I went to this one to see what people are actually doing in terms of CME in Second Life, which I had jumped into a couple of years ago and have kind of backed off of in the past year or two. It has a lot of potential, but I think the drawbacks are still pretty daunting for a lot of CME providers (drawbacks being the bandwidth it takes, participants have to download software and learn how to work their avatars in the virtual environment, among others).

The presenters really hadn’t gotten too far into their experiment in SL yet, so it was more of an exploration of what SL is, advantages and drawbacks. I think we all agreed that what so many are doing — basically recreating their bricks and mortar lecture halls virtually and putting first world content into a virtual context — isn’t the best use of SL. But what a perfect place to build simulations of all kinds, and do the kind of CME that would cost a fortune in reality, but just a few Linden dollars in SL.

If anyone is really using SL for CME that isn’t just a replication of real-world lectures in a different environment, I’d love to hear about it. I still think there’s a lot of potential that most of us haven’t realized yet.

Organizations are like battleships: They are complex, have lots of moving parts, and it takes considerable time and effort to turn them around. But it can be done using CME, said David Price, MD, and George Mejicano, MD, in a session this morning.

Some of the key takeaways for me:

* Physicians work in systems, even if they’re sole practitioners. Every patient has a team involved in their care, and you need to touch every person on that team to affect change.

*Find ways to show the benefits of change from the organization’s perspective, not the CME department’s. And remember that every person in the organization is coming at change from their own unique perspective that varies based on their resources, barriers, incentives, etc.

* Change happens over time, and it will happen at different times in different parts of the system.

* Don’t take the lowest performing 20 percent and hammer them with educational interventions — they may be the least likely to lead change. Instead, find the early adapters and get them on board and passionate about the change. It will ripple down. The tipping point comes when 10 to 20 percent of people are doing the new thing; then it takes on a life of its own.

* Don’t talk CME speak. Talk in the language of your stakeholders. They aren’t “learning objectives,” they’re “performance expectations” because that’s what you expect them to walk out the door and do.

Key quote: “The role of the CME professional is to be an organizational yenta (and a nudge)”–David Price.

All in all, it was stuffed with good advice and suggestions. I’d give it two thumbs up if my hands weren’t so sore from all that note-taking…

I don’t know if he was really going fast or if my brain was starting to clog up by the last session this afternoon, but I had a hard time keeping up with this one and know I can’t do it any kind of justice until the slides are available. There was just so much information packed into an hour that it was both ridiculous and sublime.

Basically, presenter Todd Dorman, MD, walked us through the reasons why CME has to be viewed as a value center, not a profit center, and how to go about doing it.

CME can’t be a profit center that is mandated to make a certain margin by year’s end because it can set an unconscious pressure to do things that will ensure you hit your fiscal goals, when you should be concentrating on educational goals. But CME departments often are viewed as profit centers anyway because they do, after all, bring in money (at some organizations, anyway). It’s up to you to change that around by identifying the value you provide to whoever is in charge of your organization, by showing CME to be a strategic and tactical lever to help your organization accomplish its mission.

Some possible ways to do that people at my table came up with were to show the impact on patient care, improvement in physician knowledge, impact on the organization’s brand, and even the financial benefit live activities bring to a destination in terms of hotel room nights, food and beverage expenditures, and taxes. The latter can be useful for the organization’s leaders when they’re working with local officials, and for a state or local organization, can be an important part of the organization’s actual mission. If you’re doing CME research, that can add to your value because it diversifies the research grant funds.

Once you collect data on what makes CME a value center to your organization, you have to be able to tell your story convincingly, passionately, and compellingly, he said. Touch the minds of your audience with data, but also touch their hearts by including stories of how your activities have impacted a physician on a personal level.

Other suggestions:

* Put the bulk of the data in handouts and keep the number of slides small

* Use key phrases (value, strategy, asset) repeatedly

* Use the opportunity to educate your leadership about your department, its policies and procedures, how it adds to the organization’s diversity, and other ways it supports the overall mission.

The presenter of this session was terrific; very down-to-earth and realistic about what a commercial supporter expects, wants, and sometimes doesn’t get when it comes to proposed budgets and reconciling after the fact. A lot of it comes down to perception, and the last thing a commercial supporter wants, especially these days, is a possibility that the perception could be that something isn’t right. It’s all about transparency and accountability.

