Requirement 3: Transparency in Course Planning, Delivery, and Marketing
The Provider (organization) must focus their courses on scientific and professional education, not product or service promotion. The Provider must have processes to resolve and disclose conflicts of interest. These processes must also address the management and disclosure of financial and in-kind support of CE courses. Additionally, the Provider must appropriately manage exhibits and advertising associated with CE courses.
Prior to 2012, the CEB had conflict of interest (COI) and disclosure requirements. Requirement 3 strengthened those requirements and added some new required practices.
The movement to strengthen COI requirements across all CE accreditors was prompted by a number of highly visible reports criticizing health care practitioners and health care accredited CE providers as having too many ties to industry (device and product manufacturers, pharmaceuticals, service industry, etc.). The
Accreditation Council for Continuing Medical Education (ACCME) began to overhaul their COI requirements in 2004, with other revisions coming in 2006 and 2007, and some additional tweaks to their system in subsequent years based on pressure from outside entities. Other health care CE accreditors followed ACCME's lead. The
American Nursing Credentialing Council and the
Accreditation Council for Pharmacy Education [PDF] actually now use ACCME's standards for commercial support (COI standards), and other accreditors in health care and non-health care arenas have variations on the ACCME standards. Reports pertaining to conflict of interest and disclosure were issued by the
Senate Finance Committee (2009–2010), the
Institute of Medicine (December 2009), the
Josiah Macy Jr. Foundation (December 2009), and the
Senate Committee on Aging (July 2009), to name just a few.
The CEB spent 8 years carefully observing what other accreditors were doing to strengthen their COI requirements, and the CEB learned from those observations about what best leads to transparency in course development, delivery, and marketing. As the CEB began working to strengthen its existing COI standards, the board also did a great deal of research. In 2007 and 2008, the CEB contracted with two separate consulting firms who had expertise in CE standards and were familiar with COI issues. The CEB asked the consultants to determine what standards existed in all CE accreditors (not just health care) and which of those standards exemplified the outcomes that CEB wanted to achieve with its providers and participants (learners). After extensive research, the consultant groups reached the same independent recommendation, which they then presented to the CEB in the summer of 2008. They recommended that the CEB use the "gold standard" for COI requirements (instead of reinventing the wheel). That benchmark was the ACCME standards.
Following those consultants' recommendations, the CEB embarked on strengthening its existing COI standards modeled after the ACCME standards. In the summer of 2010, those standards (or requirements) were put out for peer review and feedback to over 10,000 people, including all of our CE Administrators and CE Providers. The CEB received over 2,000 responses and spent the next 6–9 months analyzing those responses and making changes to the requirement. The changes were substantial based on the feedback. Although some of the requirement still mirrors the spirit of the
ACCME standards, there are significant differences in the final version.
The purpose of having processes to manage financial and in-kind support, exhibits/advertising, and conflicts of interest is to ensure that learners are informed of situations that might influence the content or presentation of courses. Disclosure contributes to a transparent relationship between providers and presenters of continuing education and consumers of that education.
3.1 The Provider must ensure that CE course content and the presentation focus on the science and/or contemporary practice of speech-language pathology and/or audiology. Attempts to persuade organizations and individuals involved in planning, implementing, or evaluating the course to favor, recommend, purchase, use, or promote a particular product, equipment, device, or service are not permitted. Likewise, attempts to persuade learners of the same are not permitted in courses offered for ASHA CEUs.
3.1.a The Provider must ensure that the sale or promotion of products or services are not the focus of CE course content and related materials.
Product and service promotion should not influence the following decisions:
- Identification of learning needs;
- Determination of learner outcomes;
- Selection and presentation of content;
- Selection of all persons and organizations that will be in a position to control the content of the course;
- Selection of educational methods;
- Assessment of learning outcomes;
- Evaluation of the course;
- Selection of facilities.
3.1.b Providers who offer courses about products or services or jointly plan courses with an organization that has products or services:
- Must provide information in a scholarly manner regarding (1) theoretical aspects related to the product or service and/or (2) the details of operation.
