March 12th, 2012
5 Ways CME Misses the Mark
Behnood Bikdeli, M.D.
Some people critique Continuous Medical Education (CME) programs as spoon-feeding. As a young physician struggling to learn a lot of material, I actually appreciate a bit of ready-to-consume content that I can learn quickly and effectively. The American College of Cardiology (ACC) and other reputable institutions provide CME programs that, overall, help to keep physicians up on the literature and integrate new findings with existing knowledge. However, despite the basic advantages of these programs, several limitations stand out to me as a frequent user of CME. Here are the key ones:
1. The actual content does not match what is advertised. Sometimes CME programs set up false expectations. For example, in a recent CME program offered by the ACC, called “Complex Cardiovascular Cases: Novel Treatment Strategies for High Risk Patients,” the flier suggested that the reader would learn about “existing HDL raising therapies to reduce cardiovascular risk in dyslipidemic patients.” I learned some useful information from that CME program, but nothing about HDL raising treatments that reduce the cardiovascular risk.
2. The evidence is reported selectively. Sometimes CME programs leave me feeling that I am receiving the extreme expert opinion rather than a balanced review of the evidence. For example, I have seen experts highlight the benefits of omega-3 supplements in improving cardiovascular outcomes, but with little discussion of well-conducted negative trials (e.g., Galan et al., Rauch et al., and Kromhout et al. to name a few).
3. The tests do not focus on matters of clinical significance. The pre-test and post-test questions on CME exams do not necessarily reflect the most fundamental learning points. I have, for instance, encountered questions that ask narrowly about “the average plasma LDL level in hospitalized CAD patients” but few that emphasize the strategies that improve cardiovascular outcomes.
4. Experts with conflicts of interest predominate. Many CME programs are prepared by faculty with strong industry ties. I do not doubt the scientific excellence of such investigators, and I am fully aware of the benefits of collaborative work with industry to generate new and applicable knowledge. Nevertheless, I think adding more panelists who don’t have direct links with industry would be helpful — much like the ACC and AHA policies for development of clinical practice guidelines.
5. The registration process is burdensome. Last, some CME programs require very detailed registration that is mandatory. Participants may use CMEs only to keep themselves up-to-date on particular medical topics, and a time-intensive registration process affects the ease of use, thereby potentially discouraging future participation.
I believe that if such issues were addressed appropriately, CME programs would be even more successful in bringing state-of-the-art information to larger numbers of clinicians.
What has been your experience with CME? In particular, have you noticed a difference between commercially sponsored CME programs and those with no direct funding from drug or device companies? Do my critiques resonate with what you have encountered?
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8 Responses to “5 Ways CME Misses the Mark”
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Your point 4 is the biggest problem. Any CME program offered by a site that is funded by a drug or device company should be discarded as marketing and not CME.
http://currentmedicine.tv/category/specialties/cardiology/
In addition to the five problems listed, traditional lecture-based CME, where the audience sits passively and receives information from others, is a remarkably inefficient way to transmit knowledge (as measured by subsequent retention)and doesn’t result in much measurable change in physician practice or patient outcomes. Physicians retain more when they access new material at the time they need it to solve a clinical problem or when they work through clinical problems interactively,using cases the lecturer has constructed to emphasize the points that would have been made in the lecture.
Of particular importance is item #4, the issue of conflict of interest–I completely agree with Dr. Greer’s comment above—Furthermore, on many web sites, extra effort is required to find disclosures, thereby making the process more difficult–From a cynical perspective, could this be purposeful???
So—where is the model–who does CME best?
How validated are current CME tenets?
Regarding item 5, I have found that the more complex and more data should be provided, the less the final benefit received. Some seem data collections to sell personal information commercially to others. Subtle advertisement is albeit rarely found hidden in the content. For me at least, the difference between the heavily sponsored and the only sourced, usually academic is very impressive and for the last 15 or 20 years I avoid the first category as much as possible.
I AGREE WITH DR.BIKDELI ESPECIALLY IN POINT 4, HOWEVER WE MUST NOT TAKE THE INFORMATION PREVAILED IN THAT CME AS AN INEVITABLE TRUTHS . WE SHOULD REVISE WHAT WE READ RGULARLY ESPEACIALLY WHEN WE READ A NEW DATA..
I find point 4 is reasonable, but we should revise what we learn or read regularly, so even there is a conflict of interest that affects the validity of data, so it will be disclosed elsewhere.
The answer to point #1 is that there IS no evidence that raising HDL reduces cardiovascular risk. HAVING higher HDL reduces risk, but there is no evidence that we can RAISE a lower HDL and achieve the same result.
I often find that the title/headline matches poorly with the CONTENT.