Perhaps it has something to do with the calendar turning over, or maybe it’s because we’re all going a little bit stir crazy looking out our window and imagining how cold it is outside our front door, but this is always the time of year where I hear a lot about the need for “more innovation” in the world of CME.

We need to “re-imagine” how we design and deliver education. We need to “meet learners where they are” with our programming. We need to “think outside the box” to come up with groundbreaking solutions. We need to “get closer to the real provider/patient data” with our outcomes assessments.

I am sure you can come up with some of your own buzzwords or catch phrases that I missed. It’s an annual song and dance – rah rah rah, we can do this better! Let’s tap into our creative possibilities, form strategic alliances that maximize the strengths of the many instead of the few, and really get at the core of how our target audiences want to learn!

(For those of you going to the Alliance conference next month, you are going to hear this a lot)

It’s not that any of this is bad or misguided, but it’s simply unrealistic for a variety of reasons. We’ll start with the reason that no one ever seems to talk about as one of the primary barriers to innovation in CME: Money.

Let’s not lose sight of one simple fact: For most of us, the CME provider who employs us is operating as a business. It’s a business for supporters who devote a specific budget to therapeutic areas of interest. It’s a business for providers who need funding to pay the bills and support their teams financially, whether you are in an academic center, a member association, or a MECC. This is not a charity industry. Yes, most of us are in this at least in some capacity because we care about patients and want to make healthcare providers better at what they do, but there is nonetheless a financial component that underlines our work. If we don’t convince the internal teams within our pharma company to invest in CME programming, we’re out of a job. If we don’t get enough financial support from supporters to fund our programs, we’re out of a job. Plain and simple.

At last fall’s Alliance Industry Summit, there was one presentation in particular that drove home the limits that finances place on innovation in CME. It was a panel comprised of several representatives—both providers and supporters—from a far-reaching educational initiative that involved multiple interventions, an interesting longitudinal learner assessment, and various other tidbits that I can’t remember (this happens a lot when you get to be on the wrong side of age 50). Basically, it was one of those programs that nearly everyone would agree was “innovative” (don’t get me started about how everyone has a different opinion of what is or isn’t innovative – that’s another blog post for another day).

People were really interested in the activity design and its outcomes. “Yes, we should do more of this! This is the type of project my company would love!”

And then came the inevitable question, “Can you tell us—roughly—how much this project cost?”

The response? “Somewhere upwards of $2 million.”

More banging of the drum from the small contingent in the front row — “That’s great! This proves that pharma has money to support innovation! This is what we need to be investing in! Let’s convince our peers to shovel more money into CME so we can support projects like this! We can do this, people!”

But for most of us in the room, we knew right away that this project was the kind of interesting unicorn that pops up every now and then but simply isn’t realistic across even a relatively narrow broad spectrum. When you hear, “Our CME budget is down 10% this year, and it was pretty tight last year,” that’s not a formula for support of innovative programming. While innovation doesn’t have to be expensive—I like to think we do a pretty good job at CMEpalooza being innovative on a shoestring budget—to support the kind of manpower and high-tech doodads that “groundbreaking CME” often requires, a large price tag is usually attached to it.

Every week or so, I like to do an environmental scan to see what sort of online CME programming is available in a given therapeutic area. Without fail, the majority of activities I find are flat webinars – your basic 30 minutes of talking heads and slides, maybe with an animation thrown in or something like that, that we have been doing for years and years. Certainly, it’s nothing that anyone would argue is “innovative” or “re-defines CME.” It’s the same today as it was 10 years ago. The pendulum isn’t moving. Why, you ask? Yes, repeat after me…money.

Webinars are inexpensive to develop and produce, which makes them attractive for pharma to support. They are easy to create and hugely profitable for providers, which makes them attractive to propose. So, on one hand, you get a supporter with limited budget. On the other, you get a business unit (don’t hate only on MECCs here as all providers love their webinars) that is looking to strengthen their bottom line. So then, yes, you get a lot of accredited slide-video webinars out there (at least we’ve moved past the days of slide-audio). I don’t know that many people would argue that these sorts of programs are ideal for our learners, but they are functional and they are fiscally sound for all parties.

This isn’t something that most of us discuss in any sort of public forum because, well, it is frankly a bit embarrassing to admit that a lot of what we do is driven by dollars and not by what is best for our learner community. We would all love to be involved in those $2 million programs that really are exciting and impactful, but it simply isn’t the way the CME world is structured (note from Derek: maybe it should be.)

