If you missed previous segments of the CMEslinger saga, you can read them here:

• Part 1
• Part 2
• Part 3

And now, our latest segment:

Part 4 (Derek)

The CMEslinger grabbed his leather duster and stroked the shearling collar for a moment before shrugging it on. The coat had been a 50^th birthday present from his daughter, Sierra, a few years back and was one of his few treasured possessions. The CMEslinger is not a man who surprises easily, but the quality of his daughter’s gift, not to mention the cost, had caught him off guard at the time. It shouldn’t have.

Sierra had been a precocious child, talking at 10 months, reading at 4 years old, reciting Gertrude Stein by memory at the third grade talent show (“Rose is a rose is a rose is a rose”). She tested out of fifth grade entirely and graduated from high school the same year she turned sweet sixteen. Scholarship offers came in from Harvard, Yale, and Stanford, but Sierra shocked everyone by staying local and attending Cuthbert University—a fine school, but one lovingly known as “Safety U” because no one ever listed it as their first choice. But Sierra had plans of her own, and an Ivy League education was not part of them.

There is a common saying in CME circles that “no one gets into CME on purpose.” Phinneas, of course, had his own version of that, snorting “No one gets into CME; CME gets into you!” at the CMEslinger and the man in black more times than they cared to remember. Sierra would prove the exception to that rule with a singular focus on a career in CME that could only come from an offspring of the CMEslinger. As a toddler, she would tag along with him to the TAXIE office, and even when he moved on to form his own company, Sierra remained a TAXIE loyalist and became a key member of Marge’s program management team by her senior year in high school. It didn’t hurt that Marge was also her godmother, but no one ever questioned Sierra’s capabilities. She would have skipped college entirely and gone full-time at TAXIE, except the CMEslinger put his ostrich skin booted foot down and insisted she get her degree (though it was actually the heartfelt talk between Marge and a tearstained Sierra that convinced her to accept a spot at Cuthbert and delay her burgeoning CME career by a few more years.)

At her graduation ceremony at Cuthbert, Sierra walked across the stage, grabbed her diploma, and hurried directly over to her new office at TAXIE, something given only to those with a promotion to Senior Program Manager. Over a period of 5 years, she rose to Program Director and then Vice President of Educational Strategy, the youngest employee to which TAXIE had ever bestowed a VP title. Her father’s advice helped, but it was Marge and her tough love approach that Sierra credited most for guiding her in her career. She was 25 years old, a VP at one of the largest medical education companies in the world, and the apple of the CMEslinger’s eye.

And then she went over to the dark side.

It is an inside joke to those who exist in the CME provider world, referring to the industry section of CME as “the dark side.” Still, it came as quite a shock to everyone, Marge included, when Sierra announced she was leaving TAXIE for a Grant Director position at Tower Pharmaceuticals. And yes, the CMEslinger had to admit, it stung him more than a satchel full of hornets that his little girl was leaving the provider side for a job on the dark side. He never did get a full explanation from her about why she was leaving. “I’m sorry, Dad. It’s just something I need to do,” was the most he ever got out of her.

She never offered an explanation to Marge, either, and Marge never asked for one. On Sierra’s last day in the TAXIE office, as she was making her final walk down the hallway towards the elevator, Marge called her into her office, where she sat speedily clacking away at her computer keyboard. Tilting her head down slightly and looking at Sierra over the top of her halfmoon readers, Marge imparted a final bit of advice.

“You call me when you run into trouble.”

“’When”? Not ‘if’?”

“Yes, ‘when’.”

“OK, Marge. I will. Thanks.”

Marge nodded and went back to typing. She never looked back as Sierra walked away.

All this the CMEslinger relayed to the man in black as they Ubered over to Tower Pharmaceuticals HQ.

“Yes, I know all this already, you chucklehead,” the man in black growled. “You forced me to listen to all your stories when Marge locked us in that hotel room in Vegas.”

“Ah, right, right,” the CMEslinger intoned absently.

The Uber glided up to the massive black edifice of Tower world headquarters, and the two unlikely partners jumped out and hurried into the front lobby. Neither man had been in the building previously, and it took them a moment to spot the intercom system for contacting occupants. Quickly scanning the directory, the CMEslinger punched in the numbers for Sierra’s office. She picked up on the first ring.

“Yes?”

“Sierra? It’s Dad. I’m downstairs.”

“Oh.”

An awkward silence of several seconds followed, interrupted only by the low frequency hum of the intercom.

“Sierra? You still there?” the CMEslinger asked hesitantly

“I’ll be right down,” his daughter said sharply and disconnected the line.

