Continuing Medical Education in a Time of Social Distancing

By Brian S. McGowan, PhD, FACEhp

Author’s note: I fully understand that in this time of chaos, there may be concern and worry about family, job and security. I feel the same. The following article was written more or less as an escape — one part mental exercise and one part diversion. This is not about finding a silver lining; it is about recognizing that in the time of chaos, there is often opportunity.

By now, we are all aware of the pandemic of COVID-19. While most notably China, South Korea and Italy have been dealing with the contagion for several months, the pandemic in the United States has begun to spike in the past few weeks.

With increased awareness of the impact of the pandemic and with several prominent cases in the United States, severe and necessary actions have been taken by governments and health agencies at local, state and federal levels. Many of these actions may be seen as general health recommendations, but others are novel, including social distancing.

While the continuing medical education community (CME) offers educational interventions in a variety of formats, live meetings continue to make up more than 60% of certified activities, more than 84% of hours of instruction and nearly 12 million live, face-to-face learning experiences for healthcare providers. In a time of social distancing, almost all of this creates risk.

Over the past week, I conducted interviews with five CME professionals who are rapidly coming to terms with our new reality. Each interviewee works within a medical association or society — from small specialty societies to some of the largest medical associations in the world. Each interview explored the short-term implications of social distancing and the pandemic, as well as the key decisions that their organizations have faced. While these conversations have focused on some unique realities for each organization, there are several general themes and conclusions that have emerged.

Short-term Consequences

The most pressing short-term consequences are, as expected, dramatic. Each organization is in the midst of adapting their upcoming live, in-person meetings. These changes will undoubtedly impact the learning experience, the outcomes plan, the staff focus and resources, and will have significant financial ramifications — many of which will not be fully understood for weeks to months.

Table 1 is a quick snapshot of the planned changes.

Table 1:

 

 

 

Organization

Original Plan

New Plan

Timing

A

Traditional, large, annual, multi-day, live, in-person conference in March

Re-envisioned as a multi-day, live, virtual conference managed in-house using GoToMeeting

No change in dates

B

Traditional, large, annual, multi-day, live, in-person conference in April

Re-envisioned as a multi-day, live, virtual conference managed by third-party vendor

Moving to late summer

C

Traditional, large, annual, multi-day, live, in-person conference in March

Re-envisioned as a collection of on-demand, enduring webcasts

To launch by May 15

D

Traditional, large, annual, multi-day, live, in-person conference in March

Re-envisioned as a multi-day, live, virtual conference managed by third-party vendor

No change in dates

E

More than 20, small, multi-day, live, in-person national conferences in April and May

Re-envisioned as small multi-day, live, virtual national conferences managed in-house using Zoom

Some dates will stay the same, some will change

 

Case Studies

Given the rapid nature of this article, the following case studies are not complete. The focus of the interviews centered on the impact of social distancing on educational interventions versus other value that an association/society delivers. What is presented below is what was shared in the brief interviews. Rather than present a fully explored analysis of each case, they summarize what was “front of mind.” In this way, they represent a visceral impression of the decisions that have been made and the drivers that informed these decisions.

Organization A

Organization A was scheduled to hold its traditional, large, annual, multi-day, live, in-person conference in March. This meeting has been re-envisioned as a multi-day, live, virtual conference. Organization A has experience managing live, virtual conferences in-house using GoToMeeting, so that is the path they have chosen. Giving this experience and a bit of proactive planning, they felt that they could deliver on the change in formats and still hold the meeting on the same dates.

The plans for the live, in-person meeting included more than five tracks of educational content. Their live, virtual conference will have just one track. A decision on what sessions to adapt has been an inexact science, “it won’t exactly be a ‘best of’ curriculum,” as other decision drivers are a reality (ie, faculty availability, planning committee opinion, etc.).

Organization A has a membership value proposition they believe is uniquely focused on networking, and this will suffer. But, the members are also very familiar with social media and a virtual, live meeting supported by a Twitter back channel is thought to offer a best-case scenario in this regard.

Colleagues in the meetings department are currently negotiating with the original host venue, and while the financial impact of the change is not yet known, there appears to be an expectation that a compromise (in kindness) can be met.

Moreover, an organizational decision was made to offer the live, virtual conference for free and to make it open to all. This clearly will have significant financial impacts.

Organization B

Organization B was scheduled to hold its traditional, large, annual, multi-day, live, in-person conference in April. This meeting has been re-envisioned as a multi-day, live, virtual conference. Organization B does not have in-house resources to operationalize the virtual meeting and has begun to engage with third-party technology and service vendors.

Importantly, the membership of Organization B is in the throes of the pandemic crisis, and this led to move the dates for the live, virtual meeting until late summer. But, with this delay, there is more time for planning.

Two statements stood out from their current planning: “We don’t want the change in plans to deliver any less value…” and “We don’t want to have members think back on 2020 as being a fall-back plan.” To this end, Organization B is currently surveying members to determine the right number of days, the preferred number of hours/day and to align the rescheduled curriculum with the evolving needs of the community.

The other consequence of moving the date is that Organization B chose to simply “wipe the slate clean” and refund all registrations. It also plan to start over with marketing and pricing planning for the live, virtual meeting once the scope of the meeting becomes clearer. The financial impact of this decision by Organization B is considered severe (including loss of exhibition fees and sponsorships, etc.)

Organization C

Organization C is scheduled to hold its traditional, large, annual, multi-day, live, in-person conference in March. This meeting has been re-envisioned as a collection of on-demand, enduring webcasts.

