Punxsutawney Phil saw his shadow – six more weeks of winter. Sigh.

Usually, we don’t care so much about what the seer of seers, sage of sages, prognosticator of prognosticators and weather prophet extraordinaire has to say about the seasons, but since these last few weeks have been particularly harsh for most of the country, we’re a little depressed now that spring seems further away.

You know what else has got us depressed? Our Ask Us Anything mailbag. It’s about to be empty, which should never happen. Surely you have professional and/or personal problems that you need us to weigh in on. Can you save your parking spot that you spent an hour digging out after the recent snowstorm with a traffic cone? What’s the best thing to do on a first date? How many licks does it take to get the center of a Tootsie Roll pop?

Our advice might not always be good, but it will be thoughtful and it is free. So please, submit your Ask Us Anything questions here so that we can at least have a ray of sunshine brightening our psychological skies.

And now, here is what we have to offer this month…

Dear Derek and Scott,

After reaching out to several supporters, I’ve noticed that some are happy to meet at the Alliance meeting while others are very clear that they don’t take meetings there. What drives supporters’ decisions to meet at the Alliance meeting, and why do those approaches differ?

Annoyingly,

Denied but Not Defeated

DEREK: This is a timely question considering the Alliance meeting is coming up in less than 2 weeks and I was just discussing this very issue with a couple colleagues last week. As a supporter, I’m happy to provide my thoughts on this situation and will take a crack at explaining the opposing view, too. As usual, I am compelled to provide a disclaimer that these are my own opinions, do not reflect those of my employer, blah, blah, blah.

My personal view of meeting with providers at the Alliance meeting and other conferences is that I am willing to meet and will try to agree to as many meetings as I can without driving myself nuts–accepting them on a first come, first served basis. I consider these kinds of meetings to be part of my job responsibilities and my role as a supporter. In general, I don’t have a lot of in-person external meetings throughout the year, so I’m willing to agree to more when attending conferences. Admittedly, part of my motivation stems from the years I spent working for CME providers in the first half of my career, so I guess I feel like I have a decent understanding of the value of these meetings from that side.

But let’s be honest, the true reason for this question is to ascertain why supporters don’t agree to meetings. I’ll offer three brief explanations based on conversations I have had with other supporters and my own experience.

The first reason is one of fairness and equal opportunity. If provider/supporter meetings are of value to the provider, and it is impossible to meet with every provider, then those who do meet with supporters are at an unfair advantage. If supporters can’t meet with every provider, then it is better for them to meet with no providers than some providers.

