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, California
January 31, 2009

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.

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

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

How Adults Learn: Question 1
According to Adult Learning Theorist Malcolm Knowles, adults are:
5
1. More Intelligent than
children
2. Most responsive to
didactic instruction
3. Autonomous and
Self-Directed
4. All of the above

What is the most important factor that draws learners to specific
CME activities?
6
1. Innovative learning
formats
2. Prominence of thought
leader faculty
3. Relevancy to learner’s
practice/life
4. Focus on a “hot” topic

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
(18% = other channels; mixed answers)
Source: National PCP Insights & Behaviors Study, May,
2008 (N=851 Primary Care Physicians)

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.

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.”

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

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

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

Tools for Planners and Faculty
Non-Tech Options
•Sequential/linked
education
•Activity Education
Design
Group discussion
Group exercises
Individual exercises
Handouts
Technological
Options
•ARS
•Laptops
•Insert webcasts

As CME Providers We Know Learning Erodes Over Time Without Further
Intervention
56%
37%
49%
39%
Baseline 6 WEEKS
POST
3 MONTHS
POST
6 MONTHS
POST
+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

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-Meeting
On-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

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)]
Relative
change:
+4%
“Assess and manage dyslipidemia according to ATP III guidelines”
LIPIDS MANAGEMENTBase = clinicians seeing patients with dyslipidemia
Relative
change:
+16 %
Relative
change:
+26 %

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

On-Site Handout Example: Treatment Algorithms

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

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

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 Tools
More Engaging
Presentations
Learner - Learner
Interaction
• “Town Hall”
discussions
• FAQs from Prior
Meetings
• ARS Techniques
• Workshops
Faculty – Learner
Interaction

Learning Framework
Introduction Intermediary Deep-dive
Epidemiology/MOA
 Diagnosis & Risks
Assessment
 Guidelines
 Treatment
management
 Patient management
LEARNING
OBJECTIVES:
Raise awareness &
Build knowledge in P.C.
Apply “real-life”
cases in specialty
GOAL:
Self-evaluate gaps in
clinical 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
Assessment
 Guidelines
 Treatment
management
Epidemiology/MOA
Assessment
 Guidelines
 Treatment
management

Faculty and Learner Interaction Examples
Faculty
interaction
Learner
interaction
HIGH
LOW
didactic
Case
studies
ARS
Point-
counter
point
simulations
workshops
Expert panel
Role plays

Live Meeting Innovation Strategies
Principles 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

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

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

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

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?

• 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.

• 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.

Examples/thoughts From Breakout Groups
Shared as a Group

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

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

851 PCP’s were surveyed in 2008 regarding channels
used to receive CME hours. Which answer best reflects
their responses?
(18% = other channels; mixed answers)
Source: National PCP Insights & Behaviors Study, May, 2008 (N=851 Primary Care Physicians)

Presenter Contact
For information on presentation please contact
wturell@pri-med.com

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

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