When Organization C began to explore the need to adapt the live, in-person meeting, the idea of a virtual, live meeting was quickly eliminated; the thought being that HCP would not be willing (or able) to block time to commit to such a conference. Moreover, since Organization C has vast experience creating pre-recorded webcasts, this approach seemed most viable. A third decision driver was that the live, in-person conference relied heavily on commercial support, and signed LOAs required enduring recordings of the live meeting to be available online by mid-May.

Interestingly, not all tracks of the live, in-person conference are to be modified in the same way. A decision was made to convert a track for nurses into a virtual, live conference. Historically, this track began as a separate virtual, live conference, so this was deemed to be the logical path forward.

Given the significant reliance of commercial support, the financial impact of these decisions will likely vary greatly. But, given how far along Organization C was in planning and implementation, it seems likely that the vast majority of the work was done, and the out-of-pocket expenses were committed.

Author’s note: The ACEHP IACE member section is working to share similar case studies and experience as it relates to commercial supporters in our community. Please be on the look-out for more information coming soon!]

Organization D

Organization D is scheduled to hold its traditional, large, annual, multi-day, live, in-person conference in March. This meeting has been re-envisioned as a multi-day, live, virtual conference. With the emergence of the coronavirus infection in Asia back in February, the “writing was on the wall,” and a precautionary decision was made to supplement the live, in-person conference with a virtual streaming option — the thought being that at least some members may not be able to travel.

This decision proved sage. In the weeks that followed, several faculty members had to cancel due to travel bans, and eventually on the heels of the California prohibition on gatherings larger than 50, the live, in-person conference was cancelled.

By this point, work on the live, virtual conference was well underway, and Organization D committed to the same dates, without postponement. As a matter of circumstance, the decision to cancel the live meeting aligned with the end of the early bird registration period, and Organization D made the decision to transfer all registrations from the live, in-person conference to apply to the live, virtual conference.

Since that decision, fewer than five registrants have requested a refund, and only a small handful of other registrants have argued that the price point for a live, virtual conference may be too high. In fact, the number of overall registrants has increased with what is seen as a lower cost and more convenient meeting experience.

While not all of the financial impacts of these decisions are known — negotiations with the live host venue were contentious, and eventually the force majeure clause was invoked — Organization D is actually on track to bring in more revenue this year and believe they can offer more novel, virtual experiences in the future.

Organization E

Organization E was scheduled to hold more than 20, small, multi-day, live, in-person national conferences in April and May. These conferences have been re-envisioned as small, multi-day, live, virtual national conferences managed in-house using Zoom. Prior experience with Zoom-powered virtual conferences simplified many aspects of this decision. However, Organization E is focused on skills-based training and that raises unique challenges.

Organization E has long since moved away from didactic presentations, and its educational interventions rely almost entirely problem-based, small group workshops and cadaveric labs. There are few alternatives for the cadaveric labs in a time of social distancing, at least in the short term, but Organization E is working with faculty to ensure that the problem-based, small group workshops are intentionally re-designed to maintain the interactive experience and effectiveness.

In the midterm, Organization E is working to package and deliver additional content to ensure there is ongoing, adequate access to learning experiences. And, in the long term, they are strategically working to leverage virtual reality to address the need for hands-on, cadaveric training.

Themes and Conclusions

These interviews and the resultant case studies are far from complete. What can’t be fully expressed is the emotional toll that these changes have taken on these CME professionals, their colleagues and the organizations as a whole. Interview after interview I could hear in their voices a rollercoaster of pride, disappointment, acceptance and perseverance.

“This was going to be our best meeting ever…”

“This was our XXth annual meeting, and it was going to be special!”

“We had some of the coolest break-outs planned, and we just can’t replicate that experience online.”

Admittedly, it is impossible to document every decision that is weighing on these professionals. And, not all decisions are in their hands. Nonetheless, several themes have emerged. Some of these themes are drawn from what the organizations are doing, what decisions have been made and what drivers led to these decisions. And, some themes are drawn from what these organizations are not doing and what compromises are being made (both intentionally and unintentionally).

To best navigate this time of social distancing, CME professionals must embrace our central tenet: Begin with the end in mind. This requires us to deconstruct the mission of our organizations and the goals of our interventions, and move forward to engineer new, viable solutions.

Notice I didn’t say “deconstruct the goals of our live meetings.” This should not be simplified to replicating or approximating parity with a live meeting.

Balance must be struck between financial pressures, finding the easy path, and embracing rational learning and implementation science; and not all organizations are equipped to do so.

  • If networking is your driver, asynchronous events are unlikely to help.
  • If advocacy is your driver, there must be targeted, emotional outreach.
  • If revenue is your driver, you must understand your customer and deliver real value.
  • If education is your driver, then maybe this is a real opportunity to deliver better experiences.

The COVID-19 pandemic has changed our world, and the CME profession has a crucial role in how we move forward. Be thoughtful. Be intentional.

In times like this, we can choose to lead strategically or we can choose to react logistically.

One moves us forward, and one holds us back.

My hope is that the case studies above provide us perspective and that the conversations they spark provide us direction.

#Leadership

Resources on COVID-19:

https://en.wikipedia.org/wiki/Timeline_of_the_2019%E2%80%9320_coronavirus_pandemic_in_November_2019_%E2%80%93_January_2020

https://www.jhsph.edu/events/2020/covid-19/

https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf

https://coronavirus.jhu.edu/map.html

https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen

https://www.thelancet.com/infographics/coronavirus

Additional references:

https://www.accme.org/sites/default/files/2019-07/818_20190716_2018_Data_Report.pdf

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