MedEd Blog

Harnessing Passion

2010-03-04T08:36:00.000-08:00

Wouldn't it be exciting if we could harness the passion of people in all parts of the CHE mix in Canada?

In my 20 years in this field I have had the opportunity to work with Healthcare professionals, academics, CHE professionals from industry, patient groups and others with interest in healthcare in the development of great CHE programs. The greatest successes have always come from the efforts of multidisciplinary teams that had one thing in common, how to improve patient care.

For example, according to recent data, the care of patients with high blood pressure in Canada has improved significantly. I submit, that without the efforts of industry in providing support for research and education, aligned with efforts from groups like the Heart & Stroke Foundation and CHEP this advancement would be significantly less.

Instead of throwing out the baby with the bathwater, we need to look at what works and how to harness everyone's passion and expertise to make what we do even better.

Something to think about

2010-02-27T11:42:00.000-08:00

Which is better, an education program put on by a medical school that uses a delivery method (didactic lectures) that has been shown not to result in change or a creative, multi-faceted program that incorporates small-group learning, patient assessment and reflective discussion but which is sponsored by a pharmaceutical company? Just because it is put on by a university, doesn't mean that it is better.

While I agree that not all industry-sponsored programs have been perfect, some of the most creative and interesting programs available have been created with industry support.

As a partner with industry I am proud of the work I do and I know that programs I have worked on have made a difference in patient care just as programs developed by universities have done the same.

I suggest that it is time that we start to think about how we can bring all of the interested parties together to create the best programs. It's time to think about what is possible and work together to make a difference and help the healthcare professionals remain updated in our information-rich environment.

New Media Same Rules

2009-10-01T05:45:00.000-07:00

OK, so here's the thing, when you call a meeting Social Media Marketing (SMM) in Pharma, What Works in Canada, perhaps you should actually talk about what works rather than what you can't do.

At the Toronto meeting of the PAAB workshop they did a great job of reviewing the rules governing Pharma in the SMM space and a ton of time was devoted to making sure that everyone understood what they could not do. Basically, if you couldn't (wouldn't) do it in print, don't do it using SMM. I know from my own discussions with other folks in Pharma that there is confusion about what you can do and given the fast pace of things, it is important to provide an update and opportunity for discussion, so it was valuable from that standpoint, but I have no more understanding of what works in Canada than I did before the meeting.

One area that was clarified for me was the issue of Adverse Event reporting. In particular it was noted that Adverse Events are often posted online but one study from Neilson Online that is detailed in their white paper entitled Listening to Consumers in a Highly Regulated Environment, showed only 1 in 500 met 4 criteria to count as AEs according to the FDA: reporter, patient, drug, event.

All in all, it was worth the time spent and good information was shared, with the final caveat from Pat Forsyth, one of the panelists, who reminded everyone that social media is another tactic in the marketing toolbox, but just that, a tactic that should be considered in the context of the overall marketing strategy and objectives.

Inspired again

2009-07-06T05:04:00.000-07:00

I'm trying to figure out how to better manage all of the things I want to do without compromising on the things I'm doing now. Take this blog for instance. I truly enjoy having the chance to express my thoughts about the issues and challenges of working in the CME field. When I write each entry I have to give careful consideration and thought to the issue (at least I think so). That is something I don't often take time to do on a daily basis, but which often helps when I'm working with clients or speaking with others in the industry. In turn I then make a concerted effort to do it more often. As you can see from the date of the last posting, I haven't been very successful at achieving that particular objective.

However, hope, as they say, springs eternal! So once again I'm going work on making this a part of my regular routine and do my best to post at least on a weekly basis. I just have to figure out how to do this from my Blackberry -- it sure would make it shorter...

The Death of the Medical Satellite Symposia?

2009-04-02T05:36:00.000-07:00

So last week I heard about the American Psychiatric Association phasing out Industry Supported Symposia at their annual meeting and figured that it was another attempt by a single group to present the appearance of distancing from Industry. I had discussions with some of my Industry friends about its significance and we talked about how these things seem to move their way north but that one group doesn't make a movement.

Then yesterday the other shoe dropped with the release of an Article in JAMA entitled Professional Medical Associations and Their Relationships with Industry: A Proposal fo Controlling Conflicts of Interest. The authors of this paper take the issue to an entirely different level, suggesting that the Professional Medical Associations (PMAs) totally divorce themselves from any relationship with Industry that would create a perceived conflict of interest. That changes the discussion entirely. It will create challenges for both Industry and the PMAs in Canada who rely on Industry support to bring, in my view, some very high quality programs to the healthcare professions.

