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February 16, 2016

CPD: WHY GIVE A DIME?

Why is industry investing in physician Continual Professional Development (CPD)?
Find out who gets what.

Four panelists from various disciplines were tasked with answering the following questions:

• Is the pharmaceutical industry’s investment delivering competency improvements and improved patient outcomes?
• What do recent ethical rule changes mean to future CPD development and execution?

The first speaker of the night to address this question was Dr. Claude Guimond, Director of Professional Education of the Quebec Federation of General Practitioners. He began by explaining what the CQDPCM (Conseil québécois de développement professionnel continu des médecins) is and its mission. He mentioned that the organization developed an updated Code of Ethics over a number of years that was circulated and accepted by all members, and it has been in effect since January 1, 2016. All members must follow and respect this code in order to provide accredited activities.

He then outlined the major changes to the code of ethics, including some definitions, guiding principles, transparency and potential biases. He explained the different definitions of an organizing committee and a scientific committee and their composition. He discussed transparency and explained that organizers of an activity must be transparent regarding the sources of revenue and spending allocations, both of which must be approved by the organizers. Dr. Guimond also touched on the potential for bias, mentioning that bias is not necessarily negative, although commercial bias is always negative. He explained that activity organizers must always be conscious of the potential for bias, and that activities sponsored by multiple sources are more strongly encouraged than by a single sponsor.

The Code of Ethics now requires that all organizers and members of the scientific committee declare any conflicts of interest. There is a form to fill out by the members of the scientific and organizing committees and by any other people used as resources for a program and their conflicts must be presented at the beginning of any program or activity. He also explained that the evaluation form for any activity now must include the following 3 questions:

• Does the activity respect the Code of Ethics of the CQDPCM?
• Have the conflicts of interest of the presenters been disclosed?
• Is commercial bias present during the activity?

He also mentioned that any advertising, or “tagging”, is prohibited in any activities, but the sponsor(s) can be thanked in an appropriate manner at the end of a program.

He clarified that any sponsor (i.e. a pharmaceutical company) can organize meals, rooms, audio-visual, photocopies and venues for an activity, which has not changed from the previous version of the Code of Ethics. An educational grant given to a professional organization of an accredited body can be used for travel expenses, honoraria and other expenses incurred.

Dr. Guimond pointed out that, on average, family physicians in Quebec complete 21-25 hours of accredited activities each year. A new guideline is currently under development to help physicians maintain their competencies, as many physicians are isolated and do not take part in any continuing medical education. The guideline will specify the minimum number of hours of accredited training that physicians must complete per year in a 5-year cycle, and will likely be released in July 2017.

Two representatives of Innovative Medicines Canada were the next speakers. The first was Janie Hubert, Manager of Continuing Health Education, at AbbVie. She emphasized that Innovative Medicines Canada’s mission is to always have an interdisciplinary approach to activities, with the hope of improving relationships among all members for the betterment of the healthcare community and patients. She pointed out that the pharmaceutical industry finances up to 70% of all continuing education activities in Canada. She spoke about the results of a study done by Innovative Medicines Canada conducted with physicians who had taken part in educational activities sponsored by the pharmaceutical industry. Most respondents felt that the activities offered interesting and valuable information without any particular bias. They also felt that the activities offered the opportunity to learn about new areas and/or treatments, new ways to practice and treat patients and to speak to experts in the various areas. She also mentioned the importance of transparency and disclosure of interests in all pharmaceutical programs.

The second speaker for Innovative Medicines Canada was Colette Martin, National Health Learning Development Manager at Pfizer. She began by saying that the CPD model in Quebec is very unique and different from the rest of Canada. Healthcare professionals in Quebec are very avid seekers of CPD and she felt that the FMOQ model is a big reason behind this. The Quebec model allows for physician support at a very regional, local level that meets very unique needs. Collaboration is the foundation for success for all parties involved, including the physicians, the pharma industry and medical associations. She mentioned that there are currently two codes of ethics in Quebec: one is the Innovative Medicines Canada’s code, which was revised in 2012, particularly the section about HCP to HCP learning. She pointed out that company internal compliance regulations are often more strict that this Code of Ethics. The second Code of Ethics is that of the CQDPCM, which is the only CPD/CHE-specific Code of Ethics in Canada. She mentioned that the two codes are aligned in many ways, particularly in the philosophies behind them. They both focus on providing high quality education for physicians, the management of bias and the importance of transparency. She explained that CQDPCM and Innovative Medicines Canada are working together to find solutions for working with two codes in Quebec and how to best implement them.

The last panellist of the evening to speak was Vivianne Vinet, President of CME Solutions ULC. She was asked to address the following question: what do the communication companies do to increase competencies and how is that going to change moving forward? She began with a case example of a program that her company developed with the Family Physician Airways Group of Canada called “Respiratory Updates”. The program included live programs, as well as online “touch points” (quizzes) over a 9-month period, to gather data to assess if the program was affecting physicians in their clinical practice. She showed some of the results which demonstrated that physicians’ competency improved with this program over time.

Ms. Vinet outlined what she felt were the possible roles of communication companies within the new CQDPCM Code of Ethics, where were:

• Member of the Steering Committee (SC)
  • Support for needs assessment, learning objectives, content, instructional design, format, etc.
• Member of the organization committee (different individual from SC with a firewall)
  • Support for all logistics as approved by the SC

She raised a number of unanswered questions, including:

• How will physician organizations be identified and properly informed about the Conseil Code of Ethics?
• Who will write and “market” grant proposals?
• Will physician organizations have the capacity to manage all aspects of CPD, disburse funds, create individual contracts with the sponsor, organizing committee, and members of the scientific committee?
• Will the physician organizations allow a person from the communication company to sit on the scientific committee?
• How will the scientific committee identify speakers and train them?
• Will physician organizations have the capacity to manage the process of program implementation and collect associated fees?
• What will be the impact on Canadian programs when the CFPC launches their new Code?

She concluded by saying, “It’s our duty to learn about the codes and find solutions and the right recipe moving forward.”

The panellists then entertained questions from the audience. The key points from the question period are summarized below:

• The spirit of the Codes of Ethics of the CQDPCM and Innovative Medicines Canada is similar and both organizations are working toward a plan of implementation where both “win”.
• CQDPCM would like to have the signature of Innovative Medicines Canada on their Code of Ethics.
• Individuals who work in CPD in organizations/companies must be certified by the Federation and know the Codes.
• When evaluating a CPD program or activity, one needs to ask, why are we doing it.
• There is a fine line between training and information.
• When only one product is available in a therapeutic area, CPD activities must remain unbiased and must not have a marketing focus on the product.

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Lara Holmes
Medical Writer
Email: lholmes@videotron.ca
Cell: 514-425-4977

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