Now, money isn’t the only barrier to innovation in CME, and there is quite a bit of literature that argues that money is often just an excuse instead of a root cause that prevents innovation. There is likely some truth in this, but I feel strongly that the bottom line drives a lot of what chances we are/are not willing to take with our CME programming. Who is going to spend weeks developing a proposal for a $2+ million innovative initiative that has little chance of being funded as opposed to 10, $200K more realistic “tried and true” initiatives? (note from Derek: I think the argument of one large expensive program vs 10 small inexpensive programs is worth exploring more. Stay tuned….)

The world loves disruptors. Amazon. Uber. Netflix. Companies that truly redefine a space and make us rethink how we’ve done something for many years. But that doesn’t mean that every industry will get this kind of massive disruption, for whatever the reason. It’s just not the way the business world works.

So then, no, in my opinion, there will be no drastic shifts in the way that we design, deliver, and measure accredited education in 2026. Or 2027. Or 2028. I do not believe that we are an industry where any single innovation is going to massively overhaul the way that we design and develop education, at least not that I’ve seen. Shifts will be small—but still important—as we find cost-effective ways to innovate. AI platforms are getting better and more realistic. There are lots of interesting innovators and innovations out there in our community. But disrupting our world and “re-imagining CME”? Sorry, I just don’t see it.

If you missed previous segments of the CMEslinger saga, you can read them here:

• Part 1
• Part 2

And now, our latest segment:

Part 3 (Scott)

As always, the man in black had taken a seat in the far corner of Café Gilead facing the front door.

“You’ve been watching too many movies,” the CMEslinger said as he slid into the vinyl upholstered booth. “What, you think that one of your exes is going to walk through that door with an eye for some vengeance? On second thought, I’ve met all three of your exes. Probably wise to be careful.”

“OK there, wise guy,” retorted the man in black. “Go ahead and gloat all you want. I can take it, especially from someone who looks like he just went through a car wash with the windows down. Good God, man – people warned me, but you really do look like hell.”

“Enough with the pleasantries,” the CMEslinger said. “What’s going on with TAXIE and Marge?”

The man in black proceeded to recount his actions of the last 3 days since he received the panicked call from TAXIE’s vice president of education concerning Marge’s disappearance and the organization’s dire straits regarding their upcoming accreditation review. He told the CMEslinger about the frantic calls to Marge’s sister in North Carolina, her daughter in Sweden, and her best friend in Maryland. He explained how he drove the 4 hours from his beach shack in Wildwood Crest, NJ, to TAXIE’s headquarters outside Washington DC, spending hours with the team there replaying Marge’s actions on the day she disappeared. There was a call to the ACCME, another one to the AANP, and even one to the ANCC. The man in black had even checked in with the tournament director of the U.S. Boggle Championship — Marge was a three-time national champion – to see if she was at some sort of international tournament.

No one had heard a peep from Marge in 5 days.

“So she’s not with her family,” the CMEslinger said.

“Nope.”

“And she’s not onsite at a CME event.”

“You’re catching on.”

“And she’s not on one of her accreditation jaunts or at some other special event.”

“Not that I’ve been able to figure out.”

“So that can only mean one thing. She’s helping someone who is in a whole heap of accreditation trouble.”

“Bingo, my friend. Just like 13 years ago.”

And with those words, the CMEslinger and the man in black were transported back in time to the last episode when Marge vanished. Thirteen years ago, on a random week in April, Marge had simply—poof—disappeared from the TAXIE offices for 4 days without a word. There was a similar panic until, like magic, Marge simply was back at her desk one morning as if nothing had happened. Upon questioning, Marge explained that one of her accreditation friends had made a major blunder in her interpretation of ACCME Standard 3.5 and needed some round-the-clock help to rectify the situation and alert learners retroactively to the relevant disclosures of one of her organization’s recent presenters.

“He called me to help him out of a jam,” Marge said. “What was I going to do, say no? We’ve been friends for decades.”

“But why didn’t you tell anyone where you were?” her officemates asked.

“What are you, my mother?” Marge responded. “I’m a big girl. I can do what I want and go where I want. Stop being such a busybody.”

And that was that. Until now.

