Medical education and independence from industry control in Europe

gCMEp started with an open letter to UEMS and EFPIA

In 2011 members of the Good CME Practice penned an Open Letter to UEMS and EFPIA calling on the two organisations to clarify the issue of independent (i.e. arms length) funding of CME. While being over a decade old it is still relevant today, highlighting crucially unresolved challenges around the independence of accredited CME where funding from pharma is involved.

Pharma funding of CME in Europe

Developments in recent years have provided some clarity on the funding of Independent Medical Education (IME) and CME. At #9ECF in 2016 (Workshop 4c), a group of US and European industry representatives came together and gave a presentation, the first of its kind in Europe, clarifying the role of industry in medical education and promotion. In 2018 some of these presenters and other European members of the newly-created EFPIA Working Group on Medical Education published a paper explaining how Pharma can engage with various types of medical education and promotion with respect to quality standards and funding models. It is the “Type D” funding described in the paper, the only acceptable form of funding in US CME, that is still not a requirement as standard practice by the medical regulators and accreditors in Europe (regionally or nationally).

In late 2018, the International Federation of Pharmaceutical Manufacturers (IFPMA) issued further guidance about how industry can support CME.

The current EFPIA Code of Practice was published in July 2019 The code introduced a new Article (Article 16)dedicated to Medical Education; however it fell short of providing detail on Pharma support of IME/CME that we began to hear about in 2016 at #9ECF.

In response, the Good CME Practice group co-authored a Position Paper led by Mental Health Europe, with the Standing Committee of European Doctors (CPME), Continuing Medical Education-European Accreditors (CME-EA) and other organisations. The Position Paper “Regulating for Bias in Medical Education – Reaction to the Pharmaceutical Industry Updated EFPIA Code of Practice  calling on clearer guidance for Pharma.

In December 2021 EFPIA published further guidance in a Guideline for Article 16 “Aligning the European Pharmaceutical Industry on a quality approach for industry funded and led Lifelong Learning in Healthcare activities” (subsequently incorporated as “Annex 3” to the EFPIA Code of Practice) and in May 2022 a Letter to the Editor in the Journal of CME, providing the European CME community further explanation.

European accreditor requirements

There is still little development from the European accreditors. For example, UEMS-EACCME, as well as most other accreditation bodies in Europe, still accredit CME activities run by “Medical Communications agencies” (i.e. “agents” of their industry “clients”) and some even accredit education from industry itself. “EACCME 3.0” that was launched in June 2023 continues to confuse processes and definitions around industry-controlled and independent education.

Despite this, we are finally starting to see some developments in Europe. The European Board for Accreditation of Continuing Education for Health Professionals (EBAC) and the national CME system in Germany are making these distinctions in Europe by adopting the standards for commercial support as defined by the International Academy for CPD Accreditation, as well as attaining Substantial Equivalency status with the ACCME. However, the accreditors and industry must now take action if we are to achieve the much-needed clarity on the difference between funding routes and maintaining the independence of the organisations planning and implementing accredited CME activities in Europe.

Good CME Practice group identifies challenges in Europe

In 2023 the Good CME Practice group published a consensus statement outlining of their concerns with some of the above issues. The Ongoing Challenges Faced by Providers of CME-CPD in Europe is published in Journal of CME. We are expecting that in 2024 UEMS-EACCME will significantly revise the EACCME 3.0 accreditation standards and in the UK the PMCPA will be updating the ABPI Code of Practice following a consultation process, we await further news, and detailed discussion of these topics at CME meetings during the year, especially at 17ECF in November.

Guiding principles

The gCMEp group operates on collaborative principles, discussing and addressing key challenges and developments in the European CME arena. From the very first meetings two key issues have been identified as being challenges in Europe: quality of medical education and transparency and independence.  This initial publication is still valid today and the touchstone of much of the work of the group.

Setting CME standards in Europe: guiding principles for medical education by Sheelagh Farrow, Darren Gillgrass, Alisa Pearlstone, Jack Torr, Eugene Pozniak, published in Current Medical Research and Opinion, 2012 Nov;28(11):1861-71

Further Reading

CE Educator’s Toolkit (ACCME)

International Standards for Substantive Equivalency Between CPD/CME Accreditation Systems (International Academy for CPD Accreditation)

Cologne Consensus Conference Standards and Guidelines in Accredited CPD September 13-14, 2019, Cologne, Germany. Published 15 February 2020 Journal of European CME (JECME)

Regulating for Bias in Medical Education – Reaction to the Pharmaceutical Industry Updated EFPIA Code of Practice published November 2019 in JECME

A Culture of Learning for the NHS by Robin Stevenson and Don Moore, published in JECME May 2019

Ascent to the Summit of the CME Pyramid, by Robin Stevenson and Don Moore, published February 2018 in JAMA

A conceptual framework for planning and assessing learning in continuing education activities designed for clinicians in one profession and/or clinical teams, by Don Moore et al. published July 2018 in Medical Teacher

Doctors on the move: a European case study on the key characteristics of national recertification systems, follow-up paper from Carolyn Sehlbach’s presentation at #10ECF, published in BMJ Open in 2018

What Do I Need to Learn Today – The Evolution of CME, by Graham McMahon, published April 2016 in NEJM

Framework for industry engagement and quality principles for industry-provided medical education in Europe, by medical education experts/specialists working in Europe within the pharmaceutical industry, published July 2017 in Journal of European CME (JECME)

Effectiveness of Continuing Medical Education: Updated synthesis of systematic reviews
Published July 2014 by the Accreditation Council for Continuing Medical Education (ACCME)

The relationship between commercial support and bias in Continuing Medical Education activities: A review of the literature,
published July 2008 by the Accreditation Council for Continuing Medical Education (ACCME)

European CME needs the European Specialist Societies, published May 2017 in Journal of European CME (JECME)