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ACCREDITATION CLINICAL & MEDICAL AFFAIRS COMPLIANCE OUTCOMES Wake me Up Before it’s Over: Bringing out the “LIVE” in Large Live Meetings Wendy Turell, DrPH, CCMEP, Director, Strategic Relations and Educational Development, Pri-Med Marissa Seligman, PharmD, CCMEP, Senior Vice President, Pri-Med Institute Alliance for Continuing Medical Education Annual Conference San Francisco, California January 31, 2009

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2009 ACME Presentation, co-presented with Marissa Seligman, that tackles strategies to bring innovation to live continuing medical education activities.

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Page 1: Alliance for CME 2009 Presentation, Wake me Up Before it’s Over:Bringing out the “LIVE” in Large Live Meetings, Wendy Turell and Marissa Seligman

ACCREDITATION • CLINICAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES

Wake me Up Before it’s Over:Bringing out the “LIVE” in Large Live Meetings

Wendy Turell, DrPH, CCMEP, Director, Strategic Relations and Educational Development, Pri-Med

Marissa Seligman, PharmD, CCMEP, Senior Vice President, Pri-Med Institute

Alliance for Continuing Medical Education Annual Conference

San Francisco, CaliforniaJanuary 31, 2009

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ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES2

Disclosures

Wendy Turell• does not have an interest in selling a technology, program,

product and/or service to CME professionals.

Marissa Seligman• does not have an interest in selling a technology, program,

product and/or service to CME professionals.

Page 3: Alliance for CME 2009 Presentation, Wake me Up Before it’s Over:Bringing out the “LIVE” in Large Live Meetings, Wendy Turell and Marissa Seligman

ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES3

Objectives for Session

• Identify challenges Facing Educators and faculty in delivery of “Living Live” meetings

• Discuss tools available to educators to use in their practice, increase education activity, productivity, and effectiveness, while not loosing the “best” of what live has to offer

• Demonstrate the application of at least one of these tools

Page 4: Alliance for CME 2009 Presentation, Wake me Up Before it’s Over:Bringing out the “LIVE” in Large Live Meetings, Wendy Turell and Marissa Seligman

ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES

How Adults Learn: Team Assignment

You will be assigned in to one of two “learner teams”. Please chose the appropriate team for yourself below!

4

1. My last name begins with A – M

2. My last name begins with N - Z

Page 5: Alliance for CME 2009 Presentation, Wake me Up Before it’s Over:Bringing out the “LIVE” in Large Live Meetings, Wendy Turell and Marissa Seligman

ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES

How Adults Learn: Question 1

According to Adult Learning Theorist Malcolm Knowles, adults are:

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1. More Intelligent than children

2. Most responsive to didactic instruction

3. Autonomous and Self-Directed

4. All of the above

Page 6: Alliance for CME 2009 Presentation, Wake me Up Before it’s Over:Bringing out the “LIVE” in Large Live Meetings, Wendy Turell and Marissa Seligman

ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES

How Adults Learn: Question 2

What is the most important factor that draws learners to specific CME activities?

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1. Innovative learning formats

2. Prominence of thought leader faculty

3. Relevancy to learner’s practice/life

4. Focus on a “hot” topic

Page 7: Alliance for CME 2009 Presentation, Wake me Up Before it’s Over:Bringing out the “LIVE” in Large Live Meetings, Wendy Turell and Marissa Seligman

ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES

How Adults Learn: Question 3

851 PCP’s were surveyed in 2008 regarding channels used to receive CME hours. Which answer best reflects their responses?

7

1. 60% Live, 5% Print, 17% Online

2. 51% Live, 19% Print, 12% Online

3. 30% Live, 10% Print, 42% Online

(18% = other channels; mixed answers)

Source: National PCP Insights & Behaviors Study, May, 2008 (N=851 Primary Care Physicians)

Page 8: Alliance for CME 2009 Presentation, Wake me Up Before it’s Over:Bringing out the “LIVE” in Large Live Meetings, Wendy Turell and Marissa Seligman

ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES

Key Principles of Adult Learning- Malcolm Knowles

• Adult learners are autonomous and self-directed– Impact for educators: Faculty must move from “expertise by eminence” to

facilitators who actively involve adult participants in the learning process

• Adult learners are relevancy-oriented– Impact for educators: Appeal to the learners need for “what’s in it for me”

• Adult learners are practical– Impact for educators: Make the education EXPLICITLY relevant to clinical

practice and not just “knowledge for knowledge sake”.

