Continuing medical education in the 21st century Needs to recapture professionalism in lifelong learning

The relations between large bodies of money and the healing professions have often been ambigu‐ ous. Commercial interests have sought to influence the course and content of doctors’ education. On the other hand, foundations established through personal wealth have funded some of the principal reports and reflections that have shaped professional education. For example, the Carnegie Foundation supported Abraham Flexner’s 1910 report on the state of medical education in North America. This changed medical schools dramatically in terms of scientific education and commercial influence. As a result, more than 100 schools based on commer‐ cial interests closed in subsequent years. Over the following decades, the medical professional and academic communities established accreditation systems of setting standards and mutual site visits with audit, and later quality improvement. The interlinked Committee on the Accreditation of Canadian Medical Schools and Liaison Com‐ mittee on Medical Education currently accredit approximately 150 undergraduate programmes in North America. These committees have profoundly affected undergraduate and postgraduate education by stimulating effective pedagogy devoted to pro‐ ducing dedicated, ethical, and skilled doctors for the future. In Canada and the United States, respectively, the Committee on the Accreditation of Continuing Medical Education and the Accreditation Council for Continuing Medical Education attempt to do the same for continuing professional development in an environment more akin to the “wild west” that Abraham Flexner observed and excoriated 100 years ago. The US based Josiah Macy Foundation recently sponsored a conference exploring the state of con‐ tinuing education.1 The conference was attended by some of the leading developers of continuing educa‐ tion in the US. The resulting report’s reflections on the questionable scientific basis for the practices and content of much continuing education, emphasis on the welfare of doctors rather than their patients, and commercial entanglements are distressingly similar to those noted by Flexner in undergraduate educa‐ tion almost 100 years ago (box). Unlike Flexner’s review, the report is not the result of an extensive series of visits to active medi‐ cal schools and sites of education. Instead, it is the consensus of a group of people whose experience and scholarship represent the breadth and depth of the cumulative development of continuing educa‐ tion in the US. It is an analysis of the current state of affairs; it summarises the lessons to be learnt and provides recommendations for the future. Most of the observations and recommendations of the report have support in the evolving literature on adult education, systems of care,2 professional‐ ism,3 and the behavioural impact of both continuing education and the inducements offered by indus‐ try.4‐6 These observations are not kind to the pro‐ fessions, their educators, or the existing systems of non‐academic accreditation. We are presented with a picture of a disorganised system of education with obvious foci of excellence (most in universities) but with most commercially supported events shading more towards product promotion and the welfare of doctors than prioritised dedication to enhancing the care of patients. Much of the pertinent litera‐ ture is summarised and referenced in the excellent series of presentations and responses that form the substance of a well presented, concerned but bal‐ anced, resource for all who participate in profes‐ sional development in the North American context and well beyond. M al co lM W il le tt