Newsletters - February 2010

Change is Coming to CME: Medical College of Wisconsin - Today and Tomorrow

By Robert K. Ausman, MD, Clinical Professor; Jon B. Mayer, MBA, Administrator, Department of Surgery

As a major department in a teaching institution, the Department of Surgery offers qualifying presentations designed to meet the needs and interests of physicians in community practice, as well as those who spend their professional time on the Medical College of Wisconsin campus or visit occasionally. Some CME opportunities occur weekly; others have a different periodicity, such as annual endowed lectures. Finally, there are limited subject in depth symposia which feature departmental expertise or celebrate a seminal event.

In total, the Department of Surgery and its divisions offer 448 hours of qualifying CME activities each year. In many instances, these presentations also meet the criteria for credit in associated professions (pharmacy, nursing, etc.). In a continuing commitment to graduates of Medical College of Wisconsin surgery training programs and to surgeons and others in the extended geographic area it embodies, the department has examined how it fulfills the obligation of teaching at all professional levels. “Change,” recently a very important and popular word in our lexicon, is coming to the CME programs at the Medical College of Wisconsin Department of Surgery.

CME is designed to update practitioner post-graduate knowledge, even though CME has been criticized as insufficient or ineffective. To provide greater CME availability and to serve more surgeons with useful information, particularly those graduated from Medical College of Wisconsin training programs, change is being embraced by the Medical College of Wisconsin Department of Surgery.

The new program, an addition to the present, is titled Medical College of Wisconsin Department of Surgery — Today and Tomorrow.

Some History
Organized continuing education for the medical profession developed from a recognition that practitioners were not maintaining proficiency as the pace increased for introduction of new concepts and technologies. The prevalent method of delivery has been essentially the same for more than three decades. To guarantee use of CME, state licensure agencies made mandatory attendance requirements a condition of license renewal. At this time, essentially all jurisdictions have a minimum requirement of 20 CME hours per year, enforced at the state level.

In recognition of the need for CME qualifying presentations to meet standards countrywide, a national governing agency, Accreditation Council for Continuing Medical Education (ACCME), was established. It sets provider qualifications and gives accreditation to organizational entities entitled to develop and sponsor CME activities. In the U.S., there are approximately 1,600 recognized organizations which can award CME credit hours. At the Medical College of Wisconsin, the program is under the overall academic purview of a senior associate dean, with day-to-day supervision provided by a full time director for the Office of Continuing and Professional Education.

More than 6 million CME credit hours are earned annually in the U.S. They fall in two primary categories: personal encounters and enduring materials. The former comprises about 90 percent of the total and represents credits earned by the presence of the physician at the learning site. Examples are single or multi-subject seminars, free-standing presentations (individual lectures, etc.), or annual meetings of specialty societies. To receive credit, the sponsoring entity must have received prior approval from an accredited organization (such as the Medical College of Wisconsin Office of Continuing and Professional Education) which means not just any lecture or similar event will meet the standard. While it is the most common, the primary disadvantages to this mode of CME are its often high cost and inconvenience. Personal attendance frequently means travel away from the home site, missed patient contact, and the need to make arrangements to cover a practice— not always easy.

Timing of current CME experiences is dictated by the sponsor; often, it does not blend well into patient care and personal schedules. A final problem is the fit of the subject matter to the needs of the participant. Programs are made to satisfy a majority of audience members, which may not parallel individual interests. In the multi-lecture (often all day) format only a portion of the presentations may have relevance to the listener. For these and other reasons, personal encounter CME is a diminishing share of total claimed CME credits.

The alternative, enduring materials, relies upon a learner implemented CME experience, thus favorably impacting patient care duties, convenience and personal cost. Enduring materials requirements for quality, prior approval and sponsorship are the same as personal encounter CME. As to relevance, the learner selects the subject to be heard or viewed, avoiding materials not specific to immediate practice activities.

Medical College of Wisconsin Department of Surgery— Today and Tomorrow is based on the enduring materials concept. Credits earned are generally comparable to those obtained through personal encounter.

Division of Education
In this section, we will describe how the Medical College of Wisconsin Department of Surgery is confronting the opportunity to expand its frontier in the education field.

