Friday, April 27, 2012

CME is a joke

I know it’s a good idea for us docs to participate in continuing education. What physician doesn’t understand that graduating from medical school/residency training is just the beginning of a life-long educational journey? And hospitals and states require CME for maintaining privileges and licenses.

But here’s the problem. With the possible exception of courses during which you learn a new technique [but be careful if they are industry sponsored], most CME activities are useless. A recent meta-analysis of the value of CME showed that physician effectiveness and patient outcomes are not influenced much by CME activities. Another two studies [here & here] showed that the didactic session, the most frequently used CME method, is the least effective at changing physician behavior. Samuel Johnson said it 200 years ago: “Lectures were once useful; but now, when all can read, and books are so numerous, lectures are unnecessary.”

There’s also the problem of assessing the knowledge acquired at a didactic session like a lecture or paper presented at a conference. Most society meetings or congresses just mandate that you sign in. You could be sleeping, daydreaming or surfing the Internet on your smart phone while sitting in the audience.

For an interesting take on the worthlessness of medical conferences, read an editorial by John Ioannidis in JAMA [subscription required for full text]. Another interesting [and free] link is to a blog by Richard Smith, former editor of the BMJ, who describes his adventures at a cardiology congress in Dubai with typical British humor.

What about so-called “tested” CME as required by many boards for maintenance of certification? The American Board of Surgery requires the completion of 90 hours of CME every three years, and as of July 1, 2012, 60 of those hours must include a “self-assessment activity,” otherwise known as a test.

You can obtain 48 hours of tested CME per year by answering questions found at the back of the Journal of the American College of Surgeons. That sounds challenging until you realize that of the four articles that the CME test encompasses, two sets of questions are accompanied by the answers. For the last issue, I was able to answer the questions for the other two topics without having read the papers.

The topics of papers chosen for the CME test [transplantation, hepatectomy, rat surgery, etc] are not what the average general surgeon is interested in. The principles of question construction are not followed. The questions appear to be made up as an afterthought. The exercise satisfies the letter of the law, but that’s about all.

The current state of the art in CME serves to do two things.

1. Placate the general public and regulators, both of whom assume that CME must be beneficial.
2. Make a lot of money for the conference sponsors and the travel and hotel industries.

What do you think of CME?

6 comments:

Graybill said...

I never got anything out of CME once the the gov decided that offshore trips for same were no longer deductible. How can you improve your mind if you don't spend the afternoon on the beach with a Mai Tai?

Chris Porter MD said...

Great post.
I agree, most CME is useless for updating my practice.
I've wondered the value of ABS re-cert as well

Skeptical Scalpel said...

Chris,

Both CME and re-certification, or rather "maintenance of certification," are ways the profession can give the appearance of doing something constructive.

By the way, some of the worst surgeons I know are board-certified.

Rugger said...

Completely agree.
Unfortunately, I think it is a way to keep the bad docs informed, and punish the rest of us.

Anonymous said...

Hi--What do you think ideal CME would be like?

Skeptical Scalpel said...

Anonymous, ideal CME would be pertinent to one's specialty and one's interests. It would be based on standards and not willy nilly as it is now. It would be accompanied by some sort of testing to verify that the attendee paid attention and learned something.

Finally, it would be fairly priced and not the multi-million dollar industry that it has become.

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