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The Old Time CME

Continuing Medical Education, or CME, remains a big advantage for the US health system.

But like nearly every other aspect of medicine, CME has undergone radical change in recent years, and there will be more dramatic changes likely to be just ahead. Sure, Dr. Brown still attends an occasional out-of-town conference, but at the core of the CME effort in the new millennium lies the concept of a multimedia CME training location – a comprehensive, local information clearinghouse using the latest technology to aid the physician in the difficult new world of medicine while providing an exciting new opportunity for marketing.

Wide-ranging materials are available on most medical subjects, to provide the information physicians need to best serve their patients, and to advance their specialty training and education. Programs can be custom-tailored for each doctor, following an initial assessment that pinpoints his or her strengths and weaknesses. The staff (or someone on-line) then designs an individual study program with precisely the materials needed to improve practice skills. Materials come in whatever format is best suited for a particular physician, taking full advantage of such new technologies as teleconferencing, electronic consulting, direct television, multimedia programs for personal computers via the Internet, or CD-ROM, video, and audiotapes. The resources of the center are always state-of-the-art.

Industry support underpins much of the activity through innovative sponsorship platforms. Some healthcare companies support the center itself; others underwrite the preparation and distribution of learning materials, sometimes on a cooperative basis.

A revolution underway

But that will be then, and this is now. The CME revolution is already underway and the opportunities for industry participation are wide open. Let us describe a current example that foreshadows the shape of things to come – taking into account that multimedia training locations are not yet up and running.

One pharmaceutical company was looking for an innovative way to introduce a new anti-androgen product for use in the treatment of prostate cancer. Specifically, they wanted to use an educational tool to attract physicians’ attention. The purpose was not to tie the educational material directly to the product, but rather to create awareness among specialty physicians that this company was going to be a major player in this field.

Together, we came up with the idea of sending videotapes that would prepare doctors for urology board examinations. We decided not to send them directly to physicians and residents – that would have been too expensive and represented considerable waste circulation – but to all 126 resident directors of urology at the nation’s medical schools.

The tapes were broken down into three primary parts: comprehensive medical content, questions and answers, and board exam simulation exercises.

In addition, new time-saving technology allowed users to pinpoint exactly the segments of the tapes they wanted to view. Within weeks, some two dozen letters from directors were received, thanking the company for making these materials available at no charge. In fact, the company was so pleased with the results that it plans to continue its educational efforts in other specialty areas, such as oncology.

Does such non-promotional education translate into sales? Not easy to say. Name recognition and goodwill are intangibles. But working in a field where companies compete fiercely to be recognized as leaders by their target audiences, a company that initiates creative programs will likely be remembered … and rewarded.

The concept of multimedia training is at least on the radar screen of the most innovative players, although no one yet knows what to call it, much less what final form it will take. It may be completely “virtual” and accessed from the physician’s home or office; it may include specified carrels in medical libraries or hospitals around the country; or it may involve freestanding multimedia centers in major population centers. Physicians may pay-per-view for satellite-borne applications, or pay “admission” or user fees in a library; or be given complimentary “memberships” by healthcare companies.

Whatever the ultimate configuration, we believe that the concept of multimedia training locations is the emerging new model for CME. Industry will discover dynamic new opportunities to reach audiences in the form of sponsorship and other forms of support through arrangements that satisfy their own marketing objectives as well as Food and Drug Administration (FDA) requirements.

The forces of change

There are many forces fueling the rapid evolution of this concept. Physicians have an expressed need to more efficiently design and manage their continuing education. The relentless squeeze on healthcare costs make the old ways of disseminating CME too expensive and time consuming. There is a glaring need for new channels of communication among industry, CME providers, physicians, and medical schools following the dramatic shift towards managed care. Changes in FDA and American Medical Association (AMA) guidelines during the first half of the 1990s have reduced industry involvement in CME. And, finally, the advance of new information technologies, which have the potential to slash CME costs overnight and to make delivery systems more efficient, have made the concept of a centralized, interactive multimedia center not only practical, but inevitable.

The most obvious manifestation of the cost-reduction pressures in healthcare, of course, is the enormous shift from private practice care to managed care organizations (MCOs) which has deprived many physicians of their autonomy in deciding how much time and money to spend on attending far-flung CME conferences.

The other key change of recent years was the publication of revised FDA (draft) and AMA guidelines. Under the new rules, industry must clearly separate its educational and promotional messages. In some cases, this has drastically limited industry participation in sponsorship programs. Finding new ways to reach its target markets has proved difficult and, often, companies simply opted to withdraw the financial support they had routinely given CME providers such as medical schools and community hospitals. Funds formerly devoted to CME were shifted to other areas of marketing and promotion, weakening the once-strong link between industry and information providers.

Despite these changes, industry’s need to reach these important audiences, coupled with doctors’ need for continuing education still remain, and so does the providers’ need for financial support. And while the role of MCO doctors in choosing specific drug brands may have diminished, their opinions still have substantial influence on therapeutic decisions. The MCOs, meanwhile, have a strong stake in keeping their doctors updated and board-certified, if only for competitive reasons.

The combination of these factors still gives industry a strong incentive to underwrite CME offerings and to use traditional CME providers as a link to physicians. Only if accredited providers sponsor CME courses and materials will doctors be able to earn CME credit, and accreditation remains a driving factor in determining which courses they will sign up for. Ultimately, the prestige of the provider will also greatly influence whether they accept the information as credible.

Finally, the FDA has suggested strongly in its draft policy on pharmaceutical-supported education that partnering with CME providers helps the company to make sure that it meets FDA criteria for objectivity, balance, independence, and scientific rigor. That means industry will usually have to partner with medical schools, accredited communication companies, hospitals, and professional associations. Only if planning and editorial control rests with these third-party sponsors can pharmaceutical companies be sure that they will be able to get word out on their products through educational media without falling afoul of the FDA.

Mutual cooperation needed

The new information technologies, meanwhile, have gone largely unexploited by traditional CME providers, mainly because they have been unable to finance these advances without industry’s support. That’s why the rationale for mutual cooperation is, if anything, stronger than ever.

The bottom line is that physicians are starting to turn away from traditional delivery systems, putting pressure on innovators to blaze new trails. Most industry players, however, are having a difficult time keeping abreast of the new opportunities, much less in deciphering where the future lies.

This is hardly surprising given the enormous amount of change that has taken place over a so short a period. Yet if our prediction is correct – that the future of CME will be focused on centralized, information-centered CME media centers, there will be a resurgence in industry-funded CME in the years immediately ahead. Those unprepared will break down on the shoulders of the information highway while more visionary players surge ahead.

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