The question is whether there is some middle ground where industry and the medical profession can partner and work together. The Industry has worked hard to move away from its previous excesses and I think there has to be a way to make the relationship work to everyone's benefit.

Starting the Conversation

2008-10-06T05:27:00.000-07:00

I attended an interesting presentation by Mitch Joel from Twist Image at a meeting of the OPMA last week. The presentation entitled Six Pixels of Separation is also the name of his blog and provided some interesting views of the internet world today. It’s always great when you can leave a meeting feeling like you’ve learned something new or at least updated your knowledge in some way. Mitch certainly did that with his lively and enjoyable presentation.

For instance, did you know that half of Youtube’s audience is over 34 or that there has been a significant shift in the use of the internet from a communication tool (33% of use) to a content source (47% of use)?

He also shared with the group the fact that community users remain customers 50% longer and spend 54% more. Also, research shows that 43% of members feel as strongly about online as real-world communities.

While his presentation wasn’t directed to CME or education per se, it did provide food for thought in terms of program development and approaches to communication in the Web 2.0 world that we find ourselves in. He left us with six key points that he feels are important to consider for online communication with customers:

• Think in terms of tribes
• Everything is with, not instead of -
• Don't be fleeting - build, share and grow
• Earn the right to get your users out of lurker mode
• It’s attitudinal not generational
• Upload a video to Youtube ... Do something now!

In that vein, we have uploaded a short video that we think that you will enjoy.

National Physician Survey - the e-World of Medicine

2008-07-29T04:16:00.000-07:00

Today, we continue our discussion on the National Physician Survey (NPS) with a review of some of the key points on the digital evolution of medical practice in Canada.

Over the years, there has been a trend toward developing online CHE programs designed to reach physicians who were unable (or unwilling) to participate in live programs. I certainly have been involved in discussions about developing such programs and worked on a number of initiatives including a program called mypatient.com, as well as a number of custom programs that included quizzes, surveys and resource libraries. I really think that there is opportunity to develop e-CHE programs that will deliver education in formats that meet the needs of physicians who are not interested in live programs.

It was therefore interesting to read the results of the NPS and how medical practice in Canada is evolving digitally. From a practice perspective, it appears that the use of computers and Electronic Medical Records (EMR) is beginning to gain significant speed, particularly in provinces where funding is available. As such, Alberta leads the pack but physicians in other provinces are quickly catching up. In provinces where programs supporting EMR implementation are not widespread (PEI, Quebec and New Brunswick) the use of electronic charts is negligible (0% in Prince Edward Island vs 21.7% in Alberta). Across the country the use of EMR vs paper charts is as follows:

· 9.8% of physicians use electronic charts instead of paper charts
· 26.1% use a combination of paper and electronic charts
· 57.9% continue to use paper charts in their main patient setting

From an e-CHE and communication perspective, the use of computers and the skill level of physicians continues to move forward. I think that the numbers speak for themselves and suggest that digital approaches are more important to consider than ever. In particular, skill levels and access to high-speed internet, previous barriers to digital programs, no longer appear to be an issue:

Skill level:
· 52% of physicians rate their skill level with computers as intermediate
· 17% rate their skill level with computers as advanced

Access to the internet:
· 71% have high-speed access to the Internet in their main patient setting
· 86% have high-speed access in other settings (eg, at home)

E-mail communication:
· 13% use e-mail to communicate with patients for clinical purposes
· 63% use e-mail to communicate with colleagues for non-clinical purposes
· 50% use e-mail to communicate with colleagues for clinical purposes

In our view, this means that it is more important than ever to include flexibility of delivery in CHE initiatives and consider additional options such as downloadable podcasts with key messages, or KOL presentations as a rep follow up tool to live, interactive CME. You may also want to include e-CHE versions of live programs to extend the reach beyond those who attend your live programs.

National Physician Survey

2008-07-22T06:12:00.000-07:00

The team at Integrated Healthcare (IHC) has developed a summary of insights from the recently published Canadian National Physician Survey. There is some terrific information and great insights in this data and over the next few days we'll provide some highlights from the report. We hope that you find this useful.

To start, the survey jointly sponsored by the CMA, RCPSC, and CFPC included over 19,239 responses (a rate of 32%) thus representing a significant percentage of the physician population across Canada. According to the authors of the MD PULSE 2008 report, the core questions are considered to be accurate within 1 percentage point of the true proportion 19 times out of 20.

