Alliance Almanac article accompanying the 2023 Excellence in Educational Design Award
For decades, breast cancer has been classified as HER2 positive or HER2 negative.ᶦ However, in 2019, research began to emerge showing promising results in breast cancers with low levels of HER2, for which there were no approved therapies.ᶦᶦ The potential impact was significant, as 40–50% of all breast cancers express low levels of HER2.ᶦᶦᶦ A potential new “HER2-low” classification would require a revolutionary shift in how pathologists test, report and track a patient’s HER2 status to enable easy identification of patients with breast cancer who may benefit from HER2-low therapies once approved.
Recognizing this need, American Society for Clinical Pathology (ASCP) collaborated with Q Synthesis and Clinical Care Options to design a comprehensive, multimodal approach to develop innovative HER2-low breast cancer education and resources. The aim was to advance knowledge, competence and performance in pathologists and other members of the interprofessional cancer care team.
This initiative, which won the Alliance’s 2023 Award for Excellence in Educational Design, leveraged innovative peer-to-peer learning along with a variety of online educational approaches to maximize reach and accommodate learner preferences in delivery modalities. The following activities were developed as part of this initiative:
- Virtual Tumor Boards: Two CME/CMLE credit-bearing virtual tumor boards, with recordings hosted on ASCP’s website and YouTube channel, used patient cases, digital images and Q&A to reinforce clinical practice guidelines and help learners prepare for the future landscape of HER classification in breast cancer.
- Podcasts: Two CME/CMLE credit-bearing podcasts provided convenient learning opportunities that can be accessed while on the go.
- Twitter Chat: A CME/CMLE credit-bearing Q&A-style Twitter chat facilitated networking and discussion on HER2-low breast cancer.
- Pathology Trailblazers Collaborative Learning Exchange: This CME/CMLE credit-bearing collaborative learning exchange leveraged virtual peer-to-peer discussions that enabled cohorts to address potential HER2-low implementation challenges.
- Downloadable Slideset: A curated collection of PowerPoint slides facilitated an easy content review and allowed users to teach their peers (e.g., in tumor boards).
- Pathology Implementation Guide: This CME/CMLE credit-bearing resource helped pathologists prepare for necessary changes as HER2-low therapies emerge.
- ClinicalThought™ Communication: This email blast, sent to oncologists, leveraged peer-to-peer education that encouraged oncologists to talk to pathologists about HER2-low breast cancer.
This multimodal approach provided opportunities for learners to engage with experts and peers while ensuring a variety of learning options based on their preferred format. The range of modalities also helped address a recognized challenge faced by clinicians in trying to stay abreast of rapidly emerging clinical evidence. Downloadable tools reinforced lessons learned, supported practice change and encouraged learners to share education and resources with interdisciplinary colleagues.
The innovative design of Pathology Trailblazers enabled learners to create, implement and evaluate action learning projects in their own institutions to improve HER2 testing and prepare for practice changes anticipated with the emergence of HER2-low therapies. In this activity, Q Synthesis developed case studies and facilitated virtual discussions that allowed participants to learn from each other, hone their leadership skills, and support the dissemination and implementation of best practices in HER2 testing. Summaries of the action learning projects created by learners were published on ASCP’s website to help others envision opportunities to undertake improvements in their institutions.
Through its ClinicalThought™ Communication, Clinical Care Options helped disseminate information about HER2-low breast cancer to their extensive network of medical oncologists and other cancer clinicians. They sent an article to their network about the emerging HER2-low breast cancer treatment, urging oncologists to encourage their pathology colleagues to adhere to appropriate guidelines when testing patients. That article also helped build awareness about emerging research and ASCP’s education on HER2-low breast cancer.
In addition, the formats of the activities provide built-in mechanisms for replicating and scaling the education. For example, repurposing audio, video and slides from live virtual tumor boards enabled low-cost, enduring dissemination of education in a variety of formats. Twitter chats can also easily be scaled, due to their low development costs and effort.
Outcomes
With over 2,000 unique learners and 13,500 engagements (i.e., learners, tweets/likes, page downloads/views/listens, ClinicalThought™ opens/views), this educational design demonstrated substantial impact in terms of reach; gains in knowledge, competence and performance; and progress toward addressing the clinical gaps that framed the project. There was a 21% statistically significant increase in overall knowledge from the virtual tumor boards, t(1520) = 29.9, p < 0.01, η2 = 0.4, along with the following gains outlined in the table below.
