From 2004-2014, the Almanac’s Reality CME series offered a place where the questions of real professionals in CME drove the conversation. As part of the Almanac’s celebration of the Alliance’s 50th Anniversary, I was tasked as an Almanac Editorial Board member to revisit this series and consider how we could bring it back. Doing so reminded me how powerful it is to have space for real, unfiltered questions, and I — along with the rest of the Board — knew it had to return.
Alliance members can view the article archive, including past Reality CME pieces, on our website, which offers helpful context for readers who want to revisit the original series. With that history available, I’m excited to share this first Q&A of our renewed series and hope it will be beneficial to all our readers.
Since CME/CE can be complicated, you don’t have to figure it out alone. Reality CPD Revival is here to make sense of it all, one question at a time. Send yours to almanac@acehp.org, and let’s tackle the challenges of CME/CE together.
Dear Almanac Editorial Board,
I lead continuing education at an academic medical center with Joint Accreditation. For an upcoming specialty course, a proposed speaker is a patent owner and shareholder in a device company. The product is FDA-cleared and directly tied to the content he was invited to present.
Per Joint Accreditation and ACCME rules, this makes him ineligible — his relationship with the company is non-mitigable, so he cannot serve as faculty in this context.
I applied the policy, supported my CE chair in communicating the decision to the course director, and gave leadership a heads-up in case it escalated. My intent was to protect the institution and our accreditation.
The course director was unhappy, and leadership initially pushed back, arguing that I was not respectful. I’m fortunate to be in a position where I can stand firm, but not everyone in CE has that privilege — especially early-career professionals still navigating institutional politics.
It is important to note that my leadership did back down, but here’s my question to the community:
In a situation like this, would you stand firm on non-negotiable accreditation rules even if it puts your role at risk? Or would you look for a compromise to appease leadership? How do you balance institutional hierarchy with the duty to uphold accreditor standards when those values collide?
Sincerely,
A longtime CE professional (name withheld by request)
Editor’s note: This is an abbreviated version of the original submission, edited for clarity and length.
Dear CE Professional,
Thank you for sharing this deeply thoughtful — and unfortunately, not uncommon — scenario. The intersection of compliance, hierarchy and institutional politics is where many CE professionals find themselves walking a tightrope.
There’s no one-size-fits-all answer, but there are patterns worth exploring. To illuminate the possible consequences of tough choices like this, let’s play out two potential paths: one where the rules are upheld without compromise, and one where stakeholder pressure takes the lead.
Two Roads, Two Realities: What Happens When You…
Stand Firm on Accreditation Rules
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You uphold accreditor requirements, protect the integrity of the program and leadership eventually respects your expertise. The course adjusts its faculty, the institution avoids compliance risk and your reputation is quietly strengthened. Over time, you’re seen as a steady hand, and your decision helps set precedent for future cases.
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Leadership sees your decision as insubordination. You're labeled “difficult” or “rigid,” and relationships with key stakeholders strain. You face official reprimands. The emotional toll is high, and despite doing the right thing, you feel isolated. Others in CE notice and become hesitant to speak up in the future, fearing similar treatment.
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Appease Stakeholders to Protect Your Role
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You work behind the scenes to calm tensions and propose a compliant alternative — perhaps the ineligible speaker is shifted to a non-accredited, clearly labeled session (e.g., an industry-sponsored lunch) that is separate from the certified activity. Leadership is satisfied that their chosen expert is still visible, even if not in the accredited spotlight. The course proceeds without compliance risk, and you maintain your position, relationships and peace of mind.
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The conflicted speaker lectures anyway, and the accreditor (JA) discovers the conflict of interest — through audit, complaint or routine review. The institution’s accreditation is jeopardized — probation is possible with repeated noncompliance. Suddenly, leadership needs someone to blame. You’re held accountable for allowing a non-mitigable conflict, and the earlier “solution” becomes your liability. Your credibility as a CE professional is undermined.
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Insights and Reflections
These scenarios aren’t just hypotheticals — they’re everyday decision points for those of us working in accredited continuing education. What stands out most is this: both paths come with risk. Standing firm may cost you political capital — or worse. Appeasing leadership might protect your role in the short term but could compromise your credibility or put your institution’s accreditation at risk.
In this contributor’s case, they chose clarity over comfort. They upheld a non-negotiable standard, communicated transparently and prepared leadership for potential pushback. And yet, the personal cost was real. Being written up for doing the right thing isn’t a failure of professionalism — it’s a failure of institutional culture.
This is where the burden too often falls unfairly on CE professionals: we’re expected to be both compliant and invisible. The work of protecting accreditation integrity may be behind the scenes, but it is anything but minor. When leadership misunderstands or resists those protections, CE professionals are left carrying the weight — sometimes alone.
That’s why it's essential to explore all compliant avenues early and lean on your professional network. Consult your accreditation criteria, involve your CE colleagues and, when needed, reach out to trusted peers. The Alliance community can be an invaluable resource — whether through online communities, conference connections or that colleague you met over coffee who “just gets it.”
That’s why this conversation matters. Not just to affirm those doing this work every day, but to spark internal reflection across institutions. Are we creating environments where it’s safe to speak up for standards? Are we educating leadership about what’s truly at stake?
And just as important: Are we mentoring and protecting the next generation of CE professionals, who may not yet have the security, skills or confidence to navigate these dynamics?
This is the kind of scenario that tests not just policies, but principles. Whether you’re early in your career or decades in, these moments come — and when they do, we hope you’ll remember that you’re not alone. This community exists so we can share, reflect and support one another through the tough calls.
Sincerely,
The Almanac Editorial Board
If you have insights on how to navigate the push-pull between policy and power — or if you have your own tough question — we want to hear from you. Email us at almanac@acehp.org and be part of the Reality CPD Revival or join in the conversation for this article on the Alliance community discussion page.
Disclaimer: The views expressed in this column are intended for professional discussion and peer reflection only. They do not constitute legal, employment, accreditation or regulatory advice. Readers should consult their own institutional policies, legal counsel and accrediting bodies when making decisions related to compliance or employment matters.