- Must disclose prior to the course that there will be limited or no information provided about similar products or services when a course is focused on a specific product or service. Conversely, when a specific product or service is not presented, the use of trade or product names from several companies will be considered.
3.2 The Provider must have a written process in place to (1) identify relevant conflicts of interest, (2) determine if the existence of those conflicts of interest disqualifies an individual from being involved in the course planning and delivery, and (3) disclose conflicts of interest to learners. Conflicts of interest in continuing education arise when financial and/or nonfinancial considerations, relevant to the course content, compromise or have the potential to compromise professional judgment.
3.2.a The Provider must document that each individual developing and/or delivering course content has disclosed, prior to and during course planning, all existing and relevant financial and nonfinancial relationships.
3.2.b The Provider must have a process to identify relevant financial and nonfinancial relationships that have developed after course planning and prior to course delivery.
3.2.c Any individual involved in developing and/or delivering course content who refuses to disclose relevant financial and nonfinancial relationships will be disqualified and cannot have control of, or responsibility for, the planning, management, presentation, or evaluation of the CE course.
3.2.d The Provider must have a process to determine whether relevant conflicts of interest disqualify the individual from participation in course planning and/or delivery or if the conflicts may be resolved through disclosure.
3.2.e The Provider must have a process for disclosing relevant conflicts of interest for all instructional personnel.
3.2.f The Provider must ensure that instructional personnel disclosure is available to potential registrants in promotional efforts and at the start of the course.
3.2.g The Provider must ensure that the following information is disclosed to learners:
- The name of the instructional personnel;
- Relevant financial relationship(s): Listing the name of the organization and the type of financial relationship; and/or
- Relevant nonfinancial relationship(s): Listing the name of the organization and the type of nonfinancial relationship; or
- No relevant financial or nonfinancial relationships exist.
3.3 The Provider must manage and disclose all financial and in-kind support given by other organizations that is used to pay all or part of the costs of the CE course.
3.3.a The Provider must make all decisions regarding the allocation and disbursement of funds received from other organizations.
3.3.b The Provider must be able to produce accurate and detailed written documentation of:
- Names of organizations that provided financial and/or in-kind support,
- Dollar amount received from each organization,
- Monetary value and description of in-kind support received,
- How the money and in-kind support were used.
3.3.c As a condition of receiving financial and in-kind support, a Provider is not required to accept advice or services from contributing organizations concerning planners, instructional personnel, learners, course content, planning, implementation, or evaluation.
3.3.d If payment for planners and instructional personnel is involved, it must come directly from the Provider or cooperative party (or parties) involved in course content development, not from the other organization(s) providing financial or in-kind support for the CE course.
3.3.e The Provider may use financial or in-kind support received from other organizations to pay for travel, lodging and other expenses for learners. The Provider must manage the disbursement of this assistance.
3.3.f The names of other organizations contributing financial and in-kind support must be disclosed to learners prior to the beginning of the CE course.
3.4 The Provider must appropriately manage exhibits and advertisements associated with a CE course.
3.4.a The Provider controls decision making over placement of exhibits and advertisements and the time and place of social events or meals.
3.4.b Promotional activities, such as exhibits, commercial presentations, and printed or electronic advertisements, are prohibited in the physical or virtual location where CE courses are conducted. Likewise, promotional activities are prohibited as part of the instructional portion of CE courses. For example:
- Live, face-to-face CE courses: Display or distribution of advertisements and promotional materials is prohibited in the instructional space where the CE course is conducted.
- Print-based CE courses: Advertisement and promotional materials are prohibited within the pages of the CE content. Advertisements and promotional materials may face the first or last pages of printed CE content.
- Web/computer-based CE courses: Advertisements and promotional materials are prohibited on the screen, the web page, or as "pop-ups" where the CE content is displayed.
- Recorded CE courses: Advertisements and promotional materials are prohibited within the CE course. There will be no "commercial breaks."
