Medical Education Graduates to the Next Level Physicians rely on continuing medical education, but more than ever they are insisting on high-value content when they invest their time in a program. August 2006 VIEW on Medical Education The Forum The line between promotion and education has never been clearer for providers of medical-education programs. Sales and marketing functions are under intense scrutiny in life-sciences companies in terms of their support of corporate-sponsored programs; medical- education initiatives must adhere to a strict set of guidelines. These guidelines are meant to direct sponsors and providers on how they can help keep healthcare professionals educated on the latest medical findings and treatment modalities while remaining in compliance with OIG, ACCME, and various other regulations. The practice of medicine becomes more complicated every year. New medicines, formulations, delivery systems, devices, and treatment regimens provide more choices than ever for healthcare providers. Physicians, who in many cases depend on CME credits to keep their state accreditations, must find the time to complete the courses within the confines of busy schedules, and therefore, are very selective as to which programs they choose. They want practical information precisely when they need it — when it affects the treatment of a patient. Technology is quickly becoming an important tool in the medical-education arsenal. For example, with the use of Podcasts and Web seminars, programs can be offered in a variety of formats in terms of depth, scale, and length. Programs can be developed more easily and delivered more efficiently to a small, individual practice or a large group of healthcare professionals. Live symposia are still the bedrock of CME programs, and these are being archived for as long as a year so physicians can access them for credits. The Characteristics of a Good Medical-Education Program With the pace of medicine advancing at such a rapid rate, it’s more important than ever to provide physicians with the latest information on new therapies and clinical findings. This month’s Forum experts provide their insights as to what makes an education program especially good. Beebe. Good medical education is when the content meets the needs of the learner. When a program is good, the audience is engaged, they don’t leave. A successful program includes good science and good education and provides news physicians can use, especially from a primary-care perspective. Also, if the sponsorship of the program is transparent, that’s a great symposium. Fagan. The best-designed courses are ones that encompass what the learners already know, as well as what they want to learn, and are presented in the format they want to learn in. There is a great deal of research about how adults, and especially physicians, learn. For example, if a provider has access to data about the physician, such as where he or she is located, where he or she trained, and area of specialty, some conclusions can be drawn about how he or she likes to learn. If providers do some research first, they could offer fantastic education opportunities, and those are the types of programs many sponsors, especially large pharmaceutical companies, would like to fund. Mcrogers. A truly outstanding medical-education course is one that educates physicians about the most up-to-date, evidence-based medical information that will change their behavior to ultimately improve patient care. Trout. A program worth sponsoring involves a topic of high interest that is timely, combined with a respected key opinion leader who delivers a balanced, credible presentation that clinicians can apply practically to their business. Torres. From an educational perspective, courses should be based on an audience needs assessment. Primarily, these assessments uncover areas of interest, such as best practices, new management guidelines, and new therapeutic alternatives. This information is essential to physicians to maintain, increase, or develop the scientific knowledge base that allows them to perform their caregiving duties. At Shire, we believe that an outstanding medical-education course should offer a well-articulated purpose and objectives, be presented by a reputable and well-prepared faculty, and provide content that has everyday value to the learner, and be delivered in a format that promotes learning. Ruaño. The novelty of the ideas presented during a program is one best practice. From the clinical, practical perspective, the audience must get something useful for their practices. Face-to-face Training vs. Packaged Content Delivery Education comes in many forms — in-person programs and remote packaged formats, such as teleseminars, multimedia CD-ROMs, DVDs, Web seminars, and Podcasts. Thought leaders discuss which format is appropriate for which situation. Trout. In-person programs are preferable during the launch of a new product or major initiative or at a major medical congress when a majority of the target audience is in attendance. A packaged course is preferable when there is a strategic message or a key initiative that needs to reach a global audience or when the message needs to be immediately and readily available (24/7) to primary and secondary audiences. Ruaño. We believe there has to be a mix of in-person and packaged programming. We routinely do Web-based outreach programs to maintain a user base. We also conduct