Issue 19 / 30 May 2011

Let’s take back control of education

GIVEN the flurry of pronouncements concerning the health and wellbeing of the nation, from combating the ravages of the tobacco industry to improving mental health services, there has been one glaring omission — continuing medical education.

Continuing medical education has always suffered from the “Cinderella syndrome” of being unglamorous and, some would say, outright boring. It is forced to endure the neglect of all the other worthy, but unromantic, causes.

When speaking to a colleague about US health care reform, the late Senator Edward Kennedy is reported to have said: “There are about 15 ways for this to happen. But you’ve got to find the one to make it happen.”

In the past, the preferred way to make reform happen was to initiate an inquiry and seek a report. In the past decade or so we have had a plethora of inquiries and reports on health and innumerable recommendations for reform. But, at this juncture, it all seems to have come to an abrupt end.

There has been no real appetite or leadership for actually effecting reform. And worse, we have frequently witnessed an almost cavalier disregard of the recommendations contained in comprehensive reports, such as the National Health and Hospitals Reform Commission final report and the Special Commission of Inquiry into Acute Care Services in NSW Public Hospitals report finalised in 2008.

Nor have we seen a readiness to learn the lessons of overseas experiences in this domain. Such political entropy is no more apparent than in the area of continuing medical education.

In Australia, as elsewhere, there has been no formal funding for these postgraduate activities. Invariably, continuing medical education has been funded by the pharmaceutical industry with its vested interest in promoting its products. This is big business!

Of the $US2.6 billion ($A2.46 billion) spent in the US in 2006 on accredited continuing medical education activities, $1.45 billion (60%) came from the pharmaceutical and medical devices industries. In the absence of reliable and readily accessible Australian data, there is no reason to believe that things should be any different here.

Another indicator of such support is the revelation that in 2009 Merck spent $US3.2 million over 92 days on medical experts to speak at medical meetings.

Although there is no denying that some good may come from these investments, we must ask ourselves how all these activities may be recorded or studied as to their outcomes. The Canadian Medical Association Journal in an editorial in 2008 suggested an Institute for Continuing Medical Education to take ownership, leadership and propriety of this essential activity.

The suggested mandate for such an institute is to:

  • Set guidelines and standards for efficacious, unbiased continuing education
  • Develop support and promote inter-professional educational opportunities
  • Monitor sources of all funds and set accreditation standards for continuing education providers
  • Provide continuing education grants to accredited institutions
  • Identify education and treatment gaps
  • Develop more effective ways to educate health professionals
  • Find new ways to integrate education into clinical practice
  • Help health care professionals overcome barriers to lifelong learning
  • Act as a central clearing hub for continuing education for all health professionals.

Concerns about pharmaceutical funding of continuing education were raised in an article in MJA InSight earlier this month, with one commentator suggesting pharmaceutical companies make altruistic donations to a blind fund that could administer medical education.

But it is merely an idea. It seems that establishing an institute of continuing medical education in the hands of independent and qualified people is not even really on the Australian medical radar.

Why can’t — or won’t — we make this happen?

Dr Martin Van Der Weyden is emeritus editor of the MJA.

Posted 30 May 2011

3 thoughts on “Martin Van Der Weyden: From the sidelines

  1. Doc Strange says:

    Continuing medical education will be part of our professional and private lives, whether we want it or not. The ‘good old days’ of the unchecked ticket are thankfully gone.
    Whether we accept to be taught/bought by drug companies or whether we want evidence-based education is the question
    If current post-grad education is too boring and there’s no place for it, the more reason to tackle it and change the system – where there’s a will there’s a way. Put some money on the table and I’m sure the work will be done in an entertaining and social way that enhances professional interaction, EBM and cost-effectiveness (as well as avoiding bad outcomes, complaints and stagnation).
    Good on you for tackling the big issue Martin!

  2. Alex Wood says:

    Unless we have developed ideas to help make continuing education easy, some group, less informed than us will take an initiative, which may be difficult to resist.
    Well done for leadership, details need to be fleshed out of course.
    Peter Arnold may be correct that it is easier in specialties, but I doubt many specialists work less hours than GPs and know it is hard to always keep awake in lectures, but GPs are able to select what to attend.

  3. Peter Arnold says:

    Martin, it all makes sense, except… A few things immediately come to mind:
    1. The current shortage of doctors and the intense pressure everyone is under to get their work done – not a lot of time or energy left for family, refreshing leisure, or for CME.
    2. How to make CME relevant for non-specialists. The narrower the specialty, the easier to plan CME. How to find topics relevant to the majority of GPs in their practices of diverse nature?
    3. Many of us learn better by reading and simply ‘switch off’ when lecturers drone on in the dark with their Powerpoints providing the only illumination.
    I suspect that one reason why your objectives have not been met is that CME is attempting an impossible ‘grab all’. To be realistic, I do not think, in a profession with such widespread interests and activities, that it can succeed.
    It can appear to succeed, as reflected in recorded “Brownie points”, but, despite everyone’s good and praiseworthy intentions, I seriously consider that it has less chance of success than Don Quixote.

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