Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Adopting newer technologies
- N.P. Viswanathan (15 August 2008)
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Dreaming of new educational models
- Alberto E Tozzi (19 August 2008)
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Main Stake holder's perspective ignored
- Seshu B Gosala (20 August 2008)
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Conferences cannot be omitted
- Thomas Krasemann (20 August 2008)
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For a CME off-market
- Maurizio Bonati (28 August 2008)
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Rethinking continuing medical education- 'The NHS Trusts in UK must do their bit'.
- Anthony V B Bathula, Swapna Alexander (31 August 2008)
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Provenance of CME
- Elizabeth H Hare (7 September 2008)
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N.P. Viswanathan, FamilyPhysician svclinic,gmpalya,Bangalore-560075,India
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Continuing medical education is very important for the Doctors. Throughout the world pharmaceutical industry are sponsors for such programmes. In Bangalore, India, we conducted Annual cme without getting any sponsorship from any pharmaceutical company.The concept was AWESOME. Academics with excellence, Science only, minus Extravaganza. There was stress on delivering scientific delibrations with lot of stress on audience interaction through panel discussionns, minimising didactic lectures and avoiding any financial sponsorship. Awesome cmes are now happening all over India. We can also conduct teleconference, videoconference, virtual meetings
with minimal expenditure. N.P.Viswanathan Competing interests: None declared |
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Alberto E Tozzi, Paediatrician Bambino Gesù Hospital, Epidemiology Unit, 00165 Rome, Italy
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I entirely endorse the view of Dr. Pisacane and I agree on his list of priorities. I feel that concentrating on educational objectives is essential. The choice of CME objectives should be based on a continuous analysis of quality of care indicators which serve also for verifying the impact of educational activities. Working with small groups greatly helps to focus on specific problems and does not prevent from participation in large networks. New technologies can also support a radical change in CME organisation: a bottom-up approach in the choice of CME topics is possible if end users organised in social networks make active proposals; educational portfolios may be flexible and customised taking advantage of the endless resources available on the web; educational sessions may include synchronous and asynchronous modules to fit the users' needs. I also believe that the support of a blind trust from drug companies should be pursued. We have enough knowledge and technology to set up independent, efficacious, and enjoyable medical education activities. Competing interests: None declared |
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Seshu B Gosala, Chief Medical Officer Visakhapatnam 530017
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As usual the debate on CME and pharma trade is centered around the providers of health care and the receipient of it, the patients' interests, have been left out of the discussion. One can not ignore their stake as it is they who foot the bill for any activity of supporting medical fraternity. As long as the trait of vulnerability among some of the medical community, which is not exclusive to medical professionals, thrives, the pharma industry invents methods to overcome legal, moral and ethical hurdles. The moot question, "Is it possible to sheild the sccumbers from inducements"? If not, are the medical politians smart enough to devise alternative strategies of serious CME activities which concentrate on the three domians of knowledge, KAP, (cognitive, affective and psychomotor)and not on jumborees and junket oriented titilations which are the order of the day. My opinion is it is a tall order. So live with it and "Carry on Doctor". Seshubabu Competing interests: None declared |
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Thomas Krasemann, Consultant Paediatric Cardiologist Evelina Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London SE1 7EH
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For all doctors maintaining good clinical practice is mandatory, and therefore we need to keep ourselves up to date. As one of the doctors who still thinks that attending conferences may be benficial for my daily work, I would like to comment on Piscane's suggestions: First of all it seems important, as he pointed out, to have targets and objectives for each type of training. But in the rapidly evolving field of my specialty (and I guess this is the same for many others) conferences are used to exchange new ideas and technical hints. Yes, the new ideas could be shared via video-conferencing, but to me the discussions with colleagues afterwards (not necessarily in the audience) are extremely fruitful as well. Meeting of other health professionals gives new perspectives on the own work, and cannot be replaced by video- or email exchange. Therefore there is still a need for conferences. I congratulate the author on being able to organise almost 50 educational events per year in his institution. Unfortunatley he did not specify if this included teaching junior doctors or nurses on a regular basis -if this was the case, most of the NHS consultants who give regular teaching would do the same, and without financial support from the industry. The goal here is of course not the same as for major meetings, and this should not be mixed. I wonder how he would achieve the goal of introducing new ideas to his speciality in small groups. I think this is impracticable, and journals alone do not allow the necessary first-hand-discussions in a timely manner. If any conference is sponsored by a variety of industry, then the influence of a single company will be reduced. Therefore the organisers should aim for as many sponsors as possible. Doctors quite often have to pay for their education, which then will be benficial to their employer as well. Currently the resources to help the doctors are small, and just by attending one conference per year the amount for each consultant is used. Tax relief does not mean a 100% refund. But one conference will not be enough for being up to date. Therefore industry spnosoring allows the individual to improve the service, because hardly any conference focuses on a single product. In summary conferences are still useful, and as long as these are not fully paid by the health authorities, sponsoring will be beneficial. Competing interests: None declared |
