Who's in charge here?

Abstract

The most distinctive feature of the North American CME enterprise is that it is pluralistic.In order to satisfy the vast array of learning needs of half a million highly specialized practitioners, the enterprise has deployed a host of CME providers, plying their wares in a multitude of milieus, and employing a remarkable range of educational techniques. The whole is so pluralistic as to suggest the possibility that what has been created is really a nonsystem.Can something be done to make the enterprise more cohesive and rational and effective? Is there some subset of the CME arena that could step in, don the leadership mantle, bring order out of chaos, and lead CME to the promised land?In this issue of JCEHP, Kristofco (1) nominates the medical school (he calls it by its grander name, the academic health science center) for this role. With appropriate humility (he concedes that CME is the stepchild of the educational hierarchy in all but a few academic centers) and with characteristic thoughtfulness, he makes an eloquent case for expanding the role of medical schools in the CME enterprise. The medical school, he argues, is not only the source of faculty for most CME programs, it is also the locus of research and development, both in medical science and in the technology of information transfer. In today's complex environment, he concludes, the medical school's CME division is the logical bridge (or revolving door) between the scientific world and the practicing community.A somewhat different view is that of Storey (2), who has wrestled for many years with the question of governance of the CME enterprise. Although he concedes the point that academia is the proper source of information and teachers, he contends that the specialty societies should be in charge of identifying and satisfying their members' learning needs; he also advocates an overseeing coordinating body to lessen the impact of the system's inefficiencies.Still others, notably Uhl (3), have presented the view that it is the community hospital, the work-site of most learner/practitioners, that is the logical and most efficient place to carry out the mission of CME.The whole situation is further complicated by the fact that there are many other players on the field (e.g., pharmaceutical companies, meeting managers, marketers, computer experts, and others). Even the strictly medical professional forces (i.e., medical schools, specialty societies, hospital medical staffs) are not autonomous bodies but are represented by a host of overlapping organizations 203