved on in the interim. As the Subcommittee anticipated, registration of trials is becoming standard practice. This goal is not yet achieved, but laudable and largely voluntary initiatives by the pharmaceutical industry have brought about much recent progress. Clear international consensus has yet to emerge on what needs to be included in a clinical trials registry, and when. This does not help, since it is not entirely certain what the desired end is. But it seems likely that, with or without further regulation, this end will be both clear and in sight in not too long. Headache will benefit, along with all other fields of medicine.
 
Summary of recommendations
 
1.1 Conflicts of interests in relationships with commercial sponsors
1.2 Commercially sponsored research
1.3 Commercially sponsored clinical services
1.4 Commercially sponsored education
1.5 Marketing

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