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Maurizio Bonati, Head Department of Public Health,
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The unusually positive findings concerning Pisacane’s educational activity support the utopian thought that “another world is possible”, although time, will, participation, and rules are needed. The seven practical measures for limiting commercial support to continuing medical education (CME) are the milestones in a safer road towards the most appropriate care to patients. What it is essential to clarify is who defines the direction and destination and who pays for the trip. CME should be in the interest of every health professional and of her/his working institution. In fact, CME is an investment for updating and improving both individual knowledge and skills and the quality and appropriateness of care of a health institution. In such a context, taking the CME route alongside industry should be forbidden. Individual health professionals and institutions (even if in a different manner) must contribute by paying and defining the needs, based on auditing of the practice. A CME unit should therefore be set up in each health center. CME is a complex and fruitful business (travel, stays, speakers’ fees, organization expenses, etc.) that a more effective approach, i.e. the adoption of Pisacane’s proposals and local organization, can obviously undermine. Since respected professionals or key opinion leaders can be involved in such business, transparency is necessary, also through appropriate conflict of interest declarations. After all, since the evidence shows that an effective CME is one that involves local, shared, not frontal, initiatives, taking part in clinical research should be considered in CME programs. Designing and writing a formal clinical trial protocol and facing the difficulties of organizing or participating in independent clinical research should be one of the potential challenges of CME outcomes: leading health professionals towards independency, transparency, effectiveness, and equity of care. Competing interests: None declared |
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Anthony V B Bathula, Staff Grade - General Surgery Glan Clwyd Hospital, Rhyl. LL22 7JF, Swapna Alexander
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Rethinking continuing medical education- 'The NHS Trusts in UK must do their bit'. The purpose of Continuing Medical Education (CME) for healthcare professionals is to keep them updated with ever expanding medical developments, including new disease and treatment methods (BMA, 2006). Continuing Professional Development (CPD) is a lifelong learning process that complements formal education and training (GMC, 2004). This learning process may include medical, managerial, ethical, social and personal communication skills on top of specialty-based competencies (Alahuhta et al, 2007). Alfredo Pisacane has rightly suggested that healthcare institutions should commit resources for CME. Resource allocation does not necessarily mean budgetary allocation of funds alone. As suggested one must concentrate and promote educational events such as audit meetings, clinical governance forums, multidisciplinary team meetings, hospital grand rounds, guest lectures, personal study, and hands on experience training sessions and so on within healthcare institutions. This will certainly eliminate the present dependence on drug and medical device companies in promoting CPD among the healthcare professionals. The Department of Health advises that CPD requirements of healthcare professionals should be identified on the basis of the needs of individuals, within the context of the needs of the organisation and patients. This is determined through a regular appraisal process with a personal development plan that is agreed between the individual professional and their manager within the commitment of time and resources. The key issue is to ensure that healthcare professionals maintain their competency by developing CPD strategies for the revalidation /re-certification of their members through their regulatory body (Department of Health, 2007). The employing National Health Service (NHS) Trusts must ensure that all their healthcare professionals are issued job plans and the CPD sessions are protected for its intended use. The trusts must endeavor to support these sessions, even at the expense of ‘National Targets’. This practice in our opinion will promote the idea of locally organised hospital based; non drug and medical device company dependent Continuing Professional Development. Bibliography Alahuhta s, Mellin-Olsen J, Blunnie W.P, and Knape J T A ( 2007) Charter on continuing medical education/continuing professional development approved by the UEMS Specialist Section and European Board of Anaesthesiology* European Journal of Anaesthesiology 24: 483-485. British medical Association (2006) Medical Education A to Z [Internet] BMA, London. Available from http://www.bma.org.uk/ap.nsf/Content/MedEdAtoZc Accessed on 31st August 2008. Department of Health (2007) Continuing Professional Development. [Internet] London. Available from< http://www.dh.gov.uk/en/Managingyourorganisation/Humanresourcesandtraining/EducationTrainingandDevelopment/PostRegistration/DH_4052507> Accessed on 31st of August 2008. General Medical Council (2004) Continuing Professional Development. [Internet] GMC, London. Available from< http://www.gmc- uk.org/education/documents/Continuing_Professional_Development.pdf> Accessed on 31st August 2008. Competing interests: None declared |
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Elizabeth H Hare, Consultant Psychiatrist Royal Edinburgh Hospital EH10 5H5
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In an edition on the theme of questioning the role of Pharma in continuing medical education, I was surprised Piscane suggested doctors.net.uk, along with BMJ Learning, as promising examples of the use of new technology. While I agree both sites provide many modules of excellent educational quality, the doctors.net.uk site makes it clear it relies on the suport of a number of agencies including the pharmaceutical industries. Amongst the various materials it encourages users to view to subsidise the site are modules sponsored by Pharma. A year ago, the Royal College of Psychiatrists launched a web site providing Continuing Medical Education modules on a subscription basis. Might I offer it an example of an independent provider of on-line CPD materials Competing interests: Editor RCPsych CPD Online |
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