live seminars targeted to specific practices. Torres. Each type of format has value in providing education to healthcare practitioners. New data that may have a clinical impact, such as new therapeutic options or new indications, would be reasons to have an in-person course. Typically, we follow these meetings with enduring materials, such as monographs, CDs, and online offerings. The dissemination of information regarding best practices and management guidelines lend themselves to online materials. We prefer to use a mix of programming formats to support updates in treatment practices. Fagan. One format is not necessarily preferable to the other. For example, if there is breaking news or information about a new solution to a problem, a symposium is a great venue. Or if there are a lot of regional programs that are tailored to small groups, in-person programs are an ideal way to go. We encourage development of programs based on the best way to get to the learner. If the goal is to educate an entire transplant team at the same time, then it may be better to bring the expert to them. On the other hand, if physicians don’t have a travel budget or they can’t risk being away from their practice, or if they are part of a team, they might be better suited for a Web-based education program, because they can access the information when it’s convenient for them. Beebe. The use of in-person or packaged programming depends on how learners like to learn. Primary-care, specialty physicians, and internal medicine physicians prefer live programming. Of course, we can’t get to every physician in the country this way. So these physicians also obtain CME through print. Research shows that about 14% to 17% of physicians are going online for CME. We always repurpose our live programs for the Web, DVD, CD-ROM, or print. We try to accommodate the learning styles of all physicians. Younger physicians tend to have iPods, so we are now doing more programs that involve 15-minute chunks of learning for CME credits. And it’s not just younger physicians using technology. Physicians who are more procedural-based often use a computer and tend to be very quick to adopt technology-based CME. Sponsor Support and Perceived Bias Most CME programs are underwritten by pharmaceutical companies. Do physicians have a biased perception about commercially supported programs? Our Forum experts provide their insights on this highly charged issue. Beebe. Pharmaceutical companies support 65% of CME programs. Physicians might be a bit skeptical regarding the business interests of the sponsor, but they also rely on the best practices of the accredited CME providers to ensure that programs meet the guidelines and that they are based on good science. Torres. Because the guidelines for accredited CME are specific and restrict any bias in the content or by the faculty, the majority of physicians do not differentiate between a pharma-sponsored program and nonpharma-sponsored program. Overall, physicians will seek programs offered by prestigious institutions, world-renowned faculty, and expert organizations. Ruaño. Physicians absolutely evaluate pharmaceutical company-sponsored programs differently. This is a very sensitive issue for both medical practitioners and sponsoring companies. The bottom line is if the program is perceived to be commercial, it will backfire, and physicians will not be drawn to the event. The attendee has to believe that he or she will be provided with academic information that is not biased and that the role of the sponsor is distant from the content. It takes a lot of work to figure out the right balance. Many institutions are very sensitive to this issue and want details regarding the content of the presentation ahead of time. This is the most difficult part of the whole CME sponsorship issue. McRogers. We work hard to ensure that any CME course we sponsor is independent and objective; our company has no control over the course. Physicians will always scrutinize commercially supported programs for any commercial bias. Regardless of the quality of content of the program, if even a small part is viewed as biased, the whole program loses credibility. I believe that physicians can discern the quality of the CME in which they participate and can determine whether it has commercial support or not. Again, if they believe they are learning something of value, they are not too concerned with who supports the activity. Trout. If the topic is timely and the speakers have been credible participants in past commercially supported CME courses, then there is little or no perceived difference between the two. The key is thoughtful speaker selection beforehand by the medical-education provider. Fagan. As an industry, pharmaceutical companies spend about $1 billion on industry-supported CME. From the evaluations I’ve observed over the past several years, I don’t see any comments that indicate that this is a big problem. I think providers and academics are more skeptical about sponsorship than the average attendee. Medical Education for Nonphysicians Doctors aren’t the only healthcare professionals who need to keep up with the latest medical information. A team approach to patient care is common in today’s practices. Our Forum experts comment on how they address nonphysicians in their educational materials. Fagan. We fund many programs for nonphysicians, as long as the individuals, for example nurse practitioners or