“OK,” the CMEslinger postured, taking a sip of his black coffee. “So someone close to Marge, someone she wouldn’t dare let down, is in crisis. But who? And why now?”

The CMEslinger was puzzled. But as he fixed his gaze on the man in black, he wasn’t met with the same quizzical look. The man in black’s eyes were burning a hole through the cheap upholstery. He knew. The CMEslinger thought and thought and thought, before—voila—it finally dawned on him.

“Wait, you don’t think…” the CMEslinger said.

“I do. It’s the only possible solution. Why do you think I came to you in the first place? It’s certainly not because I admire your investigative skills. In your current state, you couldn’t figure out who picked up your trash this morning even if the truck was idling down the block.”

The man in black paused for a minute to let it all sink in.

“Get your coat. Let’s go see your daughter.”

New month, new year, new edition of Ask Us Anything. In truth, the Ask Us Anything title is a bit of a misnomer since people aren’t really asking us anything—they’re asking about CME/CE. I suppose that makes sense since this is, you know, CMEpalooza, but maybe a smidge less fun than questions like: “Say Derek, who was your favorite pro wrestler when you were a kid?” (It was Tony Atlas.) Or “Hey Scott, what is the airspeed velocity of an unladen swallow?” (Trick question. Scott would need to know if it’s an African or European swallow before he could answer.) But, fine, we will continue to answer your most pressing CME/CE questions to the best of our abilities.

With the questions below answered, we have cleared the decks of all pending AUA questions and are ready for more. Please, if you have an issue (professional or personal) you would like help with, click here to submit your question(s). And for those wondering, the airspeed velocity of a European swallow is around 24 mph and an African swallow is around 29 mph. That’s one less question you need to ask.

Dear Derek and Scott,

One of our frequent event planners (she works in a department within our own organization) approached us with a presenter that was an employee of XYZ ineligible company. The presenter would be speaking on a topic directly related to the company’s primary business line.

In order to provide CME/CE credits, we advised this event planner that a topic and/or speaker change was needed. The planner declined and stated that they were moving forward because XYZ company could give CME/CE credits themselves (they do this through a state board, not a national agency).

My questions are as follows:

1. Would you allow this planner to move forward with the education and allow XYZ company to give the credits?
2. If so, would you require any sort of disclosure stating that your program had nothing to do with the education?
3. Any other suggestions on how you would handle this situation while ensuring that your program did not come under fire for any perceived bias or rule violations, both with the accrediting agencies and within your organization (insert whiny voice, “Why can they bring in a vendor to present and I can’t…”)?

Reporting for Duty,

Captain Buzzkill, CME Division

DEREK: Let me begin by saying that I’m slightly befuddled by this scenario because I can’t for the life of me come up with a situation in which an ineligible company would be allowed to provide CME/CE credits. If they’re an ineligible company, then they can’t be accredited and provide credit. Am I missing something? I’m probably missing something. Let me know in the comments if I’m missing something. I’m going to set that part of the scenario aside for now and move on.

1. Absolutely not. Ultimately, you are responsible for the integrity of accredited CME/CE programs at your organization. As we all know, it’s not just the maintenance of that integrity that is important, but also the perception of integrity. Anything that might impugn upon that integrity should be avoided. This is a program that you believe has an unresolved conflict of interest. If it still moves forward, even with another organization providing the credits, and something happens that brings that COI out into the public, it is going to reflect poorly on your organization. As much as we like to say we’re not the CME police…sometimes you have to be the CME police.
2. I mean, I would never want it to get this far. But if for some reason it still happens despite your protestations, then yes, I would definitely want some type of disclosure statement. And I would want it plastered everywhere. On the reg table. In the slide deck. In the syllabus. In the marketing materials. You get the point.
3. When I worked in the CME office of an academic medical center in Philly, it was institutional policy that any CME/CE program held on campus had to use our office to certify the program. No other accredited providers were allowed to hold programs, unless they worked directly with us and we were the designated accredited provider. There were a few departments that were annoyed by the policy, but it was very helpful in avoiding the kind of scenario you describe in your question.

SCOTT: It looks like you are dealing with someone who wants to play “The rules don’t apply to me. Nanny nanny pooh pooh” game. Depending on the organizational position of this individual, this could be a tricky political situation. For instance, if it’s the Chief of Surgery who is responsible for bringing in many millions of dollars into the organization, it’s harder to be the CME cop than if it’s a fellow who was only recently been tasked with planning grand rounds for his department.

