Continuing Medical Education (CME)
Needs and expectation of infertility specialists
The need for continuing medical education (CME) is a concern for medicine in general, as all specialties are getting ever more complex with new management options arriving at a constantly increasing pace. Logically, medical specialties caught in this trend have been fragmented in sub-specialized segments. One commonly proffers that 50% of what is taught as "state of the art" in terms of knowledge and clinical practice one day will become erroneous and/or obsolete in 10 years' time. The recent increase in medical innovations has only accelerated the process, making the needs for CME even more crucial.
Infertility and assisted reproductive technologies (ART) is no exception to this acute need for efficient CME programs. CME is also meant to ensure that proper risk and safety management is applied in this field, with CME playing an even more fundamental role for the following reasons:
- Infertility treatments imply the interaction of different categories of experts originating from different medical specialties and background. Practically, these active players include clinicians - Ob-Gyn with subspecialty in reproductive endocrinology (RE) and urologists – who have to work with the biologists involved in the in-vitro handling of gametes.
- ART outcome is prone to appear opaque and lead to misleading reports (data collected over arbitrary time intervals in certain patient sub-populations).
- ART related activities are highly media-exposed because of the emotional nature of the field in question – human reproduction.
2 Infertility and ART: The confines of different specialties
Infertility and ART is a medical activity that involves different specialists – mainly gynecologists sub-specialized in reproductive endocrinology (RE), urologists and reproductive biologist. All have vested interest in human reproduction and are dedicated to meet the needs of the infertile couples.
In ART, the interaction between clinical and biological work is self-evident. Indeed, no one questions the fact that the quality of the clinical activity – the deeds of the RE gynecologists and urologists – and that of the biology laboratory handling the human gametes are mutually dependent. Just like the oocyte depends on the quality of controlled ovarian stimulation (COS), the embryos' outcome is tributary to how the embryo transfer (ET) is conducted. Remarkably this clinico-biological interdependence is an exception rather than the rule in medicine. Indeed, the general paradigm proclaims that the quality of the laboratory service, as say a hormone measurement, is independent of the indication – its astuteness or lack of – for which that measurement is prescribed and done. The dependence between the clinical and biological activities targeted at treating infertile couples is therefore an exception in medicine. Coping with uncommon situation calls for developing innovative tools – global in scope – that can offer optimal CME programs for training and recurrent training.
The fact that the skills needed in infertility and ART are complex and imbricated – a specificity of this field – follows however a trend that generalizes in medicine, with ART being a forerunner. Hence, the education concerns and the tools to be developed for meeting the CME needs of infertility and ART are bound to find applications in other field of medicine in the future. Educations and CME programs developed in infertility and ART are thus destined to be test benches for tomorrow's needs in medicine in general. The survey conducted by Worldwide-IVF underscores the fact that ART practitioners prefer small conferences (n=200 participants) to larger ones (n≥200 participants) probably, because the former generally better meets these interactive needs.
3 The CME needs: Specificities proper to infertility and ART
Infertility and ART, which requires complex bio-clinical interactions, is also characterized by the fact that its results still hover between 0% and 100%. Quality control is indeed complex when the numbers of successes and failures nearly equal. It requires measures that are uncommonly deployed in the rest of medicine today. The first and foremost of these measures is the obligation made to ART centers in nearly all western countries to report their activity and results to governmental agencies.
In light of the above, we understand that CME programs in infertility and ART must not just address the pure medical science and review the clinical guidelines, but need to also address questions of data management and assessment. Typically, doctors have to be capable of determining: What are 'my numbers' – my activity – and those reported by others – the literature – telling me? CME offered in infertility and ART must indeed review issues – theoretical and practical – pertinent to data management and interpretation. Hence, CME programs in infertility and ART must extend well beyond the typical perimeter that is covered by common CME programs in other fields of medicine.
4 The CME offers: Time for emerging new supports
The complexity of the CME needs and the uncommon twists encountered in infertility-ART leads to consider new supports for best fulfilling this educative challenge. The concerns mentioned above lead to envision reverting to novel tools such as notably internet-supported e-learning seminars. From the results of the survey – no format strikes out as being the overall best – we believe that CME would best combine sets of teaching aides. These, we reckon, would associate novel e-learning options and techniques that could make a better and wider use of the data management systems that are implemented in ART programs for filling the reports due to the governmental agencies.
5 The CME expectation: A validation step delivering take home recipes
The Worldwide-IVF survey revealed a great variety in what participants saw as optimal for CME. Our interpretation of this survey's results is that probably none of the currently available offers satisfy the expectations of the professionals in the field adequately. We thus believe that the existing expectations in terms of CME would be better met by the combination of a dedicated trilogy: (i) CME seminars with dedicated 'validation' sections delivering ready-to-use recipes, (ii) conventional meeting and (iii) novel e-learning programs that address data management and assessment issues.
The particularities inherent infertility and ART – its multidisciplinary characteristics and imbrication with data management – creates uncommon challenges for CME programs in this field. The survey conducted by the website-based Worldwide-IVF network offers valuable information on the CME needs, as perceived and expected by practitioners in the field, and the fact that these are currently unmet.
According to the survey, CME needs in infertility and ART should include a combination of small size seminars – rather than large meetings – combined with innovative CME complements possibly, e-learning related. An optimized CME offer would include new education tools (library of virtual cases) and data reporting systems enabling live continuous forms of return on experience, which may pave the way and define both the content and format of future CME in medicine. The survey revealed that CME is mandatory for 54% of the specialists who responded to the survey, and that 70% of them consider this as being very important. Making CME mandatory is the first step toward improving the quality of the content and format of CME through the virtue of competition.
Dominique de Ziegler, MD
Professor and Head Reprod Endo and Infertility
Univ Paris Descartesc- Hôpital Cochin