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Alliance day 3: Physician, resident, and pharmacist knowledge regarding CME regulations

This turned out to be a really interesting session. Brooke Johnson, Duke Office of Continuing Medical Education, walked us through a pilot study she conducted to determine what physicians, residents, and pharmacists know about what's appropriate in a CME setting. Despite a low response rate and some other design limitations, the results were worth noting.

Most of those surveyed had attended CME activities, 40ish percent (it's hard to tell exact percentages from the bar charts) had experience as speaker/moderator, and some had served as CME committee members and course directors (almost none currently were current or past CME medical directors). Sixty-ish percent had no commercial relationships, and less than 20 percent were members of speakers bureaus, stockholders, or received clinical research grants.

The survey posed a number of questions and scenarios, most of which came straight from the American Medical Association's Web site. Johnson also had the audience respond with a yes, no, or not sure to the same questions before telling us what the survey results were for each scenario (yes, I got one wrong). Anyway, the first was: ACCME-accredited providers are responsible for reporting, to each commercial supporter, information concerning the expenditure of funds each has provided (this is the one I got wrong—I had no idea you had to do this. Still sounds wrong to me. But I digress). The answer was "true." A little more than 40 percent got it right; a little more than 20 percent said "false," and the rest were unsure. But then again, the audience at the session was really mixed, so we weren't too different from those surveyed in the study.

The second question they asked was: When a commercial supporter provides an educational grant in support of a certified CME activity, they can receive free exhibit space. Even I know that this is false, that education and exhibits have nothing to do with each (or shouldn't, anyway), though from what people in the audience were saying, it's not an uncommon practice to give them a freebie as long as it's not a part of the deal. Debra Gist, a consultant who formerly was with Duke and who helped Johnson present, said it's just good practice to avoid any possible appearance of quid pro quo going on.

The third question was a scenario: A referring physician is invited to a 45-minute lecture by a respected clinical researcher. The activity is certified for AMA PRA Category 1 (tm) credit by an academic medical center.

An educational grant has been provided by ABC pharmaceutical company, there are no registration fees, and the session will take place in a baseball park just prior to a professional game.

Following the meeting, attendees and their spouses are given free tickets to stay for the baseball game. Could this be considered in violation of the antikickback statute?

Well duh, of course. But only 40ish percent of survey respondents said yes, while 20ish percent each either weren't sure or said no.

Next scenario: A pharmaceutical company invites physicians to Whitewater Adventure for a weekend of rafting and continuing educations. Physicians will spend Saturday conquering the river, followed by a speaker who will lead a brief medical discussion Saturday evening. Is this offer appropriate?

Duh again, obviously not. Most of those surveyed recognized this as a no no, although 25 or so percent thought it was OK or weren't sure.

The next one had the really surprising results. Here's the scenario: A physician attends a CME activity certified for AMA PRA Category 1 credit by an ACCME-accredited provider and financially supported by a pharmaceutical company.

At the end of the activity, the industry rep stands up and thanks everyone for coming on behalf of the company. She also states that anyone who would like additional information about the drug discussed in the CME activity should feel free to contact her. Is the behavior of the rep appropriate for the forum?

Most definitely not. But 60 percent or so of the physicians, pharmacists, and residents thought it was just fine.

And when asked how reliable they thought the information comparing their company's drug to others on the market a pharma sales rep gives them is, the physicians were most likely to say it was very reliable, followed by the residents. The majority of all three groups, though, put it firmly in the "somewhat reliable" category.

Johnson then asked for ideas for followup research, to which I replied, why not survey the major newspapers' medical reporters on their knowledge of CME regs? (Yes, I was getting snarky, but wouldn't that be fun?) Most of the discussion centered around the fine print of some of the scenarios, and pointed out that the AMA questions were written three years ago, and things have changed since then. If you have any good ideas, I'm sure Johnson would love to hear them (you can e-mail her here). She also is looking for feedback on a site Duke put together to help increase awareness of CME regs. It's at

P.S. I asked Johnson to e-mail me her slides, and also the write-in comments people had, and I just have to share this one because I hear some version of it every year on our Annual Physicians Preferences Survey: " i wholly support drug company funded educational activities. No one else will provide them to us for free, we will not pay to attend them, and we learn a great deal from them. It is idiotic to assume that we are swayed like little children by a drug rep when the next day their competitor will come and refute it with other evidence. we are grown-ups that can decipher the truth in the materials and make clinically appropriate decisions."

Though my favorite was this one: "FACT: I am for sale and can be bought--especially if a golf trip is involved. I freely and publicly disclose this. Please share this fact with ALL in the industry." Well, dude, consider it shared.

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