Conclusion
Gains from the educational program reflect a diverse array of outcomes related to diagnosing and managing HER2-low breast cancer and have implications for the types of outcomes and impact that can be achieved from a multimodal program designed to address clinical gaps in other areas. For example, an online course or module can help provide foundational knowledge that learners may need to facilitate the application of learning in clinical contexts. It can also help provide a common frame of reference for group learning. Similarly, the complementary use of social media tools can facilitate the dissemination of key information in shorter formats to make them easier to digest, which can be especially important when rapid dissemination of emerging information and practice change are critical. In addition, the collaborative learning exchanges and publication of the action learning projects highlight how learners can implement practice changes in their institutions and inspire others to identify similar needs and opportunities.
The approach described in this article can serve as a model for others seeking to design an educational program to maximize reach and rapidly disseminate education and resources through an innovative multimodal approach using virtual live and on-demand learning, peer-to-peer education, social media and downloadable tools. To access ASCP’s HER2-low Breast Cancer Education and Resources Page, click here.
Funding
This initiative was funded by independent educational grants from AstraZeneca Pharmaceuticals and Daiichi Sankyo, Inc.
About the Authors
Kellie Beumer is the director of learning innovations for the American Society for Clinical Pathology, where she oversees the instructional design and delivery of ASCP's live and online education and grant writing efforts. With nearly 20 years of experience, she is passionate about helping associations develop innovative medical education solutions aligned with best practices in adult education and learner needs. Her background is in molecular biology and instructional design, and she is currently working on her MBA.
Melissa Kelly, PhD, is senior manager in evaluation, measurement and assessment for the American Society for Clinical Pathology, where she oversees the evaluation of educational programs and related initiatives. In addition to expertise in evaluation, she also has experience working as an instructional designer and teaching courses in assessment and program evaluation.
Joseph Kim, MD, MPH, MBA, FACEHP, CPHQ, is president of Q Synthesis LLC, an independent healthcare education and quality improvement company that advances interprofessional collaborative practice by applying principles of systems thinking, implementation science and health services research. Some of his recent projects have focused on improving team-based processes around cancer biomarker testing, identifying and managing treatment-related adverse events, aligning treatment plans with clinical guidelines and coordinating care in complex patient populations. Dr. Kim serves on the board of directors for the Alliance for Continuing Education in the Health Professions (ACEhp). He is also a past president of the National Association of Medical Education Companies (NAMEC). Dr. Kim holds a BS in engineering from Massachusetts Institute of Technology, an MD from University of Arkansas for Medical Sciences, an MPH from the University of Massachusetts Amherst and an MBA from St. Joseph’s University
Jim Mortimer is executive director of oncology programs and partnership development at Clinical Care Options, which he joined in 2005. In this position, he has worked with numerous societies and advocacy groups to deliver impactful CME-certified programs. Jim has been presenter or co-author on Alliance posters as well as posters and publications at oncology society meetings and journals. Prior to joining CCO, Jim worked for Pfizer interfacing with the U.S. cooperative groups and the National Cancer Institute to advance major clinical trials in all tumor types. Prior to Pfizer, Jim worked for a cooperative group and in big pharma in research and development and medical communication.
Kevin Obholz, PhD, serves as the senior vice president, educational strategy at Clinical Education Alliance (CEA) and also as the general manager, oncology/hematology at Clinical Care Options (CCO). Kevin is the leader of the CCO oncology team, advancing clinical outcomes for people with cancer through designing innovative CME-certified programs. Kevin has been an active member of the Alliance for over 15 years and also serves in a volunteer position on the Alliance Research Committee. Kevin has led Alliance workshops and been presenter or co-author on Alliance posters as well as presentations, posters and publications at oncology society meetings and journals.
ᶦ Tarantino P, Hamilton E, Tolaney SM, et al. HER2-low breast cancer: pathological and clinical landscape. J Clin Onc. 2020;38(17):1951-1962. doi:10.1200/JCO.19.02488
ᶦᶦ Miglietta F, Griguolo G, Bottosso M, et al. HER2-low breast cancer: evolution from primary breast cancer to relapse. Abstract presented at: ESMO Breast Cancer Virtual Conference; May 8, 2021. Ann Oncol. 2021;3(2). Abstract 4MO_PR. https://www.annalsofoncology.org/issue/S0923-7534(21)X0006-3
ᶦᶦᶦ Schalper KA, Kumar S, Hui P, Rimm DL, Gershkovich P. A retrospective population-based comparison of HER2 immunohistochemistry and fluorescence in situ hybridization in breast carcinomas: impact of 2007 American Society of Clinical Oncology/College of American Pathologists criteria. Arch Pathol Lab Med. 2014;138(2):213-221. doi:10.5858/arpa.2012-0617-OA