While I don’t disagree with anything that Derek suggests here, you do need to think about who else above your pay grade may need to weigh in on things if the conversation continue to go sideways. For instance, you may tell the planner that, “I absolutely forbid this presentation!” or “I will walk around the hospital with a sandwich board telling everyone that this was planned without our department’s input or approval,” but if they tell you, “Go ahead. We’re doing it anyway!” where will you go next? Hopefully, it wouldn’t come to that, but it’s not impossible.

I am not sure how this unsanctioned presentation would get your organization into hot water with your own accrediting bodies — I mean, it wouldn’t show up in any of your team’s documentation — but I do understand how the “They did it, why can’t we?” crowd would cause an unpleasant stink for you and your team. That’s probably the best reason I can think of to not simply let this go without a fight.

Dear Scott and Derek,

Our institution requires that the training on specific critical care unit (CCU) equipment be provided by the manufacturer’s reps. These reps obviously have disclosures as employees of an ineligible company, but they are mitigated under the exception in Standards 3.2a and 2b where they only provide technical and safety instruction on using the equipment. They do not make recommendations on when or on whom it should be used.

In previous years, we have allowed each group’s slides to include the manufacturer’s name because in this training, four different vendors of the same type of equipment are being included (all are given identical lengths of time for their presentation), and we don’t want learners to be confused about which specific piece of equipment is being discussed.

Just to get official clarity, we recently reached out to the ACCME on this issue. They responded by saying that our approach is considered advertising and should not be allowed. Which I get. To a point.

Based on this guidance, we went back to all four vendors asking them to make the necessary changes to their slides. Three of the four vendors for our upcoming training session agreed to remove their logos and company name from the slides, although they all told us that they are not able to remove the device name and trademark symbol. We feel this is acceptable under ACCME Standards and are not planning on taking any further steps. However, the fourth vendor, per guidance from her legal team, said she is not allowed to even remove their logo from the slides.

At this point, we cannot rearrange the schedule to allow a 30-minute break before and after this one presentation and just not provide CME/CE credits for that session, nor do our course directors want to prohibit awarding CME/CE credits to the providers who attend the training (24 providers, 7 hours of education with testing via written test and scenario-based questions). Our current solution? This one vendor will now do the training without her slides.

Nonetheless, I have a few questions:

1. If the Course Directors email the branded slides AFTER the education ends for learners to reference, does this create a problem with the Standards?
2. Do we need to review the written test to ensure no company names are used?
3. Does using the trademarked names of each piece of equipment cross the ACCME’s line? It is important to note that they can’t all refer to their equipment by a generic machine name, as there are four different ones being covered and confusion will ensue if they all call their product the same thing.
4. Do you have any additional thoughts on what we can do? The vendor is not happy, the course directors are not happy, and I need to ensure we don’t run afoul of the ACCME Standards.

In a pickle,

Bewildered by Bias

SCOTT: There is a lot to unwrap here, and because the majority of that unwrapping deals with accreditation nuances, I once again turned to the gurus from our Fall 2025 session, “One Step Over the Line? What’s Right, What’s Wrong, and What Falls Into the Grey Area of Accredited CE” session to get their input. I’ll do my best to summarize their thoughts. They had a lot to say, which is great is one sense, but also a challenge to condense – hopefully, I don’t misconstrue anything.

Here goes…

Company names, in and of themselves, are generally not considered marketing, although it is debatable how useful they are in the educational setting. Company logos, however, are clearly marketing. Brand names fall into somewhat of a gray area. It is generally not an issue with drugs, which typically have both a brand and a generic name.

Quick aside: This is another issue for another day, but I have found it useful for some audiences (especially nurses) to include either a table or something similar with the generic and brand names for a specific drug (I have often heard, “We never call it by anything but the brand name, so I don’t know what you are talking about when you only use the generic.”)

Devices are more challenging, as they rarely have any sort of relevant generic nomenclature. In these cases, you should use the device name itself but not the device logo.

Logos—whether company or device logos—should always be omitted. If a device image includes a logo, you can do some simple illustrative trickery in PowerPoint or another visual platform and either cover the logo with a box or erase it with a simple tool (could AI do this? Maybe. I have never tried.)

