Editorial Surg Endosc (2006) 20: 1009–1010 DOI: 10.1007/s00464-006-0075-7 Ó Springer Science+Business Media, Inc. 2006

Society of American Gastrointestinal Endoscopic Surgeons (SAGES) guidelines on continuing medical education Since the late 1990s, there has been a major change in the financial support for continuing medical education (CME) in the United States because of a major increase in commercial support, mainly from pharmaceutical companies. From 1998 to 2003, commercial support for CME rose from $302 million to $971 million, a threefold increase. Although the support from universities and institutions fell slightly over the same period, the increase in commercial support far outweighs this fall. The main increase comes from the pharmaceutical industry, which must perceive a benefit for this significant increase in their educational costs. Concerned about this rather dramatic increase in money originating from the corporate sector as well as suggestions of adverse publicity regarding possible commercial bias in CME activities, the Accreditation Council for Continuing Medical Education (ACCME) has reviewed its Standards for Commercial Support of CME. As a result its deliberations, ACCME has very correctly made significant changes that update the standards for new CME activities after May 2005, and for all activities by November 2006, placing tighter controls to ensure impartial and unbiased use of these funds. There is an absolute need for all medical education to be balanced and based on scientifically proven fact. The rapid expansion of medical knowledge has increased the need for CME, and there has been a significant increase in the amount of CME material being made available to physicians. In its delivery of knowledge, CME should be free of bias, but this significant increase in commercial support and the amount of CME activity available raises the issue of what is industry getting in return for this outpouring of financial support. The changes made by the ACCME are very stringent and may initially seem unnecessary, but it is extremely important to maintain a high educational standard for CME, with endeavor to strive for an absence of bias in all programs. Under the new standards, a faculty member must disclose his or her financial support and relationships, which the ACCME describes as ‘‘individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interests (e.g., stock, stock options, or other ownership interests excluding diversified mutual funds), or other financial benefit.’’ [1] Also covered are ‘‘financial benefits [that] are usually associated with roles such as employment,

management positions, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities from which remuneration is received or expected’’ [1]. These financial benefits extend to spouses or partners. An individual not only must disclose all financial interest, but he or she also must inform learners when no financial interest exists. ‘‘In-kind’’ support must also be disclosed. It is the responsibility not only of the faculty member, but also of the provider to ensure that a faculty member complies with these standards. The organizers and any person involved in helping to put a program together also must comply with the new regulations, so as to ensure that educational content is of the highest standards without bias. This clearly refers to program committees of academic institutions and societies. The biggest change is the requirement for organizations designing CME activities to provide a mechanism for resolving personal conflicts of interest ‘‘when an individual has the opportunity to affect the CME content about products or services of a commercial interest with which he/she has a financial relationship’’ [1]. ‘‘The ACCME considers ‘‘content of CME about the products or services of that commercial interest’’ to include content about specific agents/devices, but not necessarily about the class of agents/devices, and not necessarily content about the whole disease class in which those agents/devices are used’’ [1]. There is therefore a fine line of specific agents/devices and classes of agents/devices, which means that trade names giving preference to a manufacturer must be excluded. This mechanism must resolve conflicts of interest and be responsible for replacement of speakers when it is thought that a conflict of interest cannot be resolved. Steinbrook [2] pointed out that this can be done by finding another speaker, by assigning the speaker to another topic, or by having an effective peer review of the content for a talk or written material. The provider of CME is now responsible for ensuring that everyone in a position to control the content of educational activity has disclosed all relevant financial relationships over the previous 12 months. The correct interpretation and implementation of these changes are extremely important for all medical societies. They also are of paramount importance to the Society of American Gastrointestinal and Endoscopic

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Surgeons (SAGES), a world leader in the field of endoscopy and laparoscopic surgery, and will have a great impact on SAGES activities. Consequently, SAGES has taken the important step of devoting considerable time and effort to interpreting these new guidelines as they relate to the CME activities of SAGES, and has written new guidelines governing its own CME activities, so that the society is in full compliance with the new guidelines developed by the ACCME. These guidelines affect the organizers, speakers, authors, and moderators taking part in CME activities of SAGES. It has handled the issue of resolving conflicts of interest, one of the major changes in the new ACCME guidelines, by forming a subcommittee for conflict resolution. However, it is hoped that speakers so clearly define their financial support and conflict of interest that the subcommittee will have little work to perform. This committee will be the ultimate arbiter in the replacement and/or reassignment of speakers as well as in the reorganization of presentations and even whole focused sessions should there appear to be a conflict of interest that cannot be resolved. These changes will undoubtedly place hardship on those arranging and organizing CME activities for SAGES, and also on the participants in these activities. However, at the same time, the changes will markedly improve the quality of the CME activities offered by SAGES. This was a major undertaking that will have an impact on all those taking part in any CME activity of SAGES. But it will have the beneficial effect of improving the quality of the education for those attending meetings and courses, and should improve the

care of our current and future patients. It is of paramount importance that material presented at any CME activity of SAGES be balanced, that it has undergone the rigors of study, and that it is free of corporate bias. We owe this to ourselves, our patients, and any patient we may treat in the future. We must therefore commend SAGES and its Board for being proactive and taking these steps, onerous though they may seem to be, so that the materials presented at SAGES courses and meetings will be of a high quality and balanced nature. Those attending SAGES meetings hopefully will appreciate the hard work of the dedicated people who have devoted time to interpret the new ACCME standards and apply them so that the quality of the educational content is of the highest standard.

References 1. ACCME Accreditation Policies Accreditation Council for Continuing Medical Education. Available at www.accme.org 2. Steinbrook R (2005) Commercial support and continuing medical education. N Engl J Med 356: 534–535

D. H. Birkett Department of General Surgery Lahey Clinic Medical Center 41 Mall Road Burlington, MA 01805-0001 Received: 31 January 2005/Accepted: 7 February 2005/ Online publication: 3 June 2006