Overcoming the cultural challenges of CME in the United Kingdom

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Published: 17 Dec 2014
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Prof Robin Stevenson - Journal of European CME, Glasgow, UK

Prof Stevenson explains the challenges of bringing continuing medical education (CME) to into medical culture for ecancertv at the 2014 European CME Forum.

While many hospitals in Europe and America have embraced CME planning, Prof Stevenson notes that the United Kingdom could invest more.

"We simply do not invest in hospital-based, practice-based CME in the United Kingdom, and I think that is a defect in our system," Prof Stevenson says.

He offers several solutions for the future of CME in the United Kingdom, as well as more global guidance.

I was president of the European board for CME accreditation in pneumology, respiratory medicine as it’s known in Britain, and I was president of that for about five or six years. Then I was, I still am, a member of the EACCME task force set up to improve CME and in the last three to four years I have been editor-in-chief of the Journal of European CME, a new open-access on-line journal which is very slowly becoming established but it has been a rather difficult path to go down because unlike North America Europe doesn’t really have academic units devoted to or dedicated to CME. So there is very little CME research done in Europe in contrast to Canada and the USA where almost all the world research in CME is carried out because they have academic units devoted to CME. Also in the hospitals in North America they will have a department of CME which doesn’t happen in Britain. You can look on the websites of the great American and Canadian hospitals and you will find details about their CME department; you look in vain for any such departments in the Great British hospitals.

We just do not invest in hospital based, practice based, CME in this country which I feel is a defect in our system which organisations like the General Medical Council and indeed the government, the Department of Health, the universities, the colleges, they should be addressing that, they should be appreciating that doctors in the UK and Europe are more or less left to their own devices in their place of work to organise their own CME. They do it, of course, it happens; it’s very good CME and, in many ways it’s the most important CME they do. In other words, I’m talking about multidisciplinary team meetings, grand rounds, case conferences. And they do that and it’s of enormous value to their CME but it’s done in a wholly unstructured way because there’s no department in the hospital with responsibility for contributing to the organisation of these meetings.

Why do you think there is a lack of structure in Europe and do you expect it to change in the future?

It’s easy to say why there might not be any because governments have invested most of their money in medical schools. So undergraduate medical education is very well funded and it’s very well researched, in fact probably too well researched because they keep going round in circles with all their educational theories. Then we also spend a lot of money training people to become consultants, but when they become consultants we take the view, or the European view has been, that’s it – they’re on their own, let them do their own thing. For some curious reason which I don’t quite understand that didn’t happen in America. It may be because the insurance companies have been very keen for CME to be carried out in order that the doctors will perform better and the cost to the insurance companies will be diminished. That’s one factor, I’m sure it’s not the only reason why the situation is so different in North America but it is different and I think they are ahead of us in this regard.

If that change is implemented in Europe, who will lead it?

It is the government, the Department of Health, and the General Medical Council, I would say, should be the prime movers. Then perhaps the universities but the universities, I think, are reluctant to do it. But the medical schools perhaps should get together and come up with some opinion on this subject. Even if it’s to say they don’t want to do it, we should know what they think.

What can happen to make these changes take place?

What is happening, in Britain particularly, is if you look at the GMC report for 2014 the number of cases of negligence being referred to the GMC is rising. The number of people being struck off is rising. The number of people to whom sanctions are being applied is rising. The amount of money paid out in compensation is rising. So eventually the government and the GMC will say, “We have to do something about this.” Now, what they have up until now rested their hopes on has been revalidation which I believe to be simply a punitive bureaucratic instrument which I do not believe will improve clinical performance. Now that’s just, if you like, a prejudice on my part but I’m not aware of any comparable situation anywhere else where an instrument like that has resulted in doctors performing at a higher level. So if it comes home to them that the situation in terms of professional performance is going in the wrong direction, eventually it might dawn on them that the obvious solution is to invest in CME/CPD, in other words, to use a carrot for the doctors instead of a stick, revalidation being the stick.

How do you think the accreditation process should work?

I’ve always taken the view that the American system of accrediting the providers rather than the individual educational activities is more sensible. It’s cheaper, it works more easily, it’s got an economy of scale and probably it is more likely to improve the quality of the education. Whereas in Europe we do activity accreditation which is a prospective system where we look at activities which haven’t taken place yet and try to accredit them on the basis of what the programme looks like. We’ve no idea how it will actually play out in reality so it’s very difficult to make a judgement on it. Whereas provider accreditation, you are accrediting providers on the basis of their past record which you can scrutinise.

How likely is it that those changes will take place?

I think it’s possibly likely that a hybrid system will be adopted over the next few years whereby the major providers will be accredited as such whereas minor providers who just put on a few activities, their activities will continue to be accredited on the basis of activity accreditation.