Perhaps it has something to do with the calendar turning over, or maybe it’s because we’re all going a little bit stir crazy looking out our window and imagining how cold it is outside our front door, but this is always the time of year where I hear a lot about the need for “more innovation” in the world of CME.

We need to “re-imagine” how we design and deliver education. We need to “meet learners where they are” with our programming. We need to “think outside the box” to come up with groundbreaking solutions. We need to “get closer to the real provider/patient data” with our outcomes assessments.

I am sure you can come up with some of your own buzzwords or catch phrases that I missed. It’s an annual song and dance – rah rah rah, we can do this better! Let’s tap into our creative possibilities, form strategic alliances that maximize the strengths of the many instead of the few, and really get at the core of how our target audiences want to learn!

(For those of you going to the Alliance conference next month, you are going to hear this a lot)

It’s not that any of this is bad or misguided, but it’s simply unrealistic for a variety of reasons. We’ll start with the reason that no one ever seems to talk about as one of the primary barriers to innovation in CME: Money.

Let’s not lose sight of one simple fact: For most of us, the CME provider who employs us is operating as a business. It’s a business for supporters who devote a specific budget to therapeutic areas of interest. It’s a business for providers who need funding to pay the bills and support their teams financially, whether you are in an academic center, a member association, or a MECC. This is not a charity industry. Yes, most of us are in this at least in some capacity because we care about patients and want to make healthcare providers better at what they do, but there is nonetheless a financial component that underlines our work. If we don’t convince the internal teams within our pharma company to invest in CME programming, we’re out of a job. If we don’t get enough financial support from supporters to fund our programs, we’re out of a job. Plain and simple.

At last fall’s Alliance Industry Summit, there was one presentation in particular that drove home the limits that finances place on innovation in CME. It was a panel comprised of several representatives—both providers and supporters—from a far-reaching educational initiative that involved multiple interventions, an interesting longitudinal learner assessment, and various other tidbits that I can’t remember (this happens a lot when you get to be on the wrong side of age 50). Basically, it was one of those programs that nearly everyone would agree was “innovative” (don’t get me started about how everyone has a different opinion of what is or isn’t innovative – that’s another blog post for another day).

People were really interested in the activity design and its outcomes. “Yes, we should do more of this! This is the type of project my company would love!”

And then came the inevitable question, “Can you tell us—roughly—how much this project cost?”

The response? “Somewhere upwards of $2 million.”

More banging of the drum from the small contingent in the front row — “That’s great! This proves that pharma has money to support innovation! This is what we need to be investing in! Let’s convince our peers to shovel more money into CME so we can support projects like this! We can do this, people!”

But for most of us in the room, we knew right away that this project was the kind of interesting unicorn that pops up every now and then but simply isn’t realistic across even a relatively narrow broad spectrum. When you hear, “Our CME budget is down 10% this year, and it was pretty tight last year,” that’s not a formula for support of innovative programming. While innovation doesn’t have to be expensive—I like to think we do a pretty good job at CMEpalooza being innovative on a shoestring budget—to support the kind of manpower and high-tech doodads that “groundbreaking CME” often requires, a large price tag is usually attached to it.

Every week or so, I like to do an environmental scan to see what sort of online CME programming is available in a given therapeutic area. Without fail, the majority of activities I find are flat webinars – your basic 30 minutes of talking heads and slides, maybe with an animation thrown in or something like that, that we have been doing for years and years. Certainly, it’s nothing that anyone would argue is “innovative” or “re-defines CME.” It’s the same today as it was 10 years ago. The pendulum isn’t moving. Why, you ask? Yes, repeat after me…money.

Webinars are inexpensive to develop and produce, which makes them attractive for pharma to support. They are easy to create and hugely profitable for providers, which makes them attractive to propose. So, on one hand, you get a supporter with limited budget. On the other, you get a business unit (don’t hate only on MECCs here as all providers love their webinars) that is looking to strengthen their bottom line. So then, yes, you get a lot of accredited slide-video webinars out there (at least we’ve moved past the days of slide-audio). I don’t know that many people would argue that these sorts of programs are ideal for our learners, but they are functional and they are fiscally sound for all parties.

This isn’t something that most of us discuss in any sort of public forum because, well, it is frankly a bit embarrassing to admit that a lot of what we do is driven by dollars and not by what is best for our learner community. We would all love to be involved in those $2 million programs that really are exciting and impactful, but it simply isn’t the way the CME world is structured (note from Derek: maybe it should be.)