nurse specialists, are part of the practitioner mix in therapeutic areas to which the company is dedicated. At Roche, we have many highly specialized products for critically ill patients, so patients are usually treated by a team of practitioners. As a company, we believe we can’t fund CME for one team member and not the other members. We endeavor to understand what forms the basis for each team member’s clinical decisions and that we understand what that person’s role is. Nonphysicians are not always able to travel, so we need to make programs practical for them. Beebe. Takeda has a plethora of CME programs for nonphysicians. Generally, we have found that Pharm.D.s are accustomed to using a computer and like Web-based programs. We develop a lot of programs for nurse practitioners and physician assistants because, on average, they spend more time with patients. For these audiences, we conduct live programming as well as Web-based and print programs. McRogers. We believe allied health professionals play a crucial role in patient care, and offering worthwhile educational programs to these professionals is a critical component of improving patient care through continuing education. Pharmacists participate in formulary decisions, nurses administer drugs and recognize adverse events, respiratory therapists work closely with patients to relieve symptoms, and all three play a role in disease management. For this reason, our company has reached out to all these groups by providing written, online, as well as live symposia continuing education programs. Measuring the Success of a Med-Ed Program There are many ways to measure the effectiveness of a medical-education program. Postevent surveys can track attendees’ opinions on items related to the quality of the environment as well as to the quality of the content. Our Forum participants provide their thoughts on the other aspects of medical education that can be measured. Beebe. Up until now, the evaluations included basic information, such as how many attendees, was the food good, and was the room temperature acceptable. We are now going beyond those noneducational valuations to identify if the learning objectives were met. When we ask physicians why they attend CME events, the No. 1 reason is the content, so they must be reading the learning objectives. And even though we are evaluating whether physicians have achieved the learning objectives, that doesn’t measure whether they will change their behaviors. After a CME program, a physician may know the best way to treat a patient, but there may be too many obstacles for him or her to implement those treatment modalities, and therefore behavior doesn’t change. We’ve done a couple of programs where we have tried to measure behavior change by asking a series of questions: are you changing your practice; do you feel confident that you can change it; and, have you made changes? It would be ideal if we could audit the results after a CME program, but the cost is too prohibitive. We are, however, asking some of our key providers to include a 60- or 90-day measure of practice-behavior change. We’re also working on developing our internal strategy to determine what things should be measured. Trout. Clearly, the number of people who attend a live program is an important early measure of success. Regular contact and third-party market research with key opinion leaders and key audience members provide further insights into the effectiveness of CME programs. Fagan. We ask attendees to complete a needs-assessment evaluation; hopefully they are willing to engage in some research on the learning outcomes of an education program. This evaluation goes beyond, “did you like the speaker?” and “was the chicken good?” These are serious pre- and post-tests; we may even come back later and ask if the course was helpful to their practice setting. I would love to see research on what physicians know, their ages, the differences between community-based practices and big consortium practices, and what are the best ways to meet their learning needs. We are looking to fund programs that are more in-depth and very scientific. Educational programs are not just about reach and noise; they have to be about learning. Ruaño. From the questionnaire that is provided to attendees from the sponsor or the academic institution hosting the program, we get feedback on content, utility, novelty, and if there was a perceived commercial bias. Most institutions we work with have their own metrics. We don’t have any internal metrics beyond measuring the number of hits to the Website and the number of calls we receive related to a program. We’re very happy with the metrics the host institutions provide. Torres. At Shire we believe that a good CME program has a postprogram assessment that asks questions about the usefulness of the program both in terms of educational value and practical value, such as whether the program was useful to the attendee. In addition, it is also important to note that postprogram assessments are part of the guidelines for CME programming. Other mechanisms we use in determining the effectiveness of our programs include reviewing the final number of participants, including audience composition and feedback from the speakers. Pharmaceutical companies do not track the number of prescriptions written by physicians who attend CME programs. The Importance of Outcomes Measurement Obtaining specific outcomes is