Lesley Bainbridge, BSR (PT), Med, PhD, with the University of British Columbia, gave an interesting keynote on teaching interprofessional collaboration in healthcare, a hot topic for a few years now. She started out with a not-shocking-but-nonetheless-horrifying statistic: 70 percent to 80 percent of medical errors are caused by poor communication and collaboration among healthcare teams. That may be because HCPs learn by doing in the clinical setting, although, she pointed out, most know more about collaboration than we tend to give them credit for.

She talked a lot about various competency frameworks, and the similarities (many) and differences (few) between those developed by U.S. and Canadian organizations. She also provided a fairly daunting list of challenges for interprofessional education, from stereotyping to time, geography (we both have big countries), to resources, power/hierarchy issues, political will, unions, professional regulators, and policies that don’t support team-based approaches.

She says she wants to “put the ‘I’ back in teamwork,” meaning that people need to take personal responsibility for examining what stops us from collaborating effectively as practitioners. What barriers do you face? She gave us several areas to think about:

* Social capital: Basically, this is about trust and respect. How do you build these among colleagues and team members? How do you lose them? Are there “teachable moments” in everyday interactions you can take advantage of to build trust and respect?

* Rhetoric: The words we choose can make all the difference in an interaction. She suggested practicing word choice in e-mail, since it has a built-in time delay you don’t get in conversation. What words do you use? Does a disregard for grammar and spelling indicate a disregard for the recipient? Think about it.

* Perspective taking: Remember, her colleague told her, it’s not all about you (what??). How do you figure out where another person is coming from? How can you teach others to discover others’ perspectives? This one is particularly sticky, I think.

* Negotiate priorities: How do you work with others to determine what’s important and what isn’t?

* Resolving conflicts: How do you create a safe place to have conversations around areas of conflict?

* Building relationships: How do we build relationships, and how do we teach people to build constructive relationships with colleagues?

Outgoing president George Mejicano kicked things off at the Alliance for Continuing Education in the Health Professions annual meeting with a quick walk-through of the work that ACEHP has done in the past year. In addition to changing its name (Mejicano revealed a new logo with the wave of a Harry Potter-inspired magic wand) and enacting a new bylaw that allows two new members to join the board, the new national disclosures system is on schedule for rollout this year, and the Alliance is also gearing up to launch a research institute. Another change for 2012, though not quite as happy a change as far as I’m concerned, is that Paul Weber, who has done an outstanding job as the Alliance’s executive director, is retiring in May. I hope to catch up with Paul this afternoon and get some of his thoughts on his time with the organization, so more on that later.

Gabrielle Kane, president of the Society for Academic CME, then took to the stage to talk about the “family reunion” feeling of working with ACEHP, with the support of a healthy grant from Pfizer specifically aimed at improving research in CME. She outlined the SACME research agenda, which is based on two main projects at this point: A literature review to identify gaps and guide new research; and a taxonomy project. She invited Alliance members to participate in both.

Finally, a clean, clear, forthright discussion on the potential for conflicts of interest in continuing medical education, and how to minimize the risk that COI will negatively affect CME, brought to you by the good folks at CME Peer Review, LLC, an independent CME review organization. You’ll see a lot of familiar faces from all corners of the CME world, including Maureen Doyle-Scharff, William Mencia, John Kamp, Richard Tischler, Stephen Lewis, Jacqueline Parochka, Elizabeth Yarboro, Kurt Boyce, Matthew Freese, Karen Overstreet, and Audrie Tornow (love to see so many of our columnists represented in this video!).

According to a press release, CME Peer Review, produced the video to “help advance awareness of COI with a goal of enhancing the quality of continuing education. ‘Standardized, effective management of COI allows planners and faculty to focus on what is important – enhancing patient care,’ says Jane Ruppenkamp, President, CME Peer Review.”

Today’s CMEChat on Twitter (held every Wednesday at 11 am Eastern) was a fun romp through what people do to prepare for a monster meeting like the Alliance for Continuing Medical Education’s (now called the Alliance for Continuing Education in the Health Professions).

Once we learned the conference’s Twitter hashtag (#acehp12) and how to pronounce ACEHP ( “a-sep,” according to one poster. “Think antiseptic”), and got an update on the weather forecast—“fluorescent and 70 degrees”—we dove into lessons learned/favorite experiences from past Alliance meetings. These included:

• Don’t feel you have to stay in a session that you’re not getting anything out of.

