The Coming Crisis in Continuing Education in Diabetes: Resolvable Issues and Novel Solutions

In a previous article,¹ a broad theoretical concept was presented that suggested that physician participation in continuing medical education (CME) programs was diminishing and would continue to diminish. The reasons suggested for this were:

1. Growing dependence on pharmaceutical companies for financial support of CME programs

2. Increasing pressure for regulatory oversight of educational programs sponsored by pharmaceutical companies

3. Increasing and negative imposition of “ethical standards” for physician behavior by pharmaceutical companies in CME interactions

4. Despite regulatory oversight, growing pharmaceutical company control of the development and marketing of physician “experts” for CME, whether promotional or accredited

5. With increased regulatory oversight, a decline in the degree of creativity and level of sophistication of such programs, converting many CME or promotional programs into “infomercials.”

According to unofficial but authoritative sources in various pharmaceutical companies, these influences have resulted in a substantial decline in physician participation in CME programs. Despite these trends, there is no evidence that the current directions will be altered in the near future. Altering these characteristics would be very desirable in diabetes care.

The Need for CME in Diabetes Care

Multiple studies have confirmed that the prevalent level of care for diabetic patients is demonstrably deviant from recommended guidelines and procedures.^2-7 This has been documented in various care settings, including primary care, family practice, and large urban managed care organizations.

Despite vigorous efforts on the part of the American Diabetes Association (ADA) and other organizations to remedy these deviations, there is no compelling evidence that such efforts have substantially improved these gaps in care. A study on the impact of the Canadian Diabetes Association's clinical practice guidelines for postpartum screening of pregnant women with gestational diabetes for type 2 diabetes demonstrated that the guidelines had no significant effect.⁸ The failure of such educational efforts in diabetes reflects a widespread failure of CME …