HealthJuly 17, 2020

Are commercial interests undermining CMEs?

By: Bana Jobe

Commercial interests in CME classes can affect education quality and patient care. As a learner, you can protect yourself by knowing what to watch for.

For all the rigor that goes into keeping continuing medical education (CME) materials bias-free, there's always the chance that corporate marketing can carry over to the classroom. When it does, it can influence decisions and impact patient care - often without physicians realizing it.

That's why accreditation groups like the Accreditation Council for Continuing Medical Education (ACCME) prohibit commercial interests in CME classes. Generally, the ACCME excludes drug and medical device companies from accreditation and requires CME providers to disclose commercial support.

But is that enough? Increasingly, many people don't think so, including the authors of a 2020 opinion in Academic Medicine, the journal of the Association of American Medical Colleges.

A missing rule of accredited continuing medical education

The authors of the paper argue that the ACCME's rules fall short because they omit electronic health records (EHR) vendors, a mighty player in the healthcare continuum. Up to 86% of physicians use EHR platforms, amounting to a $31.5 billion industry year over year.

The herculean scope of that sector, as with pharma and medical devices, represents just how entangled EHRs have become with patient outcomes, perhaps as much as with drugs or devices. No longer are they just a records tool: EHRs inform clinical decisions, ease or exacerbate physician burnout and connect patients with providers directly.

So even a small influence could have consequences if you were to change something based on what you heard in a CME. Evidence shows that it happens: Physicians who take pharmaceutical-supported CMEs have been known to change how they prescribe medicine, the Academic Medicine authors point out.

Worse still, many providers may not recognize these and other corporate influences - and that's often half the battle.

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Downstream impacts on patient care

Whether it's from a company that sells drugs, devices, EHRs or any other solution, a biased CME can have lasting impacts on patient care.

For one, physicians run the risk of modifying care plans based on subjective educational content, such as a CME that more favorably highlights one product or skips over competitors. These risks can also translate to IT, with physicians inadvertently opting for solutions, like certain EHRs, that lead to clinician burnout or limit interoperability between providers.

But also consider the relationship. Receiving gifts like free meals or CME credits from corporate sponsors can change physicians' behaviors and encourage quid pro quo at a subconscious level. We'd all like to think we're immune to those pulls, but human nature may prevail: It's simply a neuropsychological response, the Academic Medicine authors explain.

Stay on guard for commercial interests in CME classes

All corporate interests stand to taint education in some way, even within the scope of accreditation rules. That points to the need for more due diligence on the part of learners - that's you - to ensure classes are as bias-free as possible.

You can start by looking out for notices of commercial support or financial relationships, which accreditors typically require CME providers to disclose, according to the ACCME. Though many companies can't host their own events, they can still commercially sponsor CMEs to help hosts cover event costs.

In general, it's best to stick with CMEs from medical education companies, health systems, physician organizations or academic institutions. AudioDigest, a CME provider from Wolters Kluwer Health jointly accredited by the ACCME and others, is a great starting point. Be wary of CMEs provided by commercial entities such as EHR vendors, even if they're accredited. If you do attend them, stand guard for corporate influence.

Most importantly, question where the information comes from. Are there unseen interests at play? Rigor and rules can help protect you somewhat, but they don't safeguard against all bias. Sometimes, your own good judgment is the best ally there is.

Bana Jobe
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