• Don’t worry about missing sessions in favor of hallway conversations. These conversations, and the relationships that can come out of them, are some people’s best conference experiences.

• It can be empowering to look around and realize how many others in the room are in the same boat as you.

• Keep an open mind. “Some of my best ideas came from conversations with people who disagree with me,” said one person. I can’t agree more.

• It’s great to be able to meet people we previously had only known virtually.

• Know that those who preach adult learning principles don’t always practice what they preach.

• Make dinner reservations ahead of time.

• Don’t let the faculty off the hook if they start glazing over the details. Be empowered as a learner.

When it comes to preparing, most are following @theCMEguy’s blog post suggestions, particularly going through the abstracts and making a list of first-, second-, and third-tier choices for each time slot; and setting up meetings. Being a bit of a techno-geeky group, we’re also loading up on apps, such as Tweetchat and Streamboard for meeting tweets, setting a time for an in-person tweetup (Monday at 6 pm), debating whether to tweet to the main #acehp12 hashtag or use the session-specific identifiers (use both as separate hashtags I believe was the consensus), and placing wagers on the total number of tweets to come out of the conference this year.

But just going through the abstracts doesn’t necessarily mean you’re going to get what you need. How do you find out which sessions may have sounded better on paper than in reality and vice versa? Some rely on the Twitter stream for thumb-ups and –downs. Others hover in the doorway before committing to a session. Others rely on tried-and-true presenters who they know will do a good session, though I personally am always torn between going to a session whose faculty I know is great and looking for the fresh voices and fresh ideas that this community needs to hear.

The sessions people are looking forward to most seemed to depend mostly on whatever their biggest challenges are, from performance-improvement CME to updates from the Accreditation Council for CME to anything to do with grants. The on-site technology help station also is getting some interest from folks, as are technology sessions. What we all hope to get out of the conference varied too, with one recently unemployed poster looking to network and the rest of us hoping to rustle him up a job. Others are looking to make new contacts, and learn more about MOC/MOL, future trends, grants, and technology.

Among our collective goals for this year’s conference?

* Spend at least one meal as a mentor and at least one meal as a mentee.

* Find new ideas, fresh voices, and better ways of doing things. Make connections, learn, speak, share.

* Spend at least one session sitting next to someone you’ve never met.

* Spend more time at meals downstairs than up in your room checking e-mail.

• Participate! Engage, share, be an active learner.

I hope to see you in Orlando!

I spend a lot of time with continuing medical education providers, but not so much with the meeting planners who make those meetings at which the CME is conducted happen, so it was fascinating to have the chance to sit in on a frank discussion of what their biggest challenges are, and what they are doing to resolve them, as my last session of PCMA 2012.

One thing that seemed to be of huge concern was the idea that exhibitors were going to start asking them to provide physician attendees’ National Provider Identification numbers. Since this is public information, I’m having a hard time understanding why that is the meeting planner’s problem—why can’t the exhibitors just look them up? If someone can explain why this is potentially a big issue for exhibitors, please let me know. I tried to find out from a few folks after the session ended, but everyone was in a rush to leave so I didn’t really get much other than if an exhibitor demands it, it’s their problem. Which I get, but I don’t get why exhibitors would demand this from them. Light-shedding on this would be welcome!

Other big issues were the costs of complying with government regulations and Accreditation Council for CME rules, pressures to find new sources of revenue, building traffic to the exhibition floor, international initiatives (including visa-related challenges), CME credit interchange with other countries, and all the various codes and rules and regulations they are supposed to follow nowadays.

One participant was particularly concerned about the Council of Medical Specialty Societies’ newish ethical code that is designed to limit drug and device company influence over patient care. While similar in many ways to the ACCME’s Standards for Commercial Support, it also prohibits society presidents, CEOs, and editors-in-chief of society journals from having direct financial relationships with relevant for-profit companies in the healthcare sector. One participant said her organization actually had to ask one of its journal editors to resign after her society agreed to abide by the CMSS code.

