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CEJA offers help in navigating the waters of the new CME environment

A Council on Ethical and Judicial Affairs (CEJA) report and AMA ethics opinion provide ethical guidance to help physicians put into practice core principles of transparency, independence and accountability in the context of CME. AMA webinars in November and December gave the CME community a chance to learn more about this new ethics policy.

Opinion E-9.0115, Financial Relationships with Industry in Continuing Medical Education carries forward the aspiration for CME to be as independent as possible of financial relationships with industry—either in funding for CME activities or financial relationships between industry and individual physicians who play various roles in CME. During the webinars, several questions focused on clarifying when financial relationships are allowable under the new policy.

In a nutshell, financial relationships with industry can be ethically acceptable when:

• Support is needed to enable access to appropriate, high-quality CME,
• Participation by a "conflicted expert" (who has significant financial ties to industry) is central to the success of an educational activity
• The activity is designed to meet a demonstrated need in the community
• Appropriate steps are taken to preserve independence.

Those steps include adequate disclosure of the nature and source of financial interests involved and, when the activity involves a conflicted expert, the magnitude of the interest at stake. Physician-learners also should be informed of what steps have been taken to mitigate the potential influence of relationships—such as prospective peer review of content.

Other questions raised during the webinars focused on clarifying key terms in the policy, including:

• What constitutes a "significant" financial relationship? Examples include ownership interest in a company that has an interest in the educational subject matter, royalties relating to the subject matter, or ongoing compensation for services such as consulting or participating in an advisory body or speakers bureau on behalf of a company with a financial interest in the subject matter.
• What does it mean to disclose the "magnitude" of a financial interest? E-9.0115 does not set specific thresholds, but one example would be to disclose the amount of financial interest in terms of a dollar range—say, between $2,500 and $5,000.

In some cases, real-world practice may already reflect the expectations set out in E-9.0115. Where it does not, the expectation is that the community will integrate these provisions as quickly as possible. The AMA is available to answer your questions on how E-9.0115 applies to specific circumstances; please contact our Council on Ethical and Judicial Affairs or Continuing Physician Professional Development staff.