Commercial Interests in Continuing Medical Education: Where Do Electronic Health Record Vendors Fit?

The Accreditation Council for Continuing Medical Education (ACCME) will not accredit an organization that it defines as a commercial interest, that is an entity that produces, markets, resells, or distributes health care goods or services consumed by, or used on, patients. Thus, commercial interests are not eligible to be accredited organizations offering continuing medical education (CME) credit to physicians. This decision is based on the concern that commercial interests may use CME events to market their products or services to physicians, who then might inappropriately prescribe or administer those products or services to patients. Studies have shown that CME events supported by pharmaceutical companies, for example, have influenced physicians' prescribing behaviors.Currently, however, the ACCME does not recognize electronic health record (EHR) vendors, which are part of a multi-billion-dollar business, as commercial interests, and it accredits them to provide or directly influence CME events. Like pharmaceutical company-sponsored CME events, EHR vendor activities, which inherently only focus on use of the sponsoring vendor's EHR system despite its potential intrinsic limitations, can lead to physician reciprocity. Such events also may inappropriately influence EHR system purchases, upgrades, and implementation decisions. These actions can negatively influence patient safety and care. Thus, the authors of this Perspective call on the ACCME to recognize EHR vendors as commercial interests and remove them from the list of accredited CME providers.

Ethics and Industry Interactions: Impact on Specialty Training, Clinical Practice, and Research.

Physicians in training and their mentors must be cognizant of ethical concerns related to industry interactions. Mentors perceived to have conflicts of interest or to be engaging in misconduct can unconsciously and profoundly affect the learning and academic environment by implying certain values and expectations. Despite increased awareness of ethical concerns related to industry interactions in clinical practice and research, there remains a need for interventions to prevent ethical transgressions. Ethics education is essential and a move in the right direction, but it alone is likely inadequate in preventing unethical behavior. Education should be supplemented with ethical environments at institutions.

The socio-political scene and Henrys crisis influence on the curricula of physical education undergraduate courses in Brazil / O cenário sociopolítico e a influência da crise de Henry nos currículos de graduações em educação física no Brasil

ABSTRACT From 1980s to 1990s, the Brazilian Physical Education (BPE) was strongly influenced by the discussion concerning its identity as an academic discipline; the final period of the Brazilian military dictatorship; the regulation of the BPE as a profession. Hence, this study analyzed the influence of that epistemological and political setting on the curricula of three BPE undergraduate courses. The Political Pedagogic Project and the Curriculum Matrix of the three undergraduate courses, from public universities, were analyzed using two qualitative research techniques: body of knowledge analysis, and content analysis. The results showed that the curricula analyzed did not cover a definition of professional intervention procedures based on ethical conduct specific to the area. Furthermore, the knowledge basis of the curricula is mainly constituted by discipline knowledge, which contributes to distancing the student's training from their field of professional practice . These findings may be associated with the insufficient epistemological discussion early initiated by Henry's works and unclear definition if the BPE is an academic or professional area. This investigation suggests that political disputes related to professionalization of BPE overlapped the academic discussions, which might have contributed to the problems identified on the preparation through bachelor courses of physical education professionals.

RESUMO De 1980 a 1990, a Educação Física Brasileira (EFB) foi fortemente influenciada pela discussão sobre sua identidade como disciplina acadêmica; pelo período final da ditadura militar; e pela regulamentação da EFB como profissão. Assim, este estudo analisou a influência dessa configuração epistemológica e política sobre o currículo de três cursos de graduação em Educação Física (EF) no Brasil. O Projeto Político Pedagógico e a Matriz Curricular dos três cursos, de universidades públicas, foram analisados utilizando duas técnicas de pesquisa qualitativa: análise do corpo de conhecimento e análise de conteúdo. Os resultados mostraram que todos os currículos analisados não apresentaram uma definição clara dos procedimentos de intervenção profissional baseados em condutas éticas específicas da área. Além disso, a base de conhecimento dos currículos é principalmente constituída pelo conhecimento acadêmico, contribuindo para o distanciamento da formação do graduando com o campo de atuação profissional. Essas descobertas podem estar associadas à insuficiente discussão epistemológica que foi iniciada pelos trabalhos de Henry e a não definição se a EFB é uma área acadêmica ou profissional. Esta investigação sugere que as disputas políticas relacionadas à profissionalização da EFB se sobrepuseram às discussões acadêmicas, o que pode ter contribuído para os problemas identificados na formação do tipo bacharelado dos profissionais de EF.

An Ethiopian Training Program in Neurosurgery with Norwegian Support.