• Adults learners seek respect– Impact for educators: Acknowledge and use the experiences that participants bring

to the so that they will feel empowered to engage and be instructive to other participants as well as the faculty

Refs: http://en.wikipedia.org/wiki/Malcolm_Knowles; www.infed.org/thinkers/et-knowl.htm.

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ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES9

Four Critical Elements of Learning-Application to Live

• Motivation: Best motivators are “interest” and “selfish benefit”– Setting educational tone, appropriate level of concern (the clinical care gap), appropriate

level of difficulty

• Feedback: Critical to provide specific feedback so that participants leave the education with specific knowledge of their learning results. This is their “reward”

• Reinforcement: – Ensuring learners “get” the education

• Retention– Directly affected by learner baseline learning. If participant don’t learn the material well

initially, “they will not retain it well either”

• Transference:– Ability of learner to use information/skills outside the classroom setting

“Show that the course benefits the learner pragmatically, the learner WILL perform better and the benefits will be longer lasting.”

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ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES

Something to think about….

• It is paradoxical that many educators and [faculty] still differentiate between a time for learning and a time for play without seeing the vital connections between them. 

– Leo Buscaglia

• One must learn by doing the thing; for though you think you know it, you have no certainty, until you try.

– Sophocles

• A physician buries his mistakes, a dentist pulls them out but a teacher has to live with them.

– Anonymous

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ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES11

Question: We are interested in learning how you have received Continuing Medical Education (CME) over the past 12 months. For each CME source listed below, please indicate the approximate number of CME hours earned through this source.

Live Events Remain the Preferred Channel For CME Hours

51%

19%

12%

9%

8%1% Live

Print

Online

Board Review

Interactive(CDRom/AV/Mobile)Other

PERCENT OF CME HOURS EARNED BY CHANNEL

Internal Medicine: 48%FMs/FPs/GPs: 55%Ped/OBGyn: 57%Base: 851 physicians

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ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES12

Case Based-Lectures are Preferred Learning Format, Followed by Didactic Lectures and Diagnostic Challenges

Case-based lectures w/ Q&A

Didactic lectures w/ Q&A

Diagnostic challenges

w/ ARS

Interactive workshops

Point-counterpoint

debate

OtherPatient simulation

Which, if any, of the following learning formats would you be most interested in participating in?

76%

63%

48%

28%

1%

56%53%

Question: Which, if any, of the following learning formats would you be most interested in participating? Please check all that apply.

Ped/Ob/Gyn: 61%* Ped/

Ob/Gyn: 57%*

IMs: 60%

FP/FM/GPs: 33%

Base: 851 physicians

Page 13: Alliance for CME 2009 Presentation, Wake me Up Before it’s Over:Bringing out the “LIVE” in Large Live Meetings, Wendy Turell and Marissa Seligman

ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES13

Tools for Planners and Faculty

Non-Tech Options

•Sequential/linked education•Activity Education Design

Group discussionGroup exercises Individual exercisesHandouts

Technological Options

• ARS• Laptops• Insert webcasts

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ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES14

As CME Providers We Know Learning Erodes Over Time Without Further Intervention

56%

37%

49%

39%

Baseline 6 WEEKSPOST

3 MONTHSPOST

6 MONTHSPOST

+51% -30%

Source: Pri-Med Clinical Outcomes Study, 2006. Baseline N = 65, 6 wks post N = 74, 3 mths post N = 87, 6 mths post N = 91

Patient Case Vignette Presented: How Confident Would You Feel Treating This Patient?

Topic Area: Bipolar

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ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES15

Continuum of Education:Extension of Learning Cycle Pre and Post LIVE event

• Participant surveys

• Internet based engagement

• Message Boards/Chat Rooms

• Q&A Submission

• Literature Downloads

• Laminated Guidelines

• Screening Tools

• Fill-In-The-Blank Algorithms

• Patient Diagnostic Questionnaires

Take-Home ToolsPre-MeetingOn-Site Hand Out

Materials

• Online education

• Print education

• Audio education (podcast, radio broadcasts)

• Online Discussion Forums

• Online Faculty Q&A Chat / Boards

Post-Meeting- Enduring or Other Education

Page 16: Alliance for CME 2009 Presentation, Wake me Up Before it’s Over:Bringing out the “LIVE” in Large Live Meetings, Wendy Turell and Marissa Seligman

ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES16

Multi Channel Curriculums Help Reinforce Messaging to Facilitate Enhanced Outcomes (As Compared to Live Meeting Alone)

77%86%

93%

74%

Baseline Live Only Online Only Both Live and Online

Post Educational Intervention

(N = 1,816)

(N = 1,340)

Is Adherent in Treating Presented Patient (6 or 7 on the 7 pt. scale [ 7 is “ALWAYS incorporate this behavior”])

To measure performance, clinicians are asked: “How often do you incorporate the following into your practice when seeing patients with dyslipidemia?” [Scale: 1 (NEVER incorporate this behavior) to 7 (ALWAYS incorporate this behavior)]

Relativechange:

+4%

“Assess and manage dyslipidemia according to ATP III guidelines”

LIPIDS MANAGEMENTBase = clinicians seeing patients with dyslipidemia

Relativechange:+16 %

Relativechange:+26 %

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ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES17

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ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES18

On-Site Hand Out Materials

Hand Out Materials Can Include:

Diagnostic tools/Algorithms

Laminated guidelines

Practice “Pearls” in summary form

List of Resources, Online Links

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ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES19

On-Site Handout Example: Treatment Algorithms

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ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES20

Post-Meeting Reinforcement Example: Newsletter

Program Details

• Follow-up Q&A based newsletter provides an opportunity to offer reinforcement and reference materials explicitly linked to the live experience to clinicians

• 4 page reiteration of the Q&A dialogue (per session) at a live program

• Targeted distributed of pre-registration and onsite attendees

• Distributed 6 weeks after the live session

• Not certified for credit

Page 21: Alliance for CME 2009 Presentation, Wake me Up Before it’s Over:Bringing out the “LIVE” in Large Live Meetings, Wendy Turell and Marissa Seligman

ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES21

Summary

Learning Continuum Includes a focus on:

At the Live Meeting, innovative ideas can also be integrated with varying focuses:

Structure of event, technology

Focus on learner behavior at activity

Focus of faculty behavior at activity

Pre, on-site, and post meeting strategies

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ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES22

Live Meeting: Strategies to Increase Learner Engagement

• Live or Recorded Role Plays

• Integration of Multimedia

• Breakout Groups

• Working sessions

• Self-Reflection with group discussion

Take-Home ToolsMore Engaging

PresentationsLearner - Learner

Interaction

• “Town Hall” discussions

• FAQs from Prior Meetings

• ARS Techniques

• Workshops

Faculty – Learner Interaction

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ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES23

Learning Framework

Introduction Intermediary Deep-dive

Epidemiology/MOA

Diagnosis & Risks Assessment

Guidelines

Treatment management

Patient management

LEARNINGOBJECTIVES:

Raise awareness & Build knowledge in P.C.

Apply “real-life” cases in specialty

GOAL: Self-evaluate gaps inclinical practice in P.C.

LEVELS:

• Lecture

• Plenary sessions

• Webcast

• Panel of experts

• Point/counter-points

• Clinical debates

• Small workshop

• Very interactive

• Lot of cases

FORMAT:

Epidemiology/MOA

Diagnosis & Risks Assessment

Guidelines

Treatment management

Patient management

Epidemiology/MOA

Diagnosis & Risks Assessment

Guidelines

Treatment management

Patient management

Page 24: Alliance for CME 2009 Presentation, Wake me Up Before it’s Over:Bringing out the “LIVE” in Large Live Meetings, Wendy Turell and Marissa Seligman

ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES24

Faculty and Learner Interaction Examples

Faculty interaction

Learner interaction

HIGH

LOW

didactic

Case studies

ARS

Point-counterpoint

simulations

workshops

Expert panel

Role plays

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ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES25

Live Meeting Innovation StrategiesPrinciples of Adult Learning: Education should be interactive, problem-based, active and creative.

FORMAT DESCRIPTION

Diagnostic Challenge

Use ARS to engage attendees in solving clinical problems. This formats works especially well for topics where diagnostic decision-making employs visual elements (dermatology, imaging studies) but has worked well for those that do not (kidney disease).

Best of . . . Focus in one therapeutic area, but allowing faculty to frame real-life practice applications through discussion of recently published medical data or literature.

Choose Your Own Path

Using ARS, audience chooses the case they want to hear about

Competition/Game Divide the audience into groups and use ARS to pit sides against each other

Point-Counterpoint Two or more faculty members present different viewpoints on a clinical topic in a debate format, which can allow for Q&A throughout.

