1. Continuous Medical
Education
Learning from US CME’s System for India
Continuing medical education came into being in the United States in the late
twenties when the mediocrity of the initial medical training of practicing
physicians was recognized. In consultation with the Ministry of Health & Family
Welfare, Govt. of India, it had been decided in 1985 to utilise the services of
Indian Physicians settled in USA in Continuing Medical Education and Patient Care
in India. A Questionnaire based study conducted by Indian Academy of Pediatrics,
Bangalore Chapter suggest that 59% of Clinicians attending CME’s to meet the
experts. In conclusion, Indian doctors are starving for CME’s and eager to meet
the experts from different parts of the world with different outlook on their
current practice and day to day clinical problems. Also there is growing need for
changing the current approach in managing the CME’s and need for involving the
medical education companies for Identifying the growing clinical needs,
promoting the CME’s and to track the activities of growing associations and their
activities.
2014
Rohan Patel
GPE Expo Pvt. Ltd.
8/1/2014

2. Continuous Medical Education
Learning from US CME’s System for India Page 2
Introduction to CME
Medicine and its allied branches are growing at an
exponential rate, resulting in a deluge of new diagnostic and
therapeutic modalities. As clinicians, it may be difficult to
keep up with the latest developments. Continuing medical
education programs (CMEs) are hence designed to keep
clinicians informed of the latest developments in medical
field that can assist in maintaining or improving their
practice of medicine, to help them bridge the gap between
today’s care and what care should be. CMEs are also
required as a prerequisite for regular renewals of medical
license.
History of CME
Continuing medical education came into being in the United
States in the late twenties when the mediocrity of the initial
medical training of practicing physicians was
recognized. With the proliferation of new drugs in the 1950s
and 1960s, organized medicine became increasingly
concerned about the educational needs of practicing
physicians. At the same time, the pharmaceutical industry
realized a substantial commercial interest in marketing its
products to physicians.2
A partnership between the
profession and industry in the continuing education of
doctors was a natural outgrowth.
USA Scenario
In USA Continuous medical education is a billion dollar
industry. In 2012, the CME providers accredited by the
Accreditation Council for Continuing Medical Education
(ACCME) had a total income of $2.33 billion. Commercial
support for CME accredited by the ACCME quadrupled
between 1998 and 2006–from $302 million to $979 million–
and nearly tripled from other sources. In 2006, the
combined for-profit support (commercial support and
One great teacher
advised to his departing
medical students:
Lifelong learning is your
responsibility. No one is
better suited than you to
determine your own
educational needs.
“Knowing is not enough;
we must apply. Willing is
not enough; we must do.”
—Goethe

3. Continuous Medical Education
Learning from US CME’s System for India Page 3
advertising and exhibit income) represented 41.8% of total
income.7
The statistic of Directly sponsored activities reported by all
organizations during 2012 suggests that maximum no of
activities for continuing medical education were performed
by Hospitals and health care delivery systems accounts for
42%, Nonprofit (physician membership organization) 13%
and 18% by Publishing / education company. Despite of the
major activities performed by hospitals and health care
delivery system they just have 3,021,772 participants which
is 24% while Nonprofit (physician membership organization)
and Publishing / education company have participants 22%
and 31% respectively. There were total 286 Internet (Live)
CME’s during the year.
Growing Concerns for USA
Although commercial support for CME increases available
funds, it may promote sales of new medications, including
their off label use, notwithstanding the various measures to
prevent conflict of interest and commercial bias.4,5,6
The
CME activities supported by industry are often free or
subsidized for physicians. Patients and payers, however, may
Government or
military, 3%
Hospital /
health care
delivery
system, 42%
Insurance
company /
managed-care
company, 3%
Nonprofit
(other), 2%
Nonprofit
(physician
membership
organization),
13%
Other1, 2%
Publishing /
education
company,
18%
School of
medicine, 16%
Stanford University on
January 11, 2010
announced plans to
develop new continuing
education programs for
doctors that will be
devoid of the drug
industry influence that
has often permeated such
courses. The work is
being done with a $3
million grant — from the
drug maker Pfizer.
Dr. Philip Pizzo, dean of
the Stanford medical
school, says Pfizer will
have no say on how the
three-year grant will be
spent. The university
plans to set up unbiased
programs of
postgraduate education
on the Stanford campus.