Sponsorships and exhibit dollars on the decline had most of the crowd at least someone frazzled. As one person said, “With the PhRMA Code, they don’t want to sponsor anything anymore.” Several said their organizations were going the same route as PCMA, offering year-round sponsorships that extend far beyond the meeting rather than providing one-offs on tote bags and banners. (Note: This article offers some good tips on how to get more sponsorship dollars. And here’s another one.) One thing sponsors particularly seem to like, said some participants, is being able to meet with board members and other influential people in the industry at board and other high-level meetings. Some said they give preferential treatment on the show floor to exhibitors that are also in more extensive sponsorship relationships, others said they kept it completely separate.

From what people were saying, I’m not sure they’d buy into this snip of research finding that physicians aren’t eschewing the trade show floor now that the tchotches are out due to PhRMA Code restrictions. It sounds like, for medical meetings as for other types of association conferences, it’s becoming more and more of a push to get people on the show floor and interacting with exhibitors. While product theaters can help, they don’t appear to be a major solution to the exhibition drain problem. As one person said, “The surveys say they value exhibitions, but they don’t go. We give them food, product theaters, we’re even putting the reception on the show floor. Nothing seems to help.”

One said she was going to take the “continue the conversation” idea from PCMA, where a follow-on informal session is held after a keynote so those who want to can dive deeper into the material, only hold it on the show floor. Which is fine, as long as it isn’t for credit, warned another person. Another pointed to a different angle on the problem: Maybe it’s the booths that aren’t so attractive. So that organization offers a consultant who can evaluate exhibitor booths and suggest ways to improve them.

Some said they had added a virtual trade show component as a complement to repurposing educational content from the conference for online distribution, but it didn’t appear that the value was all that high (one said that only 42 percent of virtual attendees visited the virtual exhibit, which I thought actually sounded pretty good. Another said it was more like 25 percent for his group). Streaming the educational session, with or without CME credit attached, live and archived, seemed to be pretty popular among attendees of most of the planners who said they had done it. However, interest dropped off a cliff when members were asked if they would pay for it, one person said (shocking, I know!). Another said she had a good response to charging one fee to get access to all the content, and an additional fee on top of it if they wanted to get CME credit for it.

They didn’t talk a lot about CME educational grants, but one person did point out that, now that pharma budgets for CME grants are shrinking, their ad budgets actually are growing. Accordingly, medical organizations are beginning to put more of their focus on attracting those ad dollars to support the overhead for their meetings.

There was more—a lot more—but I’ll leave this one with two of the wildest promotional ploys I’ve heard of:

One was a company that brought colored chalk and proceeded to draw its logo on the sidewalk in front of the medical conference’s headquarters hotel. Another person told of a company that put its logo on the mainsail of a big sailboat and had it sail up and down the harbor in view of the meeting (I’m not sure if this was in San Diego, but I could see it happening there.)

Note: This is cross-posted at the face2face blog.

A survey conducted by MDlinx earlier this month came up with some shouldn’t-be-unexpected results: That a quarter of the docs surveyed say they’re seeing the quality of their continuing medical education activities decrease as pharma pumps fewer dollars into commercially supporting CME. Two-thirds didn’t notice any change, and a scant 9 percent thought quality was improving, according to an article in Medical Marketing & Media. Most notably on the decline was faculty, they said, though they also said it was harder to find the education they needed, and that they had to pay for more of it themselves.

This quote at the end of the article is really interesting, I thought: [Stephen Smith, chief strategist, MDLinx] called the perceptions of lesser quality an unintended consequence of the increase in regulation on pharmaceutical companies’ communications and their resulting pull-out from CME. “We’ve squeezed everything toward mediocrity to prevent abuses.”

Some pretty big news came out last week while I was in San Diego for our West Coast Life Sciences Meeting Management Forum: The Centers for Medicare & Medicaid Services announced a proposed rule designed to increase public awareness of financial relationships between drug and device manufacturers and certain healthcare providers, as required by the Sunshine Act provision of healthcare reform.

From a pharmaceutical/device meeting manager’s perspective (which I got last week in spades, being surrounded by these good folks), no one seemed to be anticipating it making much of a difference in their lives. The biggest issue for them was CMS’s delaying the collection of data on physician spend from Jan. 1, 2012, until after final regulations are issued.