More broadly, it could be worthwhile to revisit your accreditation policies regarding what constitutes commercial bias and marketing at your institution. These policies should serve as a clear backstop for all accreditation decisions, helping ensure that decisions are consistent and do not appear arbitrary.

Now, in response to your specific questions:

1. There were mixed thoughts on this. Some of our panel thought it could be OK, especially if the email comes from the course director and not the manufacturer, while others discouraged sharing any branded slides after the education ends. Seems like a grey area to me.
2. Yes, the written test should definitely be reviewed by your team and company names should be omitted. Learners should not be tested on company names, and their inclusion introduces more risk than value.
3. Again, using trademarked product names is OK and should not raise a red flag with the ACCME. This issue actually came up in a recent ACCME Compliance Check. All product logos, however, should be removed.

A few additional thoughts:

• A critical step to ensure compliance in this scenario is to document your methods for ensuring content validity (standard 1) and preventing bias and marketing (standard 2). Given that several slides were created by ineligible companies, you may want to strongly consider not offering credit for this training, although that would require separate rooms from any accompanying accredited education, a 30-minute time buffer, etc. If you decide that offering credit is too important to learners, it is strongly recommended that you ensure all content is peer reviewed by a non-planner (as per standard 1 and 2 criteria), that course directors attest all criteria under standard 1 and 2 are met, and that you maintain documentation confirming the agreement of faculty to provide only technical and safety instruction.
• Could you have a non-employee present on data regarding device efficacy, patient selection criteria, and published studies, and limit the vendor employees to a demonstration on use of the device? This could be a suitable workaround.
• Whatever you decide, document EVERYTHING, including the email from ACCME and how you mitigated any concerns. Of course, this is the type of activity that could get pulled during a self-study and there are no guarantees you won’t get majorly dinged if your paper trail is lacking.
• This would make a great case conundrum to present at a CME event (hmm, which one might be your best option? Get back to me…) or even simply a poster presentation.

Good luck.

DEREK: Sounds good!

This question/comment is directed to Respectfully Seasoned’s questions that were covered in December’s Ask Me Anything blog post. While we usually handle all of the advice in this column due to our many, many hours of professional training, since this comes from a unique perspective and is thoughtfully written, we’ll allow it. 

Dear Derek and Scott,

As a relative newbie, I feel compelled to apologize to Respectfully Seasoned. It took me at least 7 years to feel confident enough in my accreditation-related knowledge base to contribute to the conversation without asking endless questions.

Of course, I’m still learning, which keeps it exciting. What’s helped me most was picking the brains of my more seasoned colleagues, both in peer groups and on the job. Is there an opportunity to do some structured professional development for the newbies and seasoned professionals alike? Something like neutral lunch and learns based on, say, institutional knowledge, policies, and established practices? This would allow “voluntold” newbies and wise CME/CE Masters to educate each other, to start a conversation, to build respect, foster self-reflection, and practice presentation skills while skirting the “us vs. “them” trap.

Here are some possible topic ideas off the top of my head:

1. Why are things done the way they are here?
2. Nuanced cases/experiences you’ve had (include some ridiculous ones for humor)
3. What do you wish you knew early on in your CME career?
4. Onboarding on processes
5. Myth busting (source anonymous questions from the group)
6. New trends in CME/CE (highlight newbies here)

I have personally found these sort of DiSC (Dominance, influence, Steadiness, and Conscientiousness) style trainings helpful for self-awareness and sharing tips on how to work/communicate with others. AI can also be a great sounding board and has helped me craft emails and communications to my colleagues.

Any other thoughts/opinions?

Meekly,

Reluctant Millennial

DEREK: Uh…yeah. Great. Perfect. I have nothing to add here. I’m looking forward to the new CBS drama featuring Respectfully Seasoned and Reluctant Millennial driving around town armed with Myers Briggs personality assessments, resolving intra-office conflicts. This would make a great CMEpalooza session. Speaking of CMEpalooza sessions, don’t forget that we are now accepting abstract submissions for presenting at CMEpalooza Spring. More details here!

SCOTT: Geez, way to sidestep the issue. The one thing I am reminded of as I read this inquiry is the value of face-to-face interactions. I know that we all love our time working from home and being able to “zone out” on our Zoom calls, but when you are dealing with some of these intergenerational issues, finding a time to be present in the same room does make a difference. It’s easy to order lunch for a small group and have a casual agenda to calmly talk through timely topics such as those suggested here by Reluctant Millennial.