4. Continuous Medical Education
Learning from US CME’s System for India Page 4
ultimately pay the bill. Industry sponsorship also may lead to
overemphasis on medicines, medical devices, and diagnostic
tests, thereby biasing “the overall curriculum of topics,”5
regardless of their importance to improving care.8
ACCME report on relationship between Commercial
Support and Bias in ME Activities
With the widespread concern about the impact of industry
support on medical research, practice, and education, the
question of whether this support produces bias in accredited
CME activities is critically important. The ACCME Standards
for Commercial Support are designed to assure that CME
activities are not biased toward the commercial interest
supporting the activity. However, to date there is no
empirical evidence to support or refute the hypothesis that
CME activities are biased.11
Role of Medical Education Companies in USA
“Medical education companies” were established to act as
intermediaries between physicians and industry, accepting
funding from drug or device manufacturers and passing it
along to physicians, medical schools, hospitals, or other
organizations that offer lectures or educational programs.
This arm’s-length “third-party” status will eliminate the
manufacturer’s influence over the educational content of
these programs.
In 2012, 143 Publishing / education company accredited by
ACCME and State-Accredited Providers resulted in 18,020
directly sponsored activities which accounts for 18% and
attracted the highest no of physicians 3,946,727 out of
12,619,901 total physician participations in CME’s during the
year.7
“GSK will not support as
many medical education
programs, but we will
continue funding those
with the greatest
potential to improve
patient health,” *
*Said Deirdre Connelly,
GSK’s President North
America Pharmaceuticals.

5. Continuous Medical Education
Learning from US CME’s System for India Page 5
Studying the effects of company-funded CME on prescribing
behavior, it was found that in each case there was a greater
increase in prescriptions for the drug made by the
sponsoring company than for other drugs in the same class.9
perhaps because of the added attention paid to it during
these sessions.10
Indian Scenario
In India the CME’s majorly conducted by Nonprofit physician
member organization which are indirectly sponsored by
pharma company and by education and publishing industry.
Medical council of India and state medical council of India
are granting the credit hours for CME. ANNUAL REPORT
2011-2012 of MCI suggest that, In year 2012 total 190 CME
programs accredited.
Considering the need of CME’s in India, the Ministry of
Health & Family Welfare, Govt. of India had decided in 1985
to utilise the services of Indian Physicians settled in USA in
Continuing Medical Education and Patient Care in India. In
the General body meeting of the Medical Council of India on
27th February, 1997 a thought for making CME compulsory
and linking the earned 30 CME credit points during 5 years
to the renewal of registration emerged. In November 1999,
the Central Govt., Ministry of Health & Family Welfare has
also extended its approval to hold the CME Programmes
without participation of NRI faculty from USA/UK/Canada.
Concern for India
Total number of doctors registered in the Country up to 31st
March 2012 are 8,52,195 against the 1.21 billion people .12
Total 37.77 Million Diabetic patients reported in National
“There is resistance to
change by [health]
professionals who lack
the opportunity for
undergoing good quality
CME, and lack incentives
as well as motivation for
attending CME
programmes,”*
“We are moving
extremely slowly in
promoting CME,” **
* Said Dr P.T.
Jayawickramarajah,
Coordinator at the WHO’s
Regional Office for South-East
Asia in New Delhi.
**Said Dr B.V. Adkoli of the
All India Institute of Medical
Sciences in New Delhi.

