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    1 Comment for this article
    Commercial free CME is possible
    Jeff Whittle, MD, MPH | Medical College of Wisconsin
    Tabas and colleagues recent article "Clinician attitudes about commercial support of continuing medical education" (CME) is an important contribution to our understanding of the barriers to minimizing commercial bias in the information that physicians receive during CME activities.1 They reaffirm that physicians believe they are not influenced by the bias they recognize is present in industry supported presentations. They also show that physicians markedly underestimate CME costs, perhaps because they don't bear those costs.
    Drs. Dorman and Silver's accompanying commentary2 suggests that large group conferences "require" industry funding. They suggest the profession explore alternative approaches to CME including peer
    coaching, performance improvement CME and others. While I applaud efforts to develop innovative, more effective approaches to CME, it seems that large group conferences will continue, at least in the short term. With this reality in mind, I would like to provide a counter-example to their thesis that total separation from industry is impracticable. Since 2007, the annual meeting of the Society of General Internal Medicine (SGIM) has been held entirely without industry support. The most highly rated workshops are interactive small group sessions, which evidence suggests are more effective educationally than didactic lectures.3,4 Details can be found on the meeting website.5
    How is this possible? First, over 400 member volunteers perform rigorous peer review of proposed presentations; review criteria emphasize the educational value of content and format. Except invited plenary presenters, honoraria and travel support is not available. Cost considerations drive where SGIM meets; the 2011 meeting was in Phoenix, not San Francisco. Other cost cutting measures include reducing the number of events where food is served (e.g., beverages, not food, at breaks), no giveaway items, and careful attention to audiovisual costs. The President’s reception for the program committee is the only reception with a hosted bar; others have cash bars.
    Despite these measures, registration fees are comparable to other CME meetings - $595 for the four-day 2011 meeting, exclusive of travel costs, which certainly doubled that cost. It is unclear why this cost is acceptable to SGIM members. However, mean academic general internist annual income exceeds the $166,200 that marked the 95th percentile of US household incomes in 2010; the cost of the meeting, which provides 19.5 hours of CME, is less than 1 percent of their income. They apparently judge that this a realistic price to pay for high quality, peer reviewed education presented without direct commercial support.
    1. Tabas JA, Boscardin C. Jacobsen DM, Steinman MA, Volberding PA, Baron RB. Clinician attitudes about commercial support of continuing medical education: Results of a detailed survey. Arch Intern Med 2011;171(9):840- 846
    2. Dorman T, Silver IL. Continuing medical education: Is perception Reality?
    3. Stephens MB, McKena M, Carrington K.Adult learning models for large- group continuing medical education activities Fam Med 2011;43(5):334-337.
    4. Cauffman JG, Forsyth RA, Clark VA, et al. Randomized controlled trials of continuing medical education: what makes them most effective? J Contin Educ Health Profess 2002; 22(4):214-221
    5. SGIM 34th Annual Meeting website. http://www.sgim.org/index.cfm?pageId=1093&CFID=611301&CFTOKEN=88244229 Accessed June 4, 2011

    Conflict of Interest: Member of the Society of General Internal Medicine
    Original Investigation
    Health Care Reform
    May 23, 2011

    Clinician Attitudes About Commercial Support of Continuing Medical Education: Results of a Detailed Survey

    Author Affiliations

    Author Affiliations: Office of Continuing Medical Education (Drs Tabas, Boscardin, and Baron), Departments of Emergency Medicine (Dr Tabas) and Medicine (Drs Boscardin, Steinman, Volberding, and Baron), University of California San Francisco School of Medicine, and International AIDS Society–USA (Ms Jacobsen and Dr Volberding), San Francisco.

    Arch Intern Med. 2011;171(9):840-846. doi:10.1001/archinternmed.2011.179

    Background  Pharmaceutical and medical device company funding supports up to 60% of accredited continuing medical education (CME) costs in the United States. Some have proposed measures to limit the size, scope, and potential influence of commercial support for CME activities. We sought to determine whether participants at CME activities perceive that commercial support introduces bias, whether this is affected by the amount or type of support, and whether they would be willing to accept higher fees or fewer amenities to decrease the need for such funding.

    Methods  We delivered a structured questionnaire to 1347 participants at a series of 5 live CME activities about the impact of commercial support on bias and their willingness to pay additional amounts to eliminate the need for commercial support.

    Results  Of the 770 respondents (a 57% response rate), most (88%) believed that commercial support introduces bias, with greater amounts of support introducing greater risk of bias. Only 15%, however, supported elimination of commercial support from CME activities, and less than half (42%) were willing to pay increased registration fees to decrease or eliminate commercial support. Participants who perceived bias from commercial support more frequently agreed to increase registration fees to decrease such support (2- to 3-fold odds ratio). Participants greatly underestimated the costs of ancillary activities, such as food, as well as the degree of support actually provided by commercial funding.

    Conclusion  Although the medical professionals responding to this survey were concerned about bias introduced from commercial funding of CME, many were not willing to pay higher fees to offset or eliminate such funding sources.