The survey covers a wide range of topics from women in medicine to the changing complexity of care and the changing face of continuing medical education to name but a few. What we thought that we would do is to provide you with some highlights from various sections that may help as you plan and develop your future education programs. Today, we thought that we would start with a few highlights from the questions pertaining to women in medicine:

According to the survey, significantly more women than men are entering medical practice in Canada:
60% of survey respondents under 35 years of age were women and 51% of physicians under 45 are women whereas 10.5% of those over 65 years of age were women.

Women are more likely to enter family medicine than other specialties:
2/3 of the women in the youngest age group practice family medicine
1/3 in the same age group work in other specialties.

Trying to work fewer hours and maintain a better work-life balance as a physician is becoming another acceptable if not desirable norm. Female physicians reported 6 fewer hours a week (48 hours) than their male colleagues (54 hours) but physicians generally are trying to have a better balance.

From a CME perspective it means that we need to consider the different needs of female physicians. Feedback that we have obtained recently indicates that there is an increasing need for programs that are accessible after hours and which can be completed on various schedules, more likely from home than in the office. Furthermore, less is better. Help with the maintenance of a work-life balance by keeping a program shorter and delivering a program within a specified time period will be important.

How Doctors Think

2008-05-22T09:54:00.000-07:00

How Doctors Think is a book published last year by Dr. Jerome Groopman who holds a chair at Harvard Medical School. A quick scan of an excerpt of the book and a review in the Journal of Continuing Education in the Health Professions got me thinking that it might be a useful book to read to get some insight that could be used in our program development. If we had a better idea of how our audience thinks, we should be able to develop programs that better meet their needs and therefore deliver better value.

CME Reality Check

2008-03-28T10:45:00.000-07:00

Here we go again. For the last 10 years, the pharmaceutical industry has been working hard to create Continuing Medical Education (CME) programs that meet the needs of healthcare providers and deliver truly effective educational experiences. Long gone are the lavish programs that were once the mainstay of CME. CME is now about education and not entertainment. However, a recent article in the Globe and Mail would have readers believe otherwise.

It started with an editorial in the CMAJ earlier this week that suggested that there is “a need for an Institute of Continuing Health Education.” The general thesis of the editorial is that the pharmaceutical industry has too much input into the Continuing Medical Education of physicians and that a new approach should be taken. This is a theme that has arisen in many discussions in the U.S. recently, and has its genesis in the Macy Report that I mentioned in my earlier entry.

The interesting thing here is that, in the CMAJ editorial, the author makes a point of mentioning that research-based pharmaceutical companies have “implemented voluntary codes of conduct designed to discourage or ban high-priced gifts.” And I would suggest, based on my experience, that adherence to this code of conduct is universal across the membership of Rx&D.

However, in the Canadian Press story which was picked up by the Globe and Mail, reporter Helen Branswell added a spin with which I and others in the industry take issue. For some reason, Branswell felt that it was necessary to bring out an old skeleton from the closet which distorts the truth about the current CME environment. The headline read “Lavish perks from drug companies compromise doctors’ ethics,” and the story goes on to mention that “stories abound about doctors being given family cruises.”

However, if Ms. Branswell had actually read the editorial, she would see that it was more about the focus and format of the CME programs, rather than her prejudiced view of the doctor-pharma relationship. While I agree that there is still room for improvement, I don’t think that it is necessary to distort the reality with information that is long out of date in my experience.

And the drum beats louder...

2008-01-16T10:15:00.000-08:00

In November 2007, the Josiah Macy, Jr. Foundation convened a conference to "address complex issues concerning continuing education in the health professions". Late last week an executive summary was released with the conclusions and recommendations of the group. While their conclusions run the course including the role of CE and the Public, Responsibilities of health professionals, CE methods and accreditation of CE, their strongest message is that financing of CE by corporations (pharmaceutical companies) should end within 5 years.

The report is interesting reading but it struck me that the emphasis on the financial support issue was on the agenda from the start. The conclusion that "accredited organizations that provide CE should not accept any commercial support from pharmaceutical or medical device companies" seems to provide no room to fix problems or devise a compromise. Considering the seemingly high profile of the board I would have thought that a middle ground could have been identified that delivered a win-win outcome.