Now, money isn’t the only barrier to innovation in CME, and there is quite a bit of literature that argues that money is often just an excuse instead of a root cause that prevents innovation. There is likely some truth in this, but I feel strongly that the bottom line drives a lot of what chances we are/are not willing to take with our CME programming. Who is going to spend weeks developing a proposal for a $2+ million innovative initiative that has little chance of being funded as opposed to 10, $200K more realistic “tried and true” initiatives? (note from Derek: I think the argument of one large expensive program vs 10 small inexpensive programs is worth exploring more. Stay tuned….)

The world loves disruptors. Amazon. Uber. Netflix. Companies that truly redefine a space and make us rethink how we’ve done something for many years. But that doesn’t mean that every industry will get this kind of massive disruption, for whatever the reason. It’s just not the way the business world works.

So then, no, in my opinion, there will be no drastic shifts in the way that we design, deliver, and measure accredited education in 2026. Or 2027. Or 2028. I do not believe that we are an industry where any single innovation is going to massively overhaul the way that we design and develop education, at least not that I’ve seen. Shifts will be small—but still important—as we find cost-effective ways to innovate. AI platforms are getting better and more realistic. There are lots of interesting innovators and innovations out there in our community. But disrupting our world and “re-imagining CME”? Sorry, I just don’t see it.

If you missed previous segments of the CMEslinger saga, you can read them here:

• Part 1
• Part 2

And now, our latest segment:

Part 3 (Scott)

As always, the man in black had taken a seat in the far corner of Café Gilead facing the front door.

“You’ve been watching too many movies,” the CMEslinger said as he slid into the vinyl upholstered booth. “What, you think that one of your exes is going to walk through that door with an eye for some vengeance? On second thought, I’ve met all three of your exes. Probably wise to be careful.”

“OK there, wise guy,” retorted the man in black. “Go ahead and gloat all you want. I can take it, especially from someone who looks like he just went through a car wash with the windows down. Good God, man – people warned me, but you really do look like hell.”

“Enough with the pleasantries,” the CMEslinger said. “What’s going on with TAXIE and Marge?”

The man in black proceeded to recount his actions of the last 3 days since he received the panicked call from TAXIE’s vice president of education concerning Marge’s disappearance and the organization’s dire straits regarding their upcoming accreditation review. He told the CMEslinger about the frantic calls to Marge’s sister in North Carolina, her daughter in Sweden, and her best friend in Maryland. He explained how he drove the 4 hours from his beach shack in Wildwood Crest, NJ, to TAXIE’s headquarters outside Washington DC, spending hours with the team there replaying Marge’s actions on the day she disappeared. There was a call to the ACCME, another one to the AANP, and even one to the ANCC. The man in black had even checked in with the tournament director of the U.S. Boggle Championship — Marge was a three-time national champion – to see if she was at some sort of international tournament.

No one had heard a peep from Marge in 5 days.

“So she’s not with her family,” the CMEslinger said.

“Nope.”

“And she’s not onsite at a CME event.”

“You’re catching on.”

“And she’s not on one of her accreditation jaunts or at some other special event.”

“Not that I’ve been able to figure out.”

“So that can only mean one thing. She’s helping someone who is in a whole heap of accreditation trouble.”

“Bingo, my friend. Just like 13 years ago.”

And with those words, the CMEslinger and the man in black were transported back in time to the last episode when Marge vanished. Thirteen years ago, on a random week in April, Marge had simply—poof—disappeared from the TAXIE offices for 4 days without a word. There was a similar panic until, like magic, Marge simply was back at her desk one morning as if nothing had happened. Upon questioning, Marge explained that one of her accreditation friends had made a major blunder in her interpretation of ACCME Standard 3.5 and needed some round-the-clock help to rectify the situation and alert learners retroactively to the relevant disclosures of one of her organization’s recent presenters.

“He called me to help him out of a jam,” Marge said. “What was I going to do, say no? We’ve been friends for decades.”

“But why didn’t you tell anyone where you were?” her officemates asked.

“What are you, my mother?” Marge responded. “I’m a big girl. I can do what I want and go where I want. Stop being such a busybody.”

And that was that. Until now.

“OK,” the CMEslinger postured, taking a sip of his black coffee. “So someone close to Marge, someone she wouldn’t dare let down, is in crisis. But who? And why now?”

The CMEslinger was puzzled. But as he fixed his gaze on the man in black, he wasn’t met with the same quizzical look. The man in black’s eyes were burning a hole through the cheap upholstery. He knew. The CMEslinger thought and thought and thought, before—voila—it finally dawned on him.

“Wait, you don’t think…” the CMEslinger said.

“I do. It’s the only possible solution. Why do you think I came to you in the first place? It’s certainly not because I admire your investigative skills. In your current state, you couldn’t figure out who picked up your trash this morning even if the truck was idling down the block.”

The man in black paused for a minute to let it all sink in.

“Get your coat. Let’s go see your daughter.”