I heard over and over again that if they weren’t already tracking physician and other healthcare worker spend as a requirement of a corporate integrity agreement, they have been working since healthcare reform passed to get a system up and running. In fact, a survey of the forum’s participants found that 88 percent had a system already to track their spend on physicians and other healthcare professionals, and 76 percent were either already testing their system or were confident that their system was ready to roll with the new year.

But that’s about as far as I’ve had time to get with CMS’ announcement. I’m not sure whether it’s a blessing (so thankful someone’s keeping on top of all this!) or a curse (ain’t no way I can keep up with the flow of information the dude puts out, much less beat him to the punch, so I have to live with being continually scooped!), but Tom Sullivan has been churning and burning all this up on his Policy and Medicine blog. Keep in mind that he comes at it from a pro-collaboration perspective, but he provides a great overview of possible affects this announcement could have on the CME community. Some posts to check out:

Physician Payment Sunshine Act: CMS Proposed Rule - Impact on Continuing Medical Education, Medical Societies and Patient Organizations

Physician Payment Sunshine Act: CMS Proposed Regulations — Public Posting, Data Submission and Correction

Physician Payment Sunshine Act: CMS Proposed Regulations Delayed Reporting for Clinical Trials, Penalties and Preemption

Physician Payment Sunshine Act: CMS Proposed Regulations – The Cost for Sunshine

Physician Payment Sunshine Act: CMS Proposed Rule Overview

Physician Payment Sunshine Act: CMS Releases Proposed Regulations

Update:Daniel Carlat, MD, has a different take on how the new rules could affect CME (namely, he’s ecstatic that the language could include faculty honoraria in reportable income) on his Carlat Psychiatry blog.

The Accreditation Council for CME’s latest monthly e-newsletter includes a link to the ACCME’s response to the FDA’s release of a blueprint for the prescriber education component of the Risk Evaluation and Mitigation Strategy (REMS) for long-acting and extended-release opioid medications (ACCME Standards for Commercial Support.

The ACCME also has added some new examples to its compendium of complaint summaries (PDF download). If you haven’t check it out yet, I highly recommend that you do—it’s a good way to see how the ACCME handles potential problems, and is something you can check your own work against to make sure you’re not doing something it may find suspect (though, as one confessional medical educator points out, the mistakes in the compendium are so boneheaded that it’s hard to believe the providers at issue could actually be making them at this stage in the game).

The accreditor also announced its new board of director lineup: Sandra Norris, MBA, and James Burke, MD, are the 2012 Chair and Vice-Chair of the ACCME. Other board members include Todd Dorman, MD; Mira Irons, MD; David Pieper, PhD; and Carol Havens, MD.

The e-newsletter also reminds ACCME-accredited providers that it’s never too soon to get the jump on entering your data into the Program and Activity Reporting System (PARS). I get the feeling they’re really prefer you not to wait until the March 30, 2012, deadline to enter your 2011 data. Another deadline is coming up January 31, 2012, when your 2012 ACCME annual accreditation fee is due.

Continuing medical education professionals from around the world gathered via the #CMEChat hashtag on Twitter on December 7 to talk about what can be done to improve how new information flows from annual conferences to local practices. They used Medical Meetings’ November/December issue’s cover story as a jumping-off point. As one person pointed out, we need to find a way to curate the data presented at annual meetings more effectively.

They began by looking at what might be the best models for disseminating new medical information beyond major medical meetings, with “best” defined as being able to spread the word quickly to the widest possible audience while maintaining the integrity of the data. For the sake of discussion, the group decided not to complicate the process by saying the data would have to be available for CME credit; as one person said, “Credits have never been proven to motivate learning. They have been proven to complicate education.” Another chimed in to say that adding accreditation to the mix would just slow the dissemination process.

Most appeared to agree that medical societies and associations should develop clearinghouse models that enable rapid and open access, and that authors should take responsibility for ensuring that questions about the data they present are answered, at least during a specified period of time. Chat moderator and MM columnist Brian S. McGowan, PhD, suggested that local institutions could use technology to pull new medical information into their networks, and that these institutions could then stream feedback into the clearinghouse system to refine the model over time. One person suggested using bloggers as disseminators. While one participant was concerned about the possibility of bias that could come from filtering the information through a blogger, another pointed out that there could be value in having that personal point of view.