3.4.c Providers must ensure that products, equipment, or devices used in conducting the course are not sold or marketed as part of the instructional portion of the CE course.
3.4.d Print or electronic information distributed about the CE course that is not directly related to the transfer of education to the learner, such as schedules and content descriptions, may include product, service, or organizational promotion or product-specific advertisements.
3.4.e Print or digital course descriptions, promotional materials or advertisements must adhere to the following requirements:
- When referencing the credit offered, the specific type of CEUs, credit, or hours must be identified. For example, use ASHA CEUs not CEUs.
- Advertising cannot include the phrase free ASHA CEUs, or any language implying or suggesting the awarding of ASHA CEUs is free.
- The word free may be used when advertising a course that has no registration fee.
- If course registration is free, but the purchase of an item related to the course is required to participate in the course—for example, a book or a device—this must be disclosed to the learner prior to their registering for the course.
- The acronym "CEU" should not be used to mean "course." For example, say New courses for ASHA CEUs not New CEUs.
Frequently Asked Questions about Requirement 3
What are the three things that have to be disclosed about a course?
- If a course focuses on one product or service that fact must be disclosed prior to the course.
- Instructional personnel must make a disclosure that includes any and all of his or her financial and nonfinancial relationships—or lack thereo—fto the course content. The disclosure must be made available to potential attendees prior to the course and to attendees at the beginning of the course.
- If financial or in-kind support is received for the course from an entity other than the CE Provider that fact must be disclosed prior to the course.
If we do not charge participants for our courses, what do we disclose?
Regardless of whether a registration fee is charged, all ASHA Approved CE Providers must adhere to the elements of Requirement 3.
When would a CE event be cancelled because of transparency issues?
Following are examples of circumstances under which a course might be cancelled due to transparency issues:
- The course is promotional in nature.
- There are instructional personnel conflicts that can't be resolved by disclosure.
- A financial or in-kind supporter controls the resources for the course.
- The exhibitors or advertisers are somehow participating in the course in a promotional way.
When such circumstances apply, the course may still be offered, but not for ASHA CEUs.
Requirement 3 asks the Provider to have "processes" to manage transparency. What processes should we have in place?
You can find sample
processes that comply with Requirement 3 on ASHA's website.
Does the end-of-course evaluation form need to have a question such as "Did the presenter disclose his or her relationship to a vendor prior to the training?"
No. This is not a requirement. However, it is a good idea to gather feedback from course attendees on whether instructional personnel disclosed financial and nonfinancial relationship(s).
Is there a mechanism at ASHA to deter presenters who have engaged in blatant self-promotion despite requests that they present impartially and scientifically?
The CEB does have a
complaint process. Anyone with concerns about a possible violation of any of the CEB's requirements may submit a complaint in care of the Director of CE.
My company offers free training to individuals who purchase our test. Can we limit participation in our training to those who have purchased our tests?
Yes. However, related promotional materials must indicate that the training is open only to those who have previously purchased the tests. Keep in mind that only content that is not promotional in nature can be offered for ASHA CEUs.
We offer a course about our testing materials. In order to participate in the course, one must purchase the test prior to, or as part of, registering for the course. Is this permitted?
If the learner is required to purchase a product or service in order to participate in a course, this must be communicated to the learner prior to registration (see CEB Required Practice 8.4).
What steps do we need to take when working with a cooperative party in order to be compliant with Requirement 3?
Providers who choose to do a cooperative course must be
involved from the start of course planning and use their processes for adhering to Requirement 3 in the development of the course. Key points to keep in mind are
- the Provider must ensure that the sale and promotion of products or services are not the focus of CE course content and related materials;
- the Provider must use its process for identifying relevant conflicts of interest, determining if such conflicts disqualify individuals from being involved in course planning and delivery, and disclosing conflicts of interest to learners;
- the Provider must manage and disclose all financial and in-kind support;
- the Provider must appropriately manage exhibits and advertisements associated with a CE course;
- the Provider must ensure that all required disclosures are made in promotional materials and at the start of the course.