Patient Simulation Actor “patient” attends session and engages with faculty to demonstrate symptom presentation, physical examination and/or interview techniques

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ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES26

Innovative Format Example: Live Patient Cases at Pri-Med Meetings Demonstrate Real Practice Situations and Enhance Attendee Experience

Conducted in Collaboration With

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ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES27

Learner – Learner Interaction

Breakout

Groups

Working

sessions

Self-

Reflection

with group

discussionAllow participants

to exchange

solutions to

common practice

barriers – get stock

photo of docs in

small groups

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ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES28

Faculty-Learner Interaction

“Town Hall” discussions

Roving Moderator with Microphone

FAQs from Prior Meetings

Bring in past program evaluation results and comments

ARS Techniques• Audience “teams” to foster

involvement and/or debate discussion• Extended ARS response time to

encourage table discussions prior to faculty comment

• ARS “gaming” to enhance audience participation

Workshops

Getting faculty to change their education styles and interaction with participants in the LIVE format is MISSION ONE in achieving success. So

•Engage with faculty

•Train faculty not just on COI but on “best practices” in education

Page 29: Alliance for CME 2009 Presentation, Wake me Up Before it’s Over:Bringing out the “LIVE” in Large Live Meetings, Wendy Turell and Marissa Seligman

ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES29

Activity: Breakout Groups – Case 1

• A hospital-based CME office arranges for the chief of the rheumatology department to deliver a 40 minute rheumatoid arthritis lecture to the (generalist and specialist) physician attendees of the weekly grand rounds meeting.

• In order to ‘liven things up’, she shows a 5 minute video on the disease in the middle of her talk. At the end of the lecture period, the chief is joined at the podium by two other rheumatologists who engage the audience in a very lively and well-received 20 minute question and answer period.

• What was a strength of this strategy?

• How could this have been better undertaken?

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ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES30

Activity: Breakout Groups – Case 2

• A medical education company organizes a 2.5 hour live CME satellite symposium activity on the topic of overactive bladder at a national association meeting for primary care physicians. In attempts to increase the interactivity of the event, they arrange for ARS keypads to be placed at every seat.

• The 120 Learners, who are sitting in “rounds” of 8, are encouraged to chat as a group prior to keying in their ARS answers. As a follow-up, learners are sent a link to an online case-based activity on the same topic 3 weeks following the live event.

• What was a strength of this strategy?

• How could this have been better undertaken?

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ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES31

Activity: Breakout Groups – Case 3

• The Arkansas chapter of a national primary care medical association plans to host a CME lunch meeting during their annual chapter gathering on the topic of GERD. The 50 learners are served boxed lunches, and seated at long tables to listen to a 25 minute lecture.

• Following the lecture period, participants separate into “breakout rooms” in groups of 7-8, where they discuss their own experiences treating patients with GERD. The learners become so caught up in their chats that the moderator is unable to reconvene the group to share key insights of group members.

• What was a strength of this strategy?

• How could this have been better undertaken?

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ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES32

Examples/thoughts From Breakout Groups

Shared as a Group

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ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES33

How Adults Learn: Question 1

According to Adult Learning Theorist Malcolm Knowles, adults are:

1. More Intelligent than children

2. Most responsive to didactic instruction

3. Autonomous and Self-Directed

4. All of the above

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ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES34

How Adults Learn: Question 2

What is the most important factor that draws learners to specific CME activities?

1. Innovative learning formats

2. Prominence of thought leader faculty

3. Relevancy to learner’s practice/life

4. Focus on a “hot” topic

Page 35: Alliance for CME 2009 Presentation, Wake me Up Before it’s Over:Bringing out the “LIVE” in Large Live Meetings, Wendy Turell and Marissa Seligman

ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES35

How Adults Learn: Question 3

851 PCP’s were surveyed in 2008 regarding channels used to receive CME hours. Which answer best reflects their responses?

1. 60% Live, 5% Print, 17% Online

2. 51% Live, 19% Print, 12% Online

3. 30% Live, 10% Print, 42% Online

(18% = other channels; mixed answers)

Source: National PCP Insights & Behaviors Study, May, 2008 (N=851 Primary Care Physicians)

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ACCREDITATION • CLINICIAL & MEDICAL AFFAIRS • COMPLIANCE • OUTCOMES36

Presenter Contact

For information on presentation please contact

[email protected]