CME: unifying European standards and focusing on the needs of the physician

Rebecca Aris interviews Professor Robin Stevenson

JECME

Professor Robin Stevenson is a retired respiratory physician. He was president of the European Board for Accreditation in Pneumology and still serves on the EACCME taskforce for improving CME in Europe. He is the current editor of the Journal of European CME.

Professor Robin Stevenson is a retired respiratory physician. He was president of the European Board for Accreditation in Pneumology, still serves on the EACCME taskforce for improving CME in Europe.

Professor Stevenson speaks with pharmaphorum about how the CME landscape has evolved over the years and how we can unify standards across Europe.

Interview summary

RA: How have CME standards changed over the years and why do you think this is?

RS: There are two ways of thinking of standards, one is the standard actually delivered, and the other is the standard that has been decided should be aimed for.

The standard which should be aimed for has been upgraded over the recent years, both nationally and European wide. But, having said that, what is actually delivered to the doctors probably hasn’t changed hugely.

It has changed in that there has been more of a shift away from didactic lectures on to more interactive small group teaching, and that’s been a good thing. However, there are still a great many didactic lectures delivered without any terrific benefit.

The main way in which standards have changed for the better has nothing to do with CME, accreditation, or CME planning, but it’s simply the accessibility of the internet.

Now when doctors want to learn more in a particular area, they just Google it or they go into one of the medical software platforms like Up To Date. That’s been a revolution because 10 years ago that didn’t happen at all, and so to that extent doctors are much better educated, or are educating themselves much better than they ever did before.

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“…until Europe adopts provider accreditation it won’t have much chance of unifying standards for CME.”

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RA: How would you describe the current CME / CPD environment in Europe?

RS: The European scientific societies are the main providers of CME in Europe, and they all operate quite independently. They apply for accreditation to the national authorities of the country where they are operating, and also to UEMS, the European Union of Medical Specialists via their European Accreditation Council for CME – EACCME.

The process of accreditation in relation to these organisations has very little effect on the quality of CME that they deliver, because almost everything that they apply for is granted. The only time it’s not granted is if it’s thought to be obviously influenced by commercial bias.

In the European environment though, as I’ve just said, much more important is the fact that the doctors are undertaking their own CME either by themselves, or locally within their own hospitals at multidisciplinary team meetings. These provide very good educational value, but are quite below the radar of all the big players such as EACCME and the Federation of the Royal Colleges.

RA: How can we ensure that CME activities across Europe are of a more unified standard?

RS: By making the accreditation bodies more potent. At the moment a provider simply applies to the appropriate accreditation body for accreditation of the event. It’s just a formality, they almost always are given accreditation and they go ahead with it without having to change anything in their programme.

The difficulty is that the event has to be accredited before it takes place. The accrediting agency has no idea how the event will actually play out, all they can do is look at the programme, see who are holding it, and try to come to a decision about whether it’s worthy of accreditation or not. They almost always say it is, not because they believe it to be so, but because they have no justification in saying that it won’t be any good.

In the USA and in Canada they have a different system called Provider Accreditation, where it’s not the individual events that are accredited, but it’s the providers themselves. The providers apply for accreditation for a period of years. The accreditation agency in America requires the provider to show what they’ve been doing in the recent years in detail and this process may take days. They have to produce all the documentation they have for the events that they have put on, the evidence in relation to the needs assessment, the aims of the meetings, the methods of delivery of the CME, and the ways in which the effectiveness of the CME is evaluated. The agency spends a lot of time looking at all this information, and then they decide whether the provider is worthy of accreditation and for how long.

It’s an expensive system, but it means that the providers are being held to account much more rigorously than in Europe. I believe that until Europe adopts provider accreditation it won’t have much chance of unifying standards for CME.

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“It’s an expensive system, but it means that the providers are being held to account much more rigorously than in Europe.”

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RA: Do you think activities are directed proportionally across different disease areas, and why do you think this is?

RS: Most diseases involve drug therapy, and when there’s drug therapy then there will be investment in CME by the drug industry.

If you look at it across the specialties it’s the specialties which use a great many drugs or devices that have more CME, and cardiology is the classic example. There’s much more CME in cardiology than say in respiratory medicine, because respiratory doctors don’t use so many expensive drugs, or expensive devices. So there’s a huge difference in the number of activities in cardiology which are accredited in comparison with those in respiratory medicine.

RA: What changes do you think need to be made to ensure that the CME activities are more focused on the needs of the physician?

RS: CME should be predicated on an initial needs assessment. In other words the people who are providing CME should go to the trouble of identifying gaps in practice, gaps between what is and what should be. And that traditionally has not been done. That should be an important part of the planning of any CME, and without it the CME probably should not be accredited so easily.

But at the moment, the accreditation authorities don’t bother much about whether a needs assessment has been properly or rigorously done. So that would be I think one of the important points to make about trying to improve the situation.

This is followed by a decision about the best way of delivering the CME. If the CME is delivered by a didactic lecture then it’s unlikely that clinical practice will change very much. There are lots of studies showing that, if the CME is delivered in an interactive way, such that the doctor participates in the learning, it’s more likely that his practice will be affected.

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“The difficulty there is that European medicine is quite conservative and is reluctant to change.”

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RA: How would you like to see the accreditation process change to positively impact on practice in healthcare, and what role would you like pharma to play in this?

RS: As mentioned earlier I think we should change in Europe from programme accreditation to provider accreditation. That would be the single most important thing we should do to impact more positively.

The difficulty there is that European medicine is quite conservative and is reluctant to change. It is quite a big change to make, and it involves setting up a considerable infrastructure.

With regards to what role pharma would play in this, the answer is not much. The accreditation agencies which will be involved would be totally independent of pharma.

Pharma would continue to be able to sponsor education, but it would have to be done at arm’s length. In other words the drug company can decide what topic it wants to sponsor education in, but should have no part in how the programme should be developed, who the speakers should be etc. These aspects of the education should be done by a faculty or an organising committee, which should operate independently of the drug company.

But, of course, there’s no reason why sponsorship by a drug company should not continue, although there are some European countries that don’t want any involvement from the drug industry.

RA: Professor Stevenson, thank you for your time and for your insight today.

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About the interviewee:

Professor Stevenson retired as a consultant respiratory physician from Glasgow Royal Infirmary 3 years ago. He had been president of the Pneumology Section and Board of the European Union of Medical Specialists (UEMS) and is the immediate past President of the European Board for Accreditation in Pneumology (EBAP), which accredited CME material in Respiratory Medicine for European meetings, congresses and e-learning. He is also the first editor-in-chief of the Journal of European CME.

How can we ensure that CME activities across Europe are of a more unified standard?