Baylor University Medical Center Proceedings April 2014, Volume 27, Number 2 | Page 82

A tale of Congress, continuing medical education, and the history of medicine Clyde Partin, MD, Howard I. Kushner, PhD, and Mary E. Kollmer Horton, MPH, MA Well-intentioned attempts by the Senate Finance Committee to improve the content and quality of continuing medical education (CME) offerings had the unanticipated consequence of decimating academically oriented history of medicine conferences. New guidelines intended to keep CME courses free of commercial bias from the pharmaceutical industry were worded in a fashion that caused CME officials at academic institutions to be reluctant to offer CME credit for history of medicine gatherings. At the 2013 annual conference of the American Association for the History of Medicine, we offered a novel solution for determining CME credit in line with current guidelines. We asked attendees to provide narrative critiques for each presentation for which they desired CME credit. In this essay, we evaluate the efficacy of this approach. In 1957, Guthrie spoke of the history of medicine as a means, perhaps the only means, of reuniting a profession now so fragmented by many specialties, a means of reviving the wide outlook of former times. . . . Never before, in the long evolution of medicine, has there been a time when there was greater need for retrospection—for looking back, in order that we may be better qualified to look forward (1, 2). Physicians and academic historians of the history of medicine meet and discuss their research, but well-intentioned attempts by the Senate Finance Committee to improve the content and quality of continuing medical education (CME) offerings have had the unanticipated consequence of decimating academically oriented history of medicine conferences. This article outlines efforts to allow CME credit at those meetings following the changes in CME guidelines. CME IN HISTORICAL CONTEXT The genesis of CME in the United States is largely the result of the efforts of the Mayo brothers, Charles and William. Visiting surgeons, anxious to incorporate novel surgical techniques, traveled to the Mayo Clinic in Rochester, Minnesota, to learn about surgical progress. Eventually these itinerant surgeons created a Surgeons Club, which “partook in vigorous daily discourse regarding new techniques being advanced” (3). In 1927, the Clinical Week, “the prototype of the modern CME course,” began, which evolved into today’s popular clinical reviews at 156 the Mayo Clinic (3). Other medical schools and eventually specialty societies embraced the CME torch. The American Urological Association initiated the first mandatory CME program in 1934. By 1957, the American Medical Association (AMA) had published the first set of CME guidelines. However, in the 1970s, “the political predominance of the AMA in continuing education was questioned by other professional associations” (4). As a result, in 1981, a successor to the AMA’s Liaison Committee on CME—the Accreditation Council for Continuing Medical Education (ACCME)—was formed. This council, with guidance from various educational and professional groups, was a step forward in the professionalism and quality of CME. From this vantage point, the rather constitutional-sounding declaration is found: “The ACCME accreditation process is of, by, and for the profession of medicine” (5). Standards to assess accreditation requirements ensued, such as the Seven Essentials in 1982. By 1998, the revised System98 “encouraged accredited providers to focus on CME that linked educational needs with desired results, and to evaluate the effectiveness of their CME activities in meeting those educational needs.” By the early 21st century the ACCME positioned itself “to support US health care quality improvement efforts and to align with emerging continuing professional development systems to support US health care quality improvement efforts” (5). CME system challenged This seemingly bucolic and utopian situation for CME and the American medical education system was eventually challenged by the US Congress. In a 2007 letter from Senator Max Baucus, chairman of the Committee on Finance, and ranking committee member Senator Charles Grassley, addressed to Dr. Murray Kopelow, chief executive for the ACCME, the senators noted that “the pharmaceutical industry spends more than a billion dollars a year to fund CME programs that are accredited by the ACCME” (6). The letter harshly criticized the ACCME for poor oversight of CME activities and failure to adequately From Emory University, Atlanta, Georgia. Corresponding author: Clyde Partin, MD, Associate Professor of Medicine, Emory University School of Medicine, Emory Clinic, 1365 Clifton Road, First Floor, Atlanta, GA 30322 (e-mail: [email protected]). Proc (Bayl Univ Med Cent) 2014;27(2):156–160