6. Continuous Medical Education
Learning from US CME’s System for India Page 6
Health Profile 2012 published by Government of India,
Central Bureau of Health Intelligence. The doctor to patient
ratio is very high and so an Indian doctor is forced to see
more than 50 patients in their OPD per day. The clinical
burden is one of the factor which is restricting them for
attending the CME’s.
Most of the hospitals/institutions in India do not have any
provisions to send doctors to congresses and conferences.
In India, The amount of time spent for completing the
medical course or Specialization or super specialization is
high and it requires huge finances. So, after completion of
the course medical fraternity’s main focus is to recover the
Investments made and interests paid. The huge no of
patients available will serve their primary purpose and if
they got time from their busy schedules than they are
thinking of updating themselves with the latest
developments.
Indian Clinician Interest in attending CME
A Questionnaire based study conducted by Indian Academy
of Pediatrics, Bangalore Chapter suggest that 59% of
Clinicians attending CME’s to meet the experts, 20.4% to
update themselves, 18.2% to clarify doubts, 18.2% to
prepare for exams, 12.4% to participate as speakers and
0.7% attended for other reasons. There was no statistical
difference (p >0.05) between the groups in this aspect,
except that post graduates attended CME usually to prepare
for their examinations.
Dr Puneet Bedi, a
gynaecologist in Delhi,
however, believes that
doctors’ attitudes will
change as more doctors
in India realize they must
keep up to date with the
latest medical practice,
but progress is slow.

7. Continuous Medical Education
Learning from US CME’s System for India Page 7
Learning from US CME system and way forward for India
The Medical Council of India is granting the credit hours only
for the scientific programs organized by Physician
associations and with no branding of drug makers in such
program. The government officials attend such program and
personally analyze the contents of such programs before the
program and during the program. That way the CME
contents remain unbiased and which has no influence on the
program content.
Considering the busy schedules of Indian clinicians there is
need of Medical education companies who can understand
the need of clinicians with respect to continuous education
and clinical advancement, help them in identifying the right
educational source, t racing the recent advances, spreading
the awareness about the CME activities which are unbiased
among the clinicians, providing the information about the
world leading association activities and efforts in making the
successful CME Programs.
In India the system for granting the CME is appropriate and
it resulted the unbiased educational contents and hence
involving the Third Party must be restricted to only a helping
hand and the educational content finalization should be by
Physician association only. In addition to it such medical
education companies must not have any involvement in
financial matters of such education programs.
We can overcome the geographic constrains by adopting the
E-learning modules from US CME system.

8. Continuous Medical Education
Learning from US CME’s System for India Page 8
References
1. Bulletin of the World Health Organization, February 2004, 82 (2)
2. Podolsky SH, Greene JA. A historical perspective of
pharmaceutical promotion and physician education. JAMA.
2008;300:831-833.
3. Accreditation Council for Continuing Medical Education. Annual
report data 2006.
http://www.accme.org/index.cfm/fa/home.popular/popular_id
/127a1c6f-462d-476b-a33a-6b67e131ef1a.cfm. Accessed
February 11, 2008.
4. Steinbrook R. Commercial support and continuing medical
education. N Engl J Med. 2005;352(6):534-535.
5. Van Harrison R. The uncertain future of continuing medical
education: commercialism and shifts in funding. J Contin Educ
Health Prof. 2003;23(4):198-209.
6. Steinman MA, Baron RB. Is continuing medical education a drug-
promotion tool? Yes. Can Fam Physician. 2007;53(10):1650-1653.
7. Accreditation Council for Continuing Medical Education. Annual
report data 2012. http://www.accme.org/news-
publications/publications/annual-report-data. Accessed April 15,
2014
8. Katz HP, Goldfinger SE, Fletcher SW. Academic-industry
collaboration in continuing medical education: description of two
approaches. J Contin Educ Health Prof. 2002;22(1):43-54.
9. Loh LC, Ong HT, Quah SH. Impact of various continuing medical
education activities on clinical practice - a survey of Malaysian
doctors on its perceived importance. Ann Acad Med Singapore
2007;36:281-4.
10. Wazana A. Physicians and the pharmaceutical industry: is a gift
ever just a gift? JAMA. 2000;283:373–380.
11. Ronald M. Cervero and Jiang He, The Relationship between
Commercial Support and Bias in Continuing Medical Education
Activities: A Review of the Literature, June 2008
12. http://www.mciindia.org/pdf/Annual%20Report.pdf Data
assessed on 17 April 2014
Correspondence Address:
Rohan Patel
(M) +91-9727242852
GPE Expo Pvt. Ltd.
GLOBAL, 402 - 403,
Abhijyot Square,
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Highway,
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