Last Friday there was a brief discussion amongst my CME colleagues on Twitter – under the #CMEreg hashtag – about what I like to call “Cruise CME”. Cruise CME is the general term I use to refer to CME activities that are bundled together with leisure activities like skiing, hunting, and, naturally, sailing on a cruise ship.
The general consensus from those participating in the Cruise CME discussion was that of “How and why are these types of CME activities still taking place?” I made the comment that, in theory, these types of activities should be considered the “gold standard”.
The gold standard? Really?
OK, maybe I was using a bit of hyperbole to make a point, but allow me to explain. I find this issue fascinating because I started out with one opinion on it, but once I did a little more digging, did a complete 180.
A couple years ago, I was approached by a travel agency interested in offering Cruise CME packages. Half to full days of education while the ship was sailing; free days when to ship was in port at various tourist destinations.
My first instinct when I read the emailed description was to say “Absolutely not!” and delete the email. There’s no way to make this a “legitimate” CME activity, I thought.
But here’s the part that made me start to reconsider: there was no commercial support involved. The entire activity was covered by registration fees. Participants paid a fee for the cruise and a fee to participate in the CME. That was it. No grantors, no exhibitors, no institutional funds. Only reg fees.
Yes, but…it takes place on a cruise ship that travels to exotic locales! There has to be some kind of regulations about that! I know I’ve read it somewhere.
Fair point. Let’s look at the ACCME’s Standards for Commercial Support…oh, wait…there’s no commercial support. Hmmm…I think I remember reading something in the PhRMA code…nope, that doesn’t apply either. As far as I can tell, there are no specific guidelines about the location of a CME activity when commercial support is not involved. If I am incorrect about this, I hope someone can point me in the right direction.
So, we have established that there is no commercial support involved and no guidelines or standards are being broken by the location of the activity. I, as the accredited provider, would have had complete control over the content. So I’ll repeat the question I posed on Twitter: in theory, isn’t this the “gold standard” of CME?
Maybe I should pose the question another way: if you are an advocate of the elimination of commercial support from CME, isn’t the “Cruise CME” model the ultimate goal? Participants pay for their own education; the potential of any industry bias from grant funding is absent; the CME provider controls the content. What else could you want? (Yes, I’m discounting the argument about the value of didactic-based CME. I don’t think it’s relevant to this particular issue.) Does it make a difference if the activity occurs on a cruise ship or in a hunting lodge?
My guess is that for a lot of people, the answer to that last question is “yes”. Cruise CME activities don’t pass the “smell test” and location is the big hang-up. We know something is wrong with these types of activities, but we just…can’t…quite…put a finger on what it is. Even after making all the arguments to myself that I laid out above, I still wasn’t totally convinced (side note: I corresponded with the travel agency mentioned previously, but nothing ever came of it. I’m not even sure if they ever did “Cruise CME” or not.)
The argument I make against it – and one I’ve heard from others – is whether or not the primary focus of the activity is on education or entertainment? But…why can’t it be both? If a physician wants to shell out $1500 to learn about…I dunno…Updates in Primary Care… and then use his free time to sip mojitos on the beach in Barbados, is that wrong? It’s a tough question, but the perception-
Perception is king in CME, right now. No, there may not be any regulations that say a commercial support-free activity can’t be on a cruise ship, but the perception is that there is or there should be. The perception is that a “legitimate” CME activity cannot take be held while cruising around the Virgin Islands. The CME community is under constant scrutiny from the outside and these Cruise CME type activities make an easy target. Does that make them wrong or out-of-compliance? Not in my book, but it does make me a little leery of being associated with them.
I’m very curious to hear what others think of this issue. Am I missing anything with regards to compliance and location? Do I have the wrong read on the perception of these types of activities? I hope to make this a topic for an upcoming #CMEreg chat and continue the conversation.