It’s vital, said one, that the data go where the learners are, instead of trying to make learners come to the content. Learners also should be able to access the system whenever is convenient for them.

Pros and Cons of Slide Decks

The moderator then asked about the pros and cons involved in having medical associations create and archive core slide decks that would become available when the data is released. “Archiving is critical,” said one person, as is organization and searchability so it’s easy to pull up X talk at Y meeting about Z topic. Otherwise it can be too challenging to find information that is applicable to the specific needs of someone’s practice.

Having a data clearinghouse as the core model not only would ensure data fidelity, but it also “would save tens of millions of dollars,” said one participant. However, said another, while a clearinghouse model works in an ideal world, there already are “10 million ‘clearinghouses’ for primary care docs.” Another countered that, while there are many channels, there currently is no true clearinghouse for new medical content. One possibility would be for each medical society to have its own clearinghouse. It would be up to the medical society to control the quality from the start, so that the data stream doesn’t become polluted with too many insignificant data points. Of course, there still can be disagreement among associations, such as the difference between the American College of Physicians and the American College of Radiology on when to require mammograms.

Of course, one practice’s insignificant data points is another’s very significant data points, depending on that practice’s needs. This led the moderator to ask the chatters to guesstimate the balance of core content to local content in an average CME program. They seemed to agree that for national meetings, the core-to-local ratio would be high, “at least 90-to-10 if not higher.” But that’s as it should be, said one person: “Local content = context. Core content shouldn’t be different anywhere.” At a minimum, said another, the intro and background sections could be shared. While one would think that there would be more contextual information coming from regional meetings, that’s not always the case, said one person.

Authors as Data Shepherds

One point that kept recurring was that it would be key to any data dissemination model to have faculty easily accessible to answer questions. “In many cases, Q&A has the most valuable information for the learner,” said one person. And, said another, it’s when “participants wake up.” Data shepherding currently is done through things like letters to the editor in a journal. The problem is that it can take five months to get an answer, and it’s behind a paywall to boot, which further limits access. A better way would be to have faculty or an editor on retainer to prompt timely responses to questions, say up to six months post-release. Learners could ask their questions online (possibly even through social media), then their answered questions could be included in the archive, along with the data. One of the CME chat participants mentioned he has been doing this on his blog by posting questions he has posed to the Accreditation Council for CME, along with their answers. (Here are a few examples: Needs assessment collaboration and independence; incentivizing surveys; accreditation language; defining commercial interest). But, he added, it would be better if the ACCME did the archiving. “Without curation, the system fails to help.”

But who is to do the curation? Should/could the vetting of core slides be done via crowdsourcing? The crowdsourcing could be done through Slideshare, blogs, tweets, Prezi, podcasts, simulations, etc. But then someone would have to take it all in and organize it. One person thought it should be up to each “house of medicine” to control and refine the new medical knowledge as it is vetted; “We can then use this data to educate.” Another participant thought the CME community could use an “uber curator” (which, along with being a good idea, someone thought would make a great name for a rock band). What we need, said one person, is to put a mashup of ACCME, PubMed, SoMe sites, and IBM’s Watson into a blender. Once we work through the barriers of cost, determining what the core content would be, gaining faculty support, etc., what would we end up with? A newly re-engineered data stream.

Pfizer recently reorganized its Medical Education Group in a pretty dramatic way, including moving 90 percent of its budget into a request-for-proposal model, rather than one based on unsolicited grant requests (here’s a fairly thorough run-down of the changes). Another big change is that the model is no longer going to be CME-centric; CME, accredited or not, may not get a very big piece of the Pfizer pie moving forward. While MEG leader Maureen Doyle-Scharff tells me that this is actually an opportunity for CME providers to prove their relevance to the big performance-improvement picture, I’m not so sure everyone would agree.

First GlaxoSmithKline limited the possible field of contenders to just 20, then Pfizer decided to eliminate medical education companies from their grantee mix, and now this. Like it or not, the grant-making models are changing.

What do you think of the evolution of commercial support models? How have these changes affected the CME community? What else do you think will be coming down the pike? (If you don’t want to leave a comment below, please e-mail me at spelletier@meetingsnet.com. I really want to know what people think about all this.)