The department has established a Division of Education whose chief is Philip Redlich, MD, PhD, Schmitz Professor of Surgery. Dr. Redlich also serves as the associate dean for Curriculum at the medical school and maintains an active practice in surgery at the Clement J. Zablocki Veterans Administration Medical Center. The Division of Education has oversight for undergraduate teaching in the department and resident education. Now,
its activity will also encompass the expanding program for CME described below.

The raw material for off-campus CME is readily available in the Department of Surgery. Each week, there are several scheduled presentations; many have been qualified prospectively for credit. The department has consent to authorize participant credit under the categories of personal encounter and enduring materials for these presentations.

The proprietary engine to operate Medical College of Wisconsin Department of Surgery — Today and Tomorrow has been developed by a faculty member in the department in collaboration with a skilled technical person who is on the Education School faculty at another university. The basic system puts regular and special department lectures on the Internet in a protected space in a synchronized audio and visual format that faithfully and realistically reprises the original lecture. They remain in place and accessible for up to three years.

Several features differentiate this Internet learning experience from other CME which has appeared from time to time. These include:

  • Sponsorship and control by a major academic department of a medical school
  • User selection from the department teaching program
  • Realistic reproduction of the original presentation
  • Pause, resume and repeat user options
  • Full device compatibility; access from any computer or personal device
  • Immediate recognition and user site printing of CME credits

Expenses and Charges
The issue of who is paying for physician CME has become an important focus politically and educationally. A major U.S. Senate subcommittee has expressed concern about drug company and medical device sponsorship; committee members believe the CME material sponsored and/or prepared by for-profit companies often contains biased statements. By not giving physicians all the information, patient interests are served adversely. This
thought has been joined by several medical schools which have decided not to accept support from for-profit healthcare organizations. To avoid further criticism, most companies have announced policies which will effectively discontinue their former support, leaving CME activities to manage on their own and raising the possibility that physicians will be paying the total cost of their CME in the near future. There has been other sponsorship in the past, such as not-for-profit foundations not connected with industry. However, drug and medical device companies previously have carried more than 90 percent of the burden amounting to millions of dollars. What will replace this massive dollar infusion is not yet clear. For now, it seems unlikely a single or even a group of entities can or will step into the breach. People usually responsible for forming public policy have been heard to say it is time physicians begin to bear the cost of their post-graduate education as do attorneys, accountants and others. Another important thought has been that medical schools, traditionally responsible for medical education at other levels, are the best equipped and qualified to carry this burden as part of the overall teaching mission. At this time, a comprehensive final pathway or its alternatives is not apparent.

As part of the Medical College of Wisconsin, the Department of Surgery perceives a responsibility for the ongoing education of physicians, especially those practicing in the specialties encompassed by the teaching programs of the department. Department faculty and administration desires to be the lifetime “surgery home” for its trainees and a resource for surgeons in the area served by the Medical College of Wisconsin. To offer Medical College of Wisconsin Department of Surgery — Today and Tomorrow without barriers or extraneous concerns now prevalent in CME, the following basic principles of operation have been established:

  • No financial sponsorship will be sought or accepted from commercial organizations for any operational costs of Medical College of Wisconsin Department of Surgery — Today and Tomorrow.
  • There will be no charge for use of Medical College of Wisconsin Department of Surgery — Today and Tomorrow by licensed physicians. Required participant registration will be for record-keeping and maintaining ACCME certification.
  • No charge will be made to physicians for earning and recording CME credits from the Medical College of Wisconsin. Regular rules for CME qualification will apply.

A beta test (clinical trial) has been completed recently. Medical College of Wisconsin Department of Surgery— Today and Tomorrow is ready for prime time. A library of more than 20 lectures covering many subjects in surgery and beyond, especially including guest lectures on diverse subjects, is ready to be accessed and downloaded for your edification and CME credit. One to three additions will be made each month. To register, please visit and follow the Grand Rounds link.

With the introduction of Medical College of Wisconsin Department of Surgery — Today and Tomorrow, the Department of Surgery has taken another step forward in fulfilling its education mission. Important pertinent components of the department teaching program have been made available to physicians in a manner compatible with their professional activities and schedules, allowing them to serve patients better. In
addition, license requirements can be accommodated with little or no personal disruption. Direct and related personal costs are no longer a factor in obtaining a good post-training educational experience which can be self-structured for relevance to practice activities.

Medical College of Wisconsin Department of Surgery— Today and Tomorrow is not the end of change for CME within the department. Further advances in technology and communication are in the development stage.

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