After a 4-year planning period, a joint Ethiopian/Norwegian training program in neurosurgery was started in June 2006. The collaborating partners were Addis Ababa University; Department of Surgery, Tikur Anbessa Specialized Hospital; University of Bergen; Haukeland University Hospital; and Myungsung Christian Medical Center, a Korean missionary hospital in Addis Ababa, Ethiopia. A memorandum of understanding was signed at dean/chief executive officer levels. Although other initiatives have been involved in supporting neurosurgery in Addis Ababa during the same period, this institutionally founded program has been the main external contributor to neurosurgical capacity building through the education of 21 Ethiopian neurosurgeons, and in supporting a sustainable environment for neurosurgical training within a network of 5 centers in Addis Ababa. This article gives an account of the strategies underlying the program planning, the history of the program, and on the experience gained by it. Finally, ethical problems and challenges encountered in the program are discussed.

Consultation's sleight of hand seeks to sugar unpalatable bursaries pill.

The Department of Health's consultation on student bursaries has begun and people are being encouraged to take part in it. However, this consultation is not a consultation - it is predictable spin where sleight of hand seeks to sugar an unpalatable pill.

Conflicts of interest in medical school: missing policies and high need for student information at most German universities.

OBJECTIVES: Medical students interact with pharmaceutical representatives already during medical school. The goal of this study was to find out: Do policies exist at German medical faculties that govern the interactions between medical students and pharmaceutical representatives, do schools offer courses on the subject and do students attend these courses? And What are the attitudes of medical students concerning the role of pharmaceutical companies in medical teaching? METHODS: All 36 German medical faculty deans and 1151 medical students at eight German universities were asked to complete a questionnaire of 4 and 7 questions, respectively, regarding the above mentioned topics. RESULTS: 30 (83.3%) deans and 1038 (90.3%) medical students filled in the questionnaire, respectively. According to the deans' answers, only one school had a policy concerning conflicts of interest and one had a policy governing the interactions between medical students and industry. 8 (26.7%) deans showed an interest in constructing a policy or educational an activity on this subject. 149 (14.4%) students had participated in an activity that focussed the subject of conflicts of interest and 779 (77.8%) wanted more education on the subject. 701 (73.4%) were opposed to an improvement of medical studies through financial support by pharmaceutical companies, whereas 216 (21.9%) were of the opinion that students should not meet with pharmaceutical representatives. CONCLUSIONS: Unlike in other countries, like the US, most German medical faculties do not have policies that govern the interactions between medical students and pharmaceutical companies. Since most students want to be taught more about these interactions, the implementation of respective policies and lectures would be desirable.

The two (institutional) cultures: a consideration of structural barriers to interdisciplinarity.

C. P. Snow's famous Two Cultures essay has become a foil for decades of discussions over the relation between science and the humanities. The problem of the "two cultures" is often framed in terms of how the particular epistemological claims or general intellectual orientations of particular individuals on either side of this purported divide obstruct interdisciplinary dialogue or cooperation. This formulation, however, fails to consider the institutional frameworks within which such debates occur. This article examines the broader structural constraints that provide incentives, erect barriers, or otherwise shape the potential for interdisciplinary research and practice, with particular attention to work involving the life sciences. It argues that in order to understand the nature and scope of the problems facing interdisciplinary work, we must focus on the institutional constraints that shape how individuals frame questions, pursue investigations, develop careers, and collaborate.

The relationship between industry and surgery.

This article examines industry's involvement in medicine, particularly with respect to surgeons and clinical research, as well as continuing medical education. We describe some historical events involving industry and how these events have led to guidelines by various organizations to handle conflicts of interest. We also review the advantages and disadvantages of collaborating with industry and provide practical guides for interactions with industry in terms of clinical research, continuing medical education, and clinical practice. With careful consideration to protect all parties involved, collaboration with industry can be advantageous to surgeons, industry, and patients.

El compromiso social de las facultades de educación: reflexiones pedagógicas en torno a la educación y la crisis de la modernidad / The social commitment of the colleges of education: pedagogical reflections around education and the modernity crisis

Este escrito parte del siguiente supuesto teórico: las facultades de educación en su fundamentación pedagógica requieren reconstruir y reflexionar acerca de sus compromisos sociales. Sin embargo, y como consecuencia de las cada vez más sugestivas y colonizadoras dinámicas del pensamiento consumista, este tema ha pasado en los últimos tiempos a ser un asunto periférico. Por lo anterior, en este texto se reivindica el tema del compromiso social como asunto fundante y central para la configuración pedagógica de las Facultades de educación

This text starts from the following theoretical assumption: the colleges of education, in their pedagogical foundation, require to reconstruct and to reflect about their social commitments. Nevertheless and as a consequence of the more and more thought-provoking and colonizing dynamics of the consumeristic thought, this issue has been recently become a peripheral matter. Due to the above, in this text, the issue of social commitment, as a founding matter, is demanded, and it is key to the pedagogical configuration of the colleges of education

