October 2008
Feature Story

Anne Ford

When Pfizer declared in July that it was revising and tightening its CME funding criteria, the most widely reported part of the company’s announcement was its elimination of direct funding for CME programs provided by for-profit medical education and communication companies. But the revised requirements included more specifics than that. Also included were a new competitive grant review period, new financial caps on grant support, and—perhaps most relevant to the CAP and its members—a new requirement that applicants for major grants meet criteria equivalent to the Accreditation Council for Continuing Medical Education’s highest level of accreditation, a.k.a. accreditation with commendation.

So when the CAP’s education division learned in late July that the ACCME had, for the first time, granted it accreditation with commendation, the victory was all the more significant. Less than five percent of the applicants achieved that status, which lasts for six years rather than the usual four, in this accreditation period.

“I was really nervous right up until the time the letter came,” says Debbie Szczesniak, CAP continuing education program manager. “We had done so much, and I really wanted it for us. It’s an indication of the quality of education the College offers.”

Specifically, the ACCME cited the CAP’s excellence in developing and implementing competency-focused CME, consistently using multiple needs-assessment data sources, writing learning objectives in terms of physician performance, performing ongoing evaluations of activity effectiveness and practice application, demonstrating innovative overall program evaluation and improvement, and establishing an optimal organizational framework for its CME unit.

Constance Filling, CAP vice president of education and publications, says that Pfizer’s decision to tighten its CME funding requirements, and the ACCME’s own decision in 2006 to make its accreditation criteria more stringent, are related to the general movement in the industry to avoid conflicts of interest (or the appearance thereof) between pharmaceutical companies and CME. “They want to self-regulate, and in order to do that, they have to be serious about this,” she says. “In part it’s because they’re afraid that somebody else” —at the behest of the U.S. Senate—“is going to step in and do it for them.”

“We’re in a very challenging time for CME because of increasing scrutiny and regulations,” Szczesniak agrees. “So it’s even more impressive, in my mind, that we got the accreditation with commendation.”

The education division has been working toward this goal since 2004, right after the College received a four-year ACCME accreditation. “We sat down and said, ‘Okay, we’ve got the opportunity to show everything we’ve got,’” Filling says. And when the ACCME tightened its accreditation requirements two years later, the education division responded by changing CAP practices to meet them.

“CAP staff took a hard look at each type of CME activity the College offered and identified risk areas,” she says. While some activities were educational for participants, others did not meet the ACCME’s specific guidelines. The CAP Council on Education and CAP committees responsible for those programs helped identify activities that were no longer “CME worthy,” Filling says, and helped determine how to improve other activities to bring them into compliance.

With CAP director of educational program evaluation Ann Neumann, PhD, Szczesniak worked to compile the self-study report ACCME required. “Ann and Debbie did most of the work to push this through,” Filling says. “They made sure we had all the processes in place and all the documentation to support that.” The self-study was due Jan. 4; the ACCME surveyors took a look at it, and CAP staff had an interview with them in February. “They gathered information and provided data input back to the ACCME committee that makes the judgment,” Filling says.

The monumental endeavor was “definitely a team effort,” Szczesniak says. Staff and CAP members design the educational activities; staff evaluates the activities. “It was because of the efforts of all these people that we were able to demonstrate to the ACCME that CAP does an outstanding job and deserved accreditation with commendation,” she says.

Also crucial to the process was the education division’s working group on CME, a CAP member group that reviews and approves education activity proposals. One member of that group, William F. Hickey, MD, professor of pathology and senior associate dean at Dartmouth Medical School, “was heavily involved from the self-study all the way to the accreditation visit,” Filling says. “And that’s an important component, the member oversight.”

The College’s financial and personnel resources put it in a unique position to achieve the distinction of accreditation with commendation. “With our in-house expertise,” she says, “we’re better able to address the more stringent criteria. We have resources focused in those areas, so we’re able to address those criteria differently than other people might.” In addition, “the College has had the financial resources to make significant investments in education without needing to recover all costs initially. That’s a luxury other organizations and associations don’t have.” For example, one of the key differences in the ACCME criteria was the restriction against commercial support. “You can have commercial support for your programs,” Filling says, “but it has to be done in very specific ways. It’s become more and more difficult to imagine how to use commercial support within the guidelines.” Again, “we’re in a luxurious position in that we can do that [limit or eschew commercial support] where other societies can’t.”

“It was actually reassuring to know that the hard work we had done to present a strong CME program earned the ACCME’s recognition.”

In the future, CME restrictions will grow only more stringent, Filling says. “There’s going to be a lot more teeth in them. I don’t think anybody who’s a surveyor at ACCME will be saying, ‘Well, I know you meant well.’”