obviously one of the goals of medical education. Our thought leaders discuss the importance of measuring outcomes for their programs. Fagan. We aggregate outcomes across audiences and across formats. The results help guide us as to what programs to fund the following year. If we find that particular topics are popular and seem to work well for learning and patient care, we can move our funding toward those types of programs. Torres. Outcomes measurement is vital to the success of education programs. Outcomes measurements can show us where the learning gaps are and can provide guidance on learning objectives for future programming. Outcomes also provide us with the ability to measure the effectiveness of a CME program, which is key to the success of our future programming efforts. Typical outcomes include participation and satisfaction with the program, and these are straightforward to measure. Changes in knowledge base and skills and their impact on practice performance are less straightforward. Ultimately, the impact on individual patient and population health is the best measure of any CME program’s effectiveness. Beebe. The purpose of CME is to enhance the physician’s knowledge and to improve patient care. Through pre- and post-tests, we can measure knowledge. We haven’t measured skills and we’re not measuring whether we’re impacting patient care, although that is very important. CME Budgets Within Sponsor Companies Funding an education program is costly, with grants often reaching $250,000. With tightening budgets across the board, companies are looking for justification for their expenditures. Our experts share their views on obtaining budgets for medical-education programs. Fagan. We believe medical-education programs are as important as our products are to achieving better patient care. Medical education is a cornerstone for us, and the funding for these programs hasn’t changed whatsoever. CME funding is no longer part of the marketing and sales budgets, which was the case in the past for all companies. It’s not hard to get funding or to ask Roche to continue to fund programs. In fact, all of our Roche medical-education teams have moved into our medical-affairs group and we all understand that we have a stake in improving patient care. Beebe. We believe physicians trust CME more than promotion, so it’s a little easier fight to obtain budgets. On average, our CME activities attract about 75 people. We are educating physicians and hopefully improving patient care if we can get them to attend an event. We are committed to education, and we have moved all of medical education into medical and scientific affairs. McRogers. Our company has actually increased the funding for continuing education programs. We believe that communication with healthcare professionals by providing credible, accurate, and valuable continuing education is a win-win for our company, the healthcare community, and the patients we serve. Torres. Our priority is to match programming to the educational goals and criteria we have established. Good, viable content delivered by top faculty is always in demand, and going forward the key will be to learn as much as possible from these programs and maximize their impact to improve the overall care of our patients. Ruaño. Hospitals and medical centers want to have CME programs, but they are very sensitive to commercial bias. It’s a deal breaker if physicians believe the program is not going to provide value or is going to be commercially biased. The Changing Roles of Stakeholders CME programs include the participation of a number of stakeholders. There are the supporters, the providers, the accreditation agencies, and certainly the healthcare professionals. Our experts provide some enlightening thoughts on how the roles of the individual stakeholders have changed in recent times. Torres. The role of each stakeholder is clearly delineated in the Accreditation Council for Continuing Medical Education’s (ACCME) guidelines separating educational programming from any other activity and assuring independence and lack of commercial bias. Based on these strict guidelines, Shire’s intention has always been to work with CME companies that will assist us in complying with these and all other legal and regulatory standards. Beebe. The role of each stakeholder has become much more focused. Each stakeholder is responsible for the credibility of the CME program, whether it’s the med-ed provider we partner with or the accrediting agency, we comply with the guidelines. We also want to make sure the healthcare professionals give us the right feedback on the CME. Fagan. The industry realized it wanted to be more independent with more scientifically rigorous programs with fair balance, because programs of this type would improve education, which benefits everybody in terms of making the best decisions in diagnosing and treating. The big shift has been that providers of care, universities, and certified groups are becoming much more sophisticated. We fund programs that make sense for groups that know how to conduct these types of programs, and they look for the groups that know how to advertise programs as the third leg of the stool. There’s not a lot of entertainment involved in education anymore; programs have to provide good education, or nobody will come. Choosing the Right CME Partner CME partners can most certainly make or break a program. With the amount of dollars involved, choosing the right CME provider is crucial. Our experts share the criteria they consider when selecting a CME partner. Beebe. My first priority is to determine if the provider is capable of understanding the science and if the organization has a particular expertise in education. The best programs have great science and usable clinical medicine. We look for a provider to have a medical director or another person who is familiar with the therapeutic area we’re interested in. We look for science expertise, creativity, the ability to reach the right audience, and expertise in handling logistical issues. Fagan. We work only with ACCME-certified providers; this is critical. We also look for partners that understand the therapeutic area; understand what the learning needs of the group are; and know the learning biases of a group, such as travel preferences, online/offline programs, and so on. We want them to not just pick the big thought leaders, but the people who can reach down into the issues in practice. Trout. We examine past business experience of potential partners, their track records, their understanding of the marketplace, and their relationships with other key stakeholders in the process. Torres. We look for a company that can be a strategic partner. Good reputation, experience in the disease categories we support, innovative learning options, good thought-leader relationships, and proven project management skills are attributes we value highly, as well as being accredited by the ACCME and other accrediting bodies. McRogers. We look for a partner that is first and foremost ethical and that has an impeccable knowledge of the compliance guidelines. We want to know that their needs-assessment process is robust, which is the first step to a successful program. We also want to know that the company has a robust process for determining conflicts of interest. If there is a perception of bias on the part of the audience, it doesn’t matter how good the program is, credibility is lost. Also avoiding conflicts of interest is a key ingredient in maneuvering the increasingly complex compliance rules governing CME. Finally, we are looking for a partner that has innovative ideas for how to impart education in a way that has positive outcomes for the participant and the patient community. Ruaño. We like to work with medical centers that have practicing doctors. We recently have begun using specialty practice settings, where we have a working seminar with a group in private practice. We try to go to the core medical centers and large medical practices. Best Practices in Stakeholder Collaborations Collaboration among stakeholders is essential to a successful program. Our thought leaders discuss some best practices for balancing varying stakeholder interests. McRogers. If a company can match the educational needs of its target audience with stakeholder interest, it will be successful every time. But if a company is simply trying to satisfy internal stakeholders, the program will suffer. This is why robust needs assessment is so critical. Fagan. Patients are becoming involved in the education process. They read medical journals just like physicians do, and some even ask their physicians how they are keeping up with post-graduate education. There are many ways in which patients can be so valuable to education. Trout. First, it is important to stay close to and know the key opinion leaders. They let us know about the changing landscape and any issues in their specialties. Then, it’s imperative to talk with the educational providers. It’s important to communicate observations of the issues and possible educational opportunities to address those issues. Think in terms of quality, practical advice that the audience hungers for, and the result is usually an excellent, well-attended CME program and a win for all stakeholders. Ruaño. We are expected to deliver a series of learning objectives for the audience. After that, we provide questions that the participants should be able to address after the event. That’s a good quality control standard. Next, the questionnaire is critical. Last, we monitor the number of requests we get from specific presentations to determine which groups or settings are most effective. Beebe. We always look for win-win opportunities for all stakeholders. We’re partnering with the Joslin Diabetes Center at Harvard. They are doing good programs focused on helping physicians manage patients in ethnically diverse populations. This was an untapped area. We’re now in our third year supporting it. The Latest CME Reforms CME regulations are as strict as they have ever been. The standards adopted by organizations, such as the ACCME, have the patients’ best interests in mind. In practice, the current guidances require precise navigation by providers, and the guidelines are having an effect on the sponsorship of new programs. Our Forum experts give us their take on the latest reforms. Trout. It’s a bit early to make conclusions, but there is a need for more uniformity in applying ACCME standards among providers. If providers overreact, it may decrease the volume of programs the industry will support. Ruaño. I think the current reforms are a necessary evil. They clearly complicate the process and add a lot of administrative work, but in the current environment the reforms are appropriate. The field will continue to weed out the commercial content from the academic content. Torres. Shire fully embraces the most current reforms as these will promote the scientific and educational value of the programs offered. Our hope is that the current reforms will make everyone more diligent about tracking their programs effectively, ensuring compliance with the application and all related forms, ensuring the CME content is balanced, and handling any potential conflicts of interest. Beebe. It’s necessary to ensure that the healthcare professional’s needs are met. There is not a lot of standardization in interpretation, which is a bit problematic. Fagan. As an industry, we got smarter. Many of us figured out that it would be a good idea to separate promotion from education. More learning can take place, which is valuable to the product and especially for the patient. When ACCME updated its guidelines, that was a pivotal moment as well. Finally, people such as Bob Fox and Dave Davis dedicated themselves to researching how physicians learn, and they discovered that many physicians are not up on all the changes and how to manage them, which led to new ideas in outcomes measurement and adult learning. Best Practices in Maintaining Compliance Failure to maintain compliance in CME costs a program time and money. Providers and sponsors must thoroughly understand all of the issues and be diligent in their pursuit of higher compliance levels. Our experts share some of their best practices for maintaining compliance. Beebe. One best practice is that every grant gets evaluated by the same criteria, whether it’s for $100 or $1 million. We have good processes. Our electronic process has helped us keep track; we can identify how much money each institution is getting from us, how much each provider is getting from us, and geographical data. One of our company mandates is to spread the wealth geographically across the United States. Trout. Once the grant is approved in-house and the check is cut, it’s important to stay at arm’s length from the provider. But it’s equally important to stay in constant contact with the med-ed provider to know that the logistics and audience generation steps are being done. Ruaño. We do not use packaged materials. We update our presentations, sometimes weekly, with new information from our lab. We always welcome comments from the audience during the Q & A. This gives us a good assessment as to whether the message got through. McRogers. Best practices include: robust needs assessment and evaluation of conflicts of interest; selection of a professional, ethical medical education company and provider; and robust internal oversight of all programs. In addition, we will not use as a provider of educational programming any company involved in, or affiliated with, a firm involved in our promotional activities. The Future of CME We asked our Forum experts to look into their crystal balls and predict where CME is going, and where it should be going. Based on their feedback, CME should remain a strong component in the relationship between healthcare professionals, producers, and sponsors. Trout. CME will continue to be an integral medium for industry in its dialogue with clinicians. CME will increasingly shift to electronic media as budgets are tightened and as companies become more global in their reach. Because the industry is the major funding source for CME programs, providers should meet the need for outcomes analysis by providing and posting general metrics to any and all interested parties, not just industry. At the same time, CME companies need to agree on and apply consistent adherence to their own standards relative to CME. Fagan. There’s going to be more collaboration; there will be more opportunities for multifunded, across-the-industry-programs. This is exciting, because collaboration is another way to broaden the exposure of medical education. There will be a greater sense of corporate responsibility and social needs. Programs will go beyond just product information. Education will be about participants, finding the right methods, and feeling proud about supporting good programs. Beebe. In diabetes alone, there may soon be 50 different drugs for a healthcare professional to choose from. If physicians prefer and trust CME over promotional programs, that’s where they will go. Some may believe that because we can’t always measure the investment, companies won’t invest in education programs. I don’t believe that at all. We need to provide education where the learners are and teach them in ways that they want to learn. That’s why iPods and PDAs will be well received in the future. The physician can quickly get 10 minutes to 15 minutes of education on a specific topic. Ruaño. Many novel technologies have arisen over the past five years. But for many of those technologies, the doctors haven’t had much training because the tools were introduced after the doctors went into practice. For example, many doctors don’t have training in genetic technologies, so we provide education that they find useful. Other areas are imaging technology and real-time monitoring, specifically with internal organs, the brain, heart, and so on. With new CME programs, the fields of DNA and imaging will not be limited just because most doctors are not geneticists or electrical engineers. Torres. There will always be a need for quality programs. The CME industry is moving toward greater access to physicians with online programs. With the advent of newer formats, such as Podcasts, physicians will have 24/7 access to education. We also believe that programs will be more patient-focused. The support processes and grant approvals will continue to be closely monitored, increasing our accountability for the dissemination of unbiased programs and enduring materials. PharmaLinx LLC, publisher of the VIEW, welcomes comments about this article. E-mail us at [email protected]. In diabetes alone, there may soon be 50 different drugs for healthcare professionals to choose from. If they prefer and trust CME over promotional programs, that’s where they will go. CME is going to increase. Christine Beebe Takeda Pharmaceuticals North America thought leaders Christine Beebe. Associate Director, Medical Education, Takeda Pharmaceuticals North America Inc., Lincolnshire, Ill.; Takeda Pharmaceuticals is a wholly owned U.S. subsidiary of Takeda Pharmaceutical Company Ltd., dedicated to serving patients by providing innovative products that improve their lives with better healthcare. For more information, visit tpna.com. Jean Fagan. Director of Science Communications, Roche, Nutley, N.J.; Roche is the U.S. pharmaceuticals operations of the Roche Group, one of the world’s leading research-oriented healthcare groups with core businesses in pharmaceuticals and diagnostics. For more information, visit rocheusa.com. Rene McRogers. Deputy Director of Scientific Relations and Communications, Talecris Biotherapeutics, Research Triangle Park, N.C.; Talecris Biotherapeutics provides life-saving and life-enhancing protein therapeutics. For more information, visit talecris.com. Gualberto Ruaño, M.D., Ph.D. President and CEO, Genomas Inc., Hartford, Conn.; Genomas is a biomedical company advancing personalized health with DNA PhyzioType systems for the diagnosis and prevention of adverse drug reactions in cardiovascular and psychiatric medicine. For more information, visit genomas.net. Gerardo R. Torres, M.D., MBA. VP, Medical Affairs, Shire Pharmaceuticals, Wayne, Pa.; Shire is a rapidly growing global specialty pharmaceutical company with a broad portfolio of products and its own direct marketing capability in the United States and seven other countries. For more information, visit shire.com. David Trout. Global Marketing Manager, Abbott Molecular Inc., Des Plaines, Ill.; Abbott Molecular’s business, which includes instruments and reagents used to conduct sophisticated analysis of patient DNA and RNA, provides physicians with critical information based on the early detection of pathogens and subtle changes in patients’ genes and chromosomes, allowing for earlier diagnosis, selection of appropriate therapies, and monitoring of disease progression. For more information, visit abbottmolecular.com. by Daniel Limbach The current reforms are a necessary evil. They clearly complicate the process and add a lot of administrative work, but in the current environment they are appropriate. The field will continue to weed out the commercial content from the academic content. Dr. Gualberto Ruaño Genomas I would appreciate seeing research on what the physicians know, their ages, the differences between community-based and practice-based physicians, and how these findings impact the physicians’ learning needs. Jean Fagan Roche A truly outstanding medical-education course is one that educates physicians on the most up-to-date, evidence-based medical information that will change physicians’ behavior to ultimately improve patient care. Rene McRogers Talecris Biotherapeutics Average Medical Affairs Budget by Activity Dollars ($ in millions) Thought Leader Management/MSL Programs Medical Publications Research/Clinical Operations Medical Education Other Source: Cutting Edge Information, Durham, N.C. For more information, visit cuttingedgeinfo.com. $5,125,833 $4,248,125 $16,365,833 $9,243,333 $1,446,042 Physicians and eCME in 2006 Disease-education courses online Online readings with multiple choice questions Online case studies Live or recorded Web-based seminars with key opinion leaders Clinical-trials presentations and results Online video with assessment Medical-education courses for a PDA or other hand-held device Podcast or downloadable audio file 0% 25% 50% 75% Base: Physicians who plan to use eCME in 2006 Source: Manhattan Research LLC, New York, N.Y. For more information, visit manhattanresearch.com. Residents and Physicians With Online Experience Who Are More Likely To Prefer eCME Physicians who are … Residents 41% Practicing M.D.s 28% Younger than 40 40% 40 or older 25% Technology optimists 34% Technology pessimists 19% Online five or more years 33% Online fewer than five years 20% Have broadband at home or work 32% Do not have broadband 11% Base: U.S. physicians who have participated in eCME Source: 2005 Physicians And Technology Study, American Medical Association/Forrester Research Inc., Cambridge, Mass. For more information, visit forrester.com. U.S. physician average=31% The industry needs more uniformity in applying ACCME standards among providers. If providers overreact, it may decrease the volume of programs industry will support. David Trout Abbott Molecular There will always be a need for quality programs. The CME industry is moving toward greater access to physicians via online programs. With the advent of newer formats, such as Podcasts, physicians will have 24/7 access to education. Dr. Gerardo Torres Shire Pharmaceuticals

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