Debates in Print |

Considerations in the Relationship Between the American College of Chest Physicians and Industry* FREE TO VIEW

Alvin Lever, MA, FCCP(Hon), Executive Vice President Chief Executive Officer
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*From the American College of Chest Physicians, Northbrook, IL.

Correspondence to: Alvin Lever, MA, FCCP(Hon), American College of Chest Physicians, 3300 Dundee Rd, Northbrook, IL 60062; alever@chestnet.org

Chest. 2001;119(4):1257-1259. doi:10.1378/chest.119.4.1257
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I would like to thank Dr. Varkey for his insightful comments. I will attempt to address the comments in the sequence in which they were offered.

I am pleased that Dr. Varkey found the meeting intellectually and personally satisfying, as Richard Irwin, MD, FCCP (the Scientific Program Chair), the Scientific Program Committee, and the American College of Chest Physicians (ACCP) staff made considerable effort to ensure these attributes. In addition, attendees submitted evaluation forms in order to receive their continuing medical education (CME) certificates, and some of the highlights noted on the evaluations include the following: 93% of respondents thought it was a valuable experience; 90.4% thought the educational content was very high; 91.6% thought the quality of the speakers was excellent; 88.7% thought there was adequate time for the exhibit hall; and 87.5% thought the exhibitors provided relevant information.

Overall, the attendees thought that CHEST 2000 was a worthwhile event and that it met their needs. This is very gratifying, since the focus of the ACCP is and always has been on educational excellence and constant improvement.

Regarding the CHEST 2000 name badges, as I am responsible to a great extent for the perception of the College, I apologize to Dr. Varkey and all of the attendees, as the badges were neither what we had planned nor envisioned. I can assure you that under my watch, this action will not be repeated, and we will be more sensitive to all items that might be perceived to affect the image of the College and its members.

One item that Dr. Varkey did not mention but was mentioned several times in the evaluations and discussed at the Scientific Program Committee meeting for CHEST 2001 was the “vision wall” that was located at the bottom of the escalators. Although this year it was located at the entry to the exhibit hall, this was also the main entrance to the meeting rooms. Next year, we are looking to have this wall outside the exhibit hall, and although one would pass it going to sessions, it will not be on the same floor as the scientific sessions. But more importantly, instead of a single sponsor’s advertisement, the principal content will be information about the meeting, the College, and The CHEST Foundation, interspersed with industry sponsor information from four to six sponsors.

In order to address Dr. Varkey’s points regarding satellite symposia, it is important to first explain the process of being accredited to provide CME. The current guidelines and requirements of the Accreditation Council for Continuing Medical Education (ACCME) are defined as 10 elements in three essential areas (and can be viewed on-line at www.accme.org/sec_acc_sta.html).

Essential Area 1: Purpose and Mission

Element 1.1: Mission

Element 1.2: Parent Organization

Essential Area 2: Education Planning and Evaluation

Element 2.1: Planning Processes

Element 2.2: Needs Assessment

Element 2.3: Purpose and Objectives

Element 2.4: Activity Evaluation

Element 2.5: Program Evaluation

Essential Area 3: Administration

Element 3.1: Organizational Framework

Element 3.2: Business and Management Practices

Element 3.3: Disclosure and Commercial Support Standards

The mission of the ACCME is the identification, development, and promotion of standards for quality CME utilized by physicians in their maintenance of competence and incorporation of new knowledge to improve quality medical care for patients and their communities. The ACCME fulfills its mission through a voluntary self-regulated system for accrediting CME providers and a peer-review process responsive to changes in medical education and the health-care delivery system.

In 1995, the ACCP had an on-site review team evaluate our programs and evaluation process in depth, and we received a full 4-year accreditation. In 1999, we had another review after submitting all required and subsequently requested documentation. The result was another full 4-year accreditation. The grading of that review was“ exceeds substantial compliance,” with two commendations in“ educational design” and “substantial compliance with all other essentials.” Clearly, the College provides quality education and appropriately follows the “CME” rules, and has demonstrated that through an independent review process by the ACCME.