Alliance for CME 2008

2008-01-14T04:49:00.001-08:00

Almost a year ago I had the opportunity to attend the annual ACME meeting in Phoenix. It was a chance to catch up on some of the trends and approaches being taken to CHE in the U.S. and to a lesser extent, in Canada. There were some very interesting talks by CHE veterans like Bob Fox . Not surprisingly, the focus of the program was on Outcomes Measurement and were the genesis of some of our innovations over the last year that we have introduced to our clients.

The theme of this year's conference, Envisioning the Future, What You Need to Know for 2012, is also intriguing and I am looking forward to participating in this event. It's my expectation that I'll come back with some more ideas that will lead to innovations from IHC to enhance our CHE offerings in the year to come. To me, that is one of the exciting parts of this field and fuel for my long-standing interest in creating and rolling out programs that make a difference in patient care.

It's also an opportunity to catch up with Canadian CHE leaders and discover what the trends are in the Canadian CHE community. Last year there were representatives from several academic organizations including Memorial University, University of Alberta and McMaster University as well as several pharmaceutical company CHE teams who delivered some interesting and thought-provoking presentations. As with any conference, it's always fun to hear people you know present their work. It should be an interesting and busy four days and I look forward to sharing my thoughts following the conference. See you in Orlando.

Canadian Association of Continuing Healthcare Education (CACHE) New Board

2007-12-07T19:52:00.000-08:00

Recent elections (November 24- 30, 2007) for the Canadian Association of Continuing Healthcare Education board of directors has resulted in the election of five new members for the board. The new members will add great diversity and experience in CHE to the board and should strengthen it as a voice for CHE in Canada. I'm looking forward to seeing where they take CACHE over the next few years. The new board members are:

Dr. Mary Bell, Director, Continuing Education and Knowledge Translation & Exchange, University of Toronto, Department of Medicine

Della Croteau, Deputy Registrar/Director, Professional Development , Ontario College of Pharmacists

Dr. Louanne Keenan, Academic Staff Faculty of Medicine and Dentistry, Dentistry and Dental Hygiene and Public Health Sciences, University of Alberta

Isabelle Mongeau, Director, Medical Communications at Pfizer Canada

Dr. Sol Stern, Chief of Staff, Halton Healthcare Services

A View From the U.S.

2007-12-02T08:07:00.000-08:00

Last week I had the opportunity to attend MedEd Forum in Philadelphia, giving me an opportunity to see first-hand where CHE is going in the U.S. This annual meeting offers a unique discussion between Pharma and the so-called CHE/CME providers. I have to say that from a Canadian perspective, it was eye-opening.

The discussion at the meeting was very frank, with pharma offering some great insights and feedback on their issues and challenges in dealing with the new environment. The discussion covered everything from maintaining an arms-length relationship in the program development process (a requirement in the current U.S. marketplace), review of the standards and regulations that they must comply with such as ACCME(and I thought PAAB review and The Rx&D Code of Conduct were time-consuming!), frustrations with some of the offerings that they are currently presented with in the grant request process and a review of the expectations for the reconciliation process (something that will likely be expected increasingly in Canada).

I learned more about what is happening in the U.S. in terms of process and expectations than I thought I would. It was very helpful to hear what the new and ever-changing rules are and get a sense of the direction for CHE generally -- some senior Pharma people expressed their opinion that the direction is decidedly global for CHE accreditation. Expectations have also changed in terms of the expertise offered by agencies (more instructional design and education expertise, less marketing), the relationships they might bring to the table and the types of programs they submit.

The change in structure and direction for CHE departments in pharma has also, interestingly, meant that CHE has become more of a profession than a stepping-stone in the pharma business. This is good news for the development of programs that use instructional design and adult learning principles and look at performance improvement rather than just knowledge transfer. It also means that CHE has a greater chance to deliver on the promise of true behaviour change and better patient care, the ultimate goal for everyone in the field.

What's all the com.motion?

2007-11-27T07:29:00.000-08:00

Today marks the launch of Veritas' new practice called com.motion along with a poll on social media. First, to define it for the unitiated, the entry in Wikipedia defines social media as "anything that uses the internet to facilitate conversations". At com.motion, the practice will include communication through any number of social media tools including blogs, Facebook, social media releases and other ways to help generate meaningful two-way communication online. While this is going on, it gives me the opportunity to consider how social media can be part of the CHE landscape.