A few takeaways:

* If you don’t use it all, return the leftover funds. They’ll go back into the pot and fund another activity.

* Don’t be surprised if you’re asked to reconcile your budget and account for line items after the activity. It is spelled out right in Standard 3.13 that you have to be able to document the details of your expenditures of commercial support.

* Don’t inflate your fees.

* Don’t include entertainment as a line item (!)

* Don’t include one lump sum for faculty; break out how much each member will get so the commercial supporter can see that you’re paying fair market value.

* Get rid of the “miscellaneous” line item. It could be anything from stamps to honoraria. Spell out what those expenses are.

* Keep your receipts, and make sure they align with your budget.

* Overages on honoraria and F&B are no-no’s these days. Stick with what you have budgeted.

And, of course, keep in mind that these rules may vary from commercial supporter to commercial supporter. Still, I think most of these points likely would apply to most companies these days.

I loved that the panel of pharma folks decided to do this session a little differently. They each took on a role as legal, education, or medical, for either Company A or Company B, then role-played how a grant review committee meeting for various cases could go. Interesting to see that what would be fine for one company could be a deal-breaker for another. And these people really got into their roles. Maybe it was the [literal] hats they put on to do it, or maybe they’re just good actors, but it was a hoot as well as a good learning experience.

A few of the many interesting things that came out of it:

*Including names of faculty could work against your grant proposal, especially if the faculty is a member of the company’s speaker’s bureau and that company is operating under a CIA. It’s better to include the type of faculty you intend to have, but not exactly who it would be.

* They really do read through those huge proposals, unless they hit a red flag early on that would make it impossible to fund the activity. But laying out every aspect in excruciating detail is not necessarily in your best interest, since it could give the appearance that you are looking for supporter approval of the content. Executive summaries, particularly in the form of a table, are a good thing.

* Include contingency plans on how you would reduce the scope of the activity if you don’t get full funding, especially if you’re looking for multiple commercial supporters for an activity.

And this, which bears repeating: Every company is different, and you will never find one magic formula that will satisfy everyone. I did walk away with the sense that they do feel your pain, and are doing their best to give every application a fair hearing.

The bottom line, according to three pharma panelists, is don’t do it. Don’t let your requests for support mingle educational grants with charitable contributions and exhibits. Tease out the different requests and send them to the appropriate department. The commercial supporter will appreciate not having to try to figure out what exactly it is you’re asking for, and you may just have a better chance of getting it.

They provided a fairly long list of cases of the types of bundled requests they’ve seen, a few of which caused some laughs and head-shaking among the audience because of their absurdity. And yet these are requests that they’ve gotten, so even in this day and age, some providers are confusing education and promotion and charitable contributions in their requests.

They’re doing a followup session this afternoon (F54 for those who are here) outlining the preliminary results of a PACME and medical association/society section collaborative study group’s efforts to come up with some best practices and at least a common vocabulary to help reduce the confusion. If you can’t make it to the session, do go download the handout with the results and give them your feedback.

This session was held at the same time as the ACCME’s Accreditation Tools and Tips session, which is always a huge draw, and managed to have a pretty full room, which I took to be a sign that there’s a pretty high interest in improving this aspect of the granting process.

The medical education theater session was nothing short of awesome, though at first I wasn’t sure where it was going. Presenter Richard Aghababian, MD, started by taking a hard look at where we’re at when it comes to establishing and monitoring performance, and helping physicians enhance their performance. While outcomes research is nice, it isn’t the be-all and end-all of performance, he said. The patient-physician relationship is an important piece of medical competence (I am so in his camp on this one).

He then went all the way back to King Hammurabi of Mesopotamia and his code to see how medical competence has been measured over time. Turns out many of his rules had to do with medical care — and if you think malpractice punishments are harsh now, at least they won’t actually cut your hand off, as called for by Hammurabi’s code! He went through Hippocrates to the AMA’s current code of ethics and everything in between, pointing out that at the core docs have always been measured at least in part on their ability to accord patients dignity and respect, along with responding to their medical needs. You can download the handout from the Alliance site, which I plan to do. It was a great historical overview.

He also went through recent public scrutiny of physician behavior, such as the Institute of Medicine’s To Err Is Human report, the Macy Foundation report on commercial support and bias in CME, the Baucus and Grassley investigations, and other recent developments that put CME and physician performance outcomes under the microscope.