Posibilidades y límites de la universidad latinoamericana desde una perspectiva histórica / Possibilities and limits of the latin american university from a historical perspective

La Universidad Latinoamericana se configuró a través de la historia bajo el influjo de diversas fuerzas que le dieron una forma particular dados los contextos específicos donde surgió, en relación con las potencias coloniales, la iglesia, el Estado y el impacto de los diferentes modelos que se establecieron acerca de los propósitos a los que debía atender, definidos por los ingleses, franceses, alemanes y americanos. Pese a los intereses que se ciernen sobre La Universidad Latinoamericana, surgen desde múltiples miradas (las experiencias de México, Perú, Guatemala, Argentina, Chile y Colombia), posibilidades de considerar la idea de estructurar un pensamiento propio, que diera cuenta de una identidad distinta que la separa del discurso eurocentrista y la ubica en una perspectiva de análisis concerniente a las realidades a las que debe hacer frente. En la conformación de la Universidad Latinoamericana se ubican entonces, el pensamiento de Andrés Bello, las ideas de José Vasconcelos y las implicaciones del movimiento de Córdoba, en relación con otros movimientos sociales y estudiantiles con características similares, que convergen en la reflexión acerca de la necesidad de hacer un giro decolonial, no sólo a modo de resistencia, sino de autoconciencia acerca de quiénes somos y cómo cimentar un futuro común, fundamentalmente en esta época cuando la Universidad Latinoamericana enfrenta los embates de la globalización y la aplicación de políticas macroeconómicas que desdibujan su ser social y académico deslegitimándola

The Latin American University, throughout history, was shaped under the influence of diverse forces which outlined it in a particular manner, given the specific contexts where it appeared, in relation with colonial powers, the church, the State, and the impact of the different models which were established based on the purposes it had to fulfill, which were defined by the English, the French, the German, and the American people. Despite the interests which hang over the Latin American university, from diverse glances (the experiences of Mexico, Peru, Guatemala, Argentina, Chile, and Colombia) appear possibilities of considering the idea of restructuring an individual thinking which could recount a different identity that separates it from the Euro-centered discourse and places it in a perspective of analysis concerning the realities it has to deal with. In the configuration of the Latin American University, the following can stand out: Andrés Bello’s thought, José Vasconcellos’ ideas, and the implications of the Movement of Cordoba, as for the social and student movements with similar characteristics, which are directed toward the reflection about the need of making a decolonized change, not just as a matter of resistance, but of self-awareness of who we are and how to strengthen a common future. This is especially done in this epoch when the Latin American University is facing the attacks of globalization and the application of macro-economic policies that blur its social and academic being, undermining it

Repercusiones en la formación y los ingresos en México / Repercussions in the training and the income in Mexico

En este trabajo se analiza, por una parte, la relación entre la formación y el ingreso de los trabajadores, y por otra, la relación entre formación y ocupación en el mercado de trabajo en México. Los resultados señalan que las titulaciones que tiene salarios altos son las relacionadas a las ciencias exactas, las que tienen mayor probabilidad de estar contratadas son las relacionadas a la educación, y finalmente se observa, que las profesiones relacionadas a las aéreas de salud, educación, la economía, profesiones administrativas, tiene alta correspondencia con su empleo e inserción positiva en el mercado de trabajo.

This paper examines, firstly, the relationship between education and income of workers, and secondly, the relationship between training and employment in the labor market in Mexico. The results show that the degrees that have the highest salaries are those related to the exact sciences, and those which are more likely to be hired are those related to education, and finally, it is observed that the areas of health, education, and economic administration, are highly correlated with employment and positive insertion in the labor market.

Pharmaceutical industry financial support for medical education: benefit, or undue influence?

Presently, the pharmaceutical industry funds about half of the costs of continuing medical education (CME) programs in the U.S. This contributes to the ethical problems that pervade the relationship between medicine and the pharmaceutical industry: trustworthiness and conflicts of interest. The problems are exacerbated by rationalizations prevalent on both sides that deny the ethical concerns. Commercialism and commercial bias are highly visible at large CME gatherings, and available data, while scanty, back up the view that physician attendees' subsequent prescribing practices are influenced by the commercial message. The industry believes that it will recoup $3.56 in increased sales for every dollar that it invests in CME. New guidelines instituted by the Accreditation Council for Continuing Medical Education (ACCME) in 2004 may succeed in reducing excessive commercial influence, especially since the Department of Health and Human Services has also warned the industry of possible anti-kickback violations if firewalls are not erected between CME funding and marketing of drugs. Critics counter that early indicators of improvement are lacking.