Personally, I already make use of social media tools as part of my ongoing education. Regularly scanning blogs relevant to what I am doing such as Anne Taylor-Vaisey's blog, a great source of information on what is going on in CHE. Other blogs help me understand the approaches being used in other disciplines that may be applicable to medical education. Recently, I've been investigating social media tools that can help with the educational process, such as using Youtube as a way to provide case vignettes that can be the genesis of a discussion among interested healthcare professionals.

I believe that social media tools can provide a unique way to generate valuable discussion and input on education programs and if used effectively can facilitate some conversations that would not have occurred otherwise. Are you using some of the new social media tools in your education programs? What is working? What's not working?

Lost in Translation?

2007-11-26T05:40:00.000-08:00

A recent article in The Medical Post caught my attention because it demonstrated the continuing need for CHE despite years of effort at trying to change behaviour. In this case, it was a report on two presentations at the North American Primary Care Research Group about the first part of a study called Lost in Translation as presented by Drs. McCrate and Godwin. The presentations covered a chart audit program that looked at control of blood pressure and cholesterol in type 2 diabetics. Despite the fact that there have been discussions, presentations and CHE programs on these topics for some time now, the presenters reported a large difference between what physicians thought they were doing versus the actual results with their patients, as seen in the chart below.

From: Nicholson P. Fewer patients than you think are reaching diabetes treatment goals. The Medical Post. 14, November 13, 2007

From an education point of view it demonstrates that there remains a need to continue to provide focused education on these topics. Perhaps more importantly it suggests that there is a need to further explore why the past efforts have failed. The Canadian Hypertension Education Program (CHEP) guidelines and Canadian Diabetes Association clinical practice guidelines have clearly shown the evidence for change but somehow, they have not been communicated to the target audience of physicians who treat and manage diabetic patients every day, or to their patients.

I once heard someone say that the definition of insanity is doing the same thing over and over but expecting different results, perhaps it is time to look at the approaches that have been used in the past and see what we might do differently to change the results. Clearly the current approach is not working. Exploring different ideas and looking to success stories from other disciplines or other industries could help to find a way that better enables the change process.

The Force of Change

2007-11-20T07:35:00.000-08:00

It has never been more important than it is today for CHE designers, planners and implementers in Canada to keep abreast of the changes that are occurring in the U.S. marketplace. Whether from market forces, legislation or evolution, pharma is changing at an ever-increasing pace in the U.S. with the requisite spillover into the Canadian marketplace.

In an article by Eric Campbell in the November 01 issue of New England Journal of Medicine, a summary of the current discussions in the U.S. on the relationships between drug companies and physicians provides insight into the direction that the pharma-physician relationship may be heading. Stricter reporting of financial and other exchanges including educational considerations, is either required or is being suggested as a way to ensure that pharma influence on prescribing is controlled. What that may mean to CHE is tighter restrictions and perhaps less support of programs as they fall under tighter scrutiny.

It is important, therefore, that we continue to stay informed as we evolve our CHE offerings to meet more stringent requirements, including stronger accreditation protocols and more robust measurement of outcomes, both of which have been influenced by changes in the U.S. marketplace. Furthermore, using sound instructional design principles in the development of the programs and keeping change models in mind will help us develop programs that meet educational needs and drive behaviour change, leading to improved patient care. High quality programs will ultimately attract interest and attendance and meet global standards, and will continue to provide opportunity for partnerships with pharma that meet their business objectives as well.

What are innovations?

2007-11-13T06:10:00.000-08:00

Time and again I've heard the phrase "we want an innovative Medical Education supplier". The question that quickly comes to mind is "What does an innovative Medical Education supplier look like to you?" In reality, innovation is in the mind of the beholder so to speak. Is a program innovative because it makes use of new technology, or is it borrowing of ideas from other related disciplines like the behavioural sciences or education faculties at colleges and universities and using them in some unique way? How frequently is an innovation used before it becomes the traditional program and a new option needs to be considered? What makes an innovation successful? I'm planning to look at all of these questions and use this forum to share any insights, book summaries and research highlights that may help us explore new ideas and innovations that can help our clients achieve their objectives.For instance, in his book, Diffusion of Innovations, Everett Rogers discusses the process of diffusion of innovations and provides some interesting insight into what can lead to success, or failure, of an innovation. One of his points that I really like is that anything is an innovation if it is new to you. So here is the challenge, how do we discover what is new to our audience that we are trying to reach? Moreover, how do we identify the folks that are the opinion leaders and will help to drive the success or failure of our "innovative" products?I look forward to your thoughts on this.