The New ACCME Standards: A Pendulum Swung Too Far?

Judith Kleinerman, MD
Former practicing hematologist at Steward Medical Group Medical Specialists of Taunton, Massachusetts

In this edition, Judith Kleinerman, MD, talks about the implications of the Accreditation Council for Continuing Medical Education’s (ACCME’s) new Standards for Integrity and Independence in Accredited Continuing Education for practicing hematologists and CME providers.

How would you like to go to an American Society of Hematology (ASH) meeting, attend a great session that covers information you need to provide the best care possible for your patients, and then not receive continuing medical education (CME) credits? This is the situation we may find ourselves in with the ACCME’s new Standards for Integrity and Independence in Accredited Continuing Education.

These new standards, for which mandatory compliance is required by January 2022, provide strict guidance regarding commercial bias and financial relationships. They assume, quite cynically, that there is no amount of mitigation or disclosure that could result in an unbiased presentation from someone with certain financial interests in a biomedical company. They consider owners and employees of such companies to have irreconcilable conflicts of interest, as they are legally required “to act in the company’s best interest.”

Furthermore, these new standards state that the ACCME, “in its sole discretion, determines which organizations are awarded ACCME accreditation,” and, therefore, which organizations’ representatives are to be excluded. This assumes that educational meeting planners do not have the ability to mitigate conflicts, review session content, and ensure delivery of an unbiased program. But who could know better than ASH what hematologists need to learn – and from whom?

It used to be the case that various agencies within the federal government funded most biomedical research projects. Over the years, however, these funding sources have dwindled and private funding has become more dominant – and necessary. Private biomedical startup companies are developing cutting-edge treatments. We cannot expect this reality to change anytime soon and we should not use it as a reason to deprive learners of the state-of-the-art clinical practice information they expect from a meeting.

Meeting attendees want to learn from the experts who are making new discoveries and developing new treatments, not from someone several degrees removed from the work. These medical contributions are not trivial. In fact, they have a huge impact on the treatment of hematologic disorders and significantly improve the lives of our patients. They also go far beyond hematology, like mRNA technology used in COVID-19 vaccines.

The physicians and scientists who present at ASH meetings want to help doctors improve their medical practice, not deceive learners. Besides, meeting planners, presenters, and professional societies have their own reputations to protect.

I want to know that my colleagues practicing hematology will continue to receive the education they need and the CME credits they deserve.

So, how can ASH and other professional medical societies ensure compliance with these standards? Despite the guidance provided by the ACCME, ASH’s position is vulnerable. There is a fine line between acceptable and unacceptable sessions and the distinction is ultimately subject to the ACCME’s interpretation. ASH could put together an educational session that it believes follows these standards to the letter, only to be told after the presentation that it was not compliant. This could result in probation or revocation of certification as a CME provider.

The safest way to avoid this consequence would be to hold non-CME sessions in a location separate from CME sessions. However, this option would require attendees to consider sacrificing CME credits in favor of getting the state-of-the-art teaching they have come to the meeting for.

Why does this matter to me? I am a retired hematologist/oncologist who was in private practice in southeastern Massachusetts for 22 years. Because I was the only hematologist in my geographic area, my practice evolved into pure hematology. There was no one for me to run cases by, so I relied on my colleagues in the Boston academic centers and the information I learned at educational meetings. I have attended the ASH annual meeting yearly since 1993, where I confidently rely on a program featuring up-to-date and unbiased sessions. I am familiar with ASH’s strict conflict of interest policy, which is routinely reviewed and revised to keep bias out of the Society’s educational meetings. I have also reviewed some meeting sessions as an ASH volunteer, which includes looking closely for bias and failures to disclose conflicts. In addition, meeting attendees and speakers are always encouraged to challenge anything that appears to reflect bias or a conflict of interest.

Going forward, I want to know that my colleagues practicing hematology will continue to receive the education they need and the CME credits they deserve.

Several years ago, ASH was one of the first medical societies to challenge the changes instituted by the American Board of Internal Medicine (ABIM) for maintenance of certification. Over time, the ABIM met with and listened to the concerns of ASH and other medical societies. ABIM eventually modified some of its requirements. I sincerely hope that the ACCME likewise hears our concerns and considers changing the counterproductive aspects of the new standards.