What does all this have to do with medical education theater? When you re-create the clinical setting, props and all, and include the entire team in a role-playing exercise, the results can be pretty amazing. He showed us a few clips of sessions that centered on patient communications and the healthcare provider-patient relationship, then brought three members of the audience up to play out a skit.

Explaining it doesn’t do it justice, because the whole point of education theater-style is the experience. What you learn hits not just your head, but your gut and heart as well. It was a show, don’t tell, session, and it really, really worked. What a great — though likely pretty expensive — educational format.

Went to one of the new “transitions” sessions this morning. This one was about “reinventing yourself,” or how to deal with downsizing, new career twists, and other changes. It was pretty general advice, not specific to CME providers, though the three session leaders had some compelling stories of their own to tell of transitions they’d gone through professionally, both positive and negative. They gave us several cases, then had us pick one to talk about with our tablemates.

We picked one where a hospital CME provider lost all her staff due to downsizing and had to figure out how to do it all herself, without any loss in quality or accreditation status. We agreed we would panic, then panic some more, but had a hard time getting past that. Once we did, we ended up doing what one of the presenters said everyone tended to do in these situations: Prioritize, figure out new ways to manage time, reflect on our own strengths and weaknesses and how best use what resources and relationships we had left.

Some things to watch out for are falling into a victim mindset and/or a negative attitude (even if the trajectory is upward, this can still happen if you think you might not be up to the new challenges).

It was interesting, and the presenters gave some really useful ways of thinking about and coping with career transitions. I’m not sure if it was interesting enough to try another transition session tomorrow, but maybe. I was thinking this would be very pertinent in today’s economy, but attendance wasn’t very high, so maybe people aren’t facing too many transitions. Or if they are, they’re concentrating more on learning some of the more CME-centric ways to move their career forward, rather than personal improvement.

Also working against this session was that it was held in one of the larger ballrooms, when it really needed a more intimate setting that would make it easier to share and brainstorm with each other. #acme2010

Getting up at 2:30 am for my flight to New Orleans today for the Alliance for CME meeting has left me pretty groggy, but I still managed to take reams of notes at the MECCs section meeting I went to this afternoon. For all the heat medical education companies have taken this year, even getting banned from the grant lists of several pharmaceutical companies, there was a lot of optimistic spirit in the air — and a ton of people in the room.

A few of many, many highlights:

Jan Perez from CME Outfitters pointed out that 2009 wasn’t all bad for MECCs: The Accreditation Council for CME’s evolving complaints and inquiry process, in which Perez’s company played a not-insignificant role last year, led to a heightened awareness of MECCs’ role in producing quality and innovative education, she said. NAAMECC also got a seat at the ACCME’s board of director’s meeting.

Maybe I just haven’t found it yet, but there seems to be a bit of a dearth of information on how CME providers are using (or not using) social media (by the way, the Twitter hashtag for the Alliance meeting is #acme2010, if you want to follow the tweets). So it was pretty interesting to hear Jeremy Lundberg of DLC Solutions talk about the social media survey they did of the MECCA group. They kept it to just 13 fairly basic questions, so it didn’t go into huge detail, but a few of the more interesting numbers were:

81% of respondents use some form of social media in their personal lives, 84% said they had either an intermediate or advanced understanding of it, but only half of them said their organizations were using social media around their CME programs, and much of that was just for marketing their activities. Three-quarters of the respondents whose organizations were using social media for CME didn’t have a formal strategic plan in place. Which I found amazing, since everything else you guys do is strategized, documented, evaluated, etc., to the nth degree.

Twitter was the big winner, with 69% saying they used that platform. Facebook came in second at 58%, and LinkedIn third at 51% (I hope I wrote down these percentages right!). Surprising that only 38% used community discussion boards, which I guess I wrongfully assumed a lot of online CME incorporated.

Look for a white paper to come in the next month or so with all the data. He also said he’s looking to do more in-depth research on how social media is being used for CME, which I am really looking forward to. I remember hearing years ago now about one physician blogger who was looking into finding a way to use his blog for accredited CME. Now that blogging is so old hat as to almost be forgotten about in all the Twitterati glory of newer social media, is anyone actually doing this? I’d love to know.