To address the points regarding the satellite symposia, in the 1980s and early 1990s, the ACCP instituted satellite symposia. As a result of comments regarding the marketing/sales approach to those programs, the Continuing Education Committee (CEC) and the Board of Regents decided to eliminate them from the meeting. Recently, however, we discovered that some companies were presenting satellite symposia during our meeting without our approval or input. These were often in opposition to some of our programs, and we received many complaints about them. In an effort to address the concerns raised by our members, the Board of Regents gave permission to the CEC to develop satellite symposia with the direction that they must comply with the College’s CME process. The process for satellite symposia is as follows:

1. A satellite symposium application and guidelines document are sent by us to industry for any proposals they might have for topics and speakers. Proposals may be generated also by our staff, individual CEC members, and the membership at large. Any Chairperson must be a Fellow of the College (FCCP) and may only chair one satellite symposium.

2. Next, these proposals are presented to the whole CEC for their review. Each proposal is presented with no reference to the potential sponsor.

3. On CEC review, many titles, programs, and Chairs are revised, and these revisions are communicated to potential industry sponsors. If the CEC-specified program is approved, the College enters into a contract with the sponsor that indicates compliance by both parties with the ACCME and US Food and Drug Administration rules, and stipulates that the College is in control of the content and selection of the speakers and moderators. (The speakers and moderators may or may not be those suggested in the original proposal.)

4. The College staff then works with the Chair to finalize the program and speakers.

5. This year, the CEC had a member of its committee at each satellite symposium to evaluate and ensure the quality and objectivity of the programs.

Regarding the satellite symposia this year, we had 25 submitted and 20 were approved. They accounted for only 35 CME hours out of the total of approximately 410 CME hours offered in the scientific program, postgraduate courses, cram courses, and the satellite symposia. These satellite symposia were well attended, with attendance ranging from 86 to > 350 persons, and the average and mean evaluations for meeting stated goals and objectives and application to current practice were 4.5 on a 5-point scale. As the outlined process may not have been known by everyone, some members may have perceived that satellite symposia were biased. It has been the intent of the CEC to provide a mechanism to make each satellite symposium a venue for an objective, in-depth presentation of a topic. The evaluators also graded all of the sessions on the basis of objectivity and balance. The overwhelming response from attendees was positive. Hence, the attendee can attend with a degree of confidence in the objectivity of the information, mindful of the tag line of the magazine Brill’s Content, “Skepticism Is a Virtue.”

Another point made by others regarding the satellite symposia was the extensive mailings made by the commercial companies working with the symposia. The College is reviewing this process, considering the members’ feedback, which ranged from comments appreciating all the marketing reminders, and that they may have contributed to our excellent attendance, to remarks that some members found the mail intrusive.

The financial support that the College receives from industry through advertising in CHEST, unrestricted educational grants, exhibits, and donations allows it to provide quality services to our members, their patients, and their communities in an economical manner. We are then able to use member dues to develop clinical practice guidelines and patient education brochures; to educate members and policy makers on legislative and regulatory issues; and to pursue community outreach initiatives, to name a few. I am proud of the manner in which the College and its leadership and staff professionally and ethically maintain a relationship with industry in order to effectively meet our mission in a fiscally responsible manner.

I thank Dr. Varkey and the attendees who expressed their views, as it is the intent of the leadership and the staff to respond to the needs and observations of the membership. I also want to thank the Editor of CHEST for allowing me to respond on behalf of the College and to begin an ongoing dialogue regarding the College relationship with industry. This open conversation hopefully will foster ideas from our members to public health groups and to industry, in order to develop a new paradigm for ACCP clinical education—one that will encourage active learning and behavior change. As we learned from our conference on “Translating Guidelines Into Practice: Implementation and Physician Behavior Change,” and its subsequent publication as a supplement to CHEST, education programs alone do not change behavior.

Depending on the responses from the membership, the College might establish a question and answer feature in ChestSoundings to address the evolving issues and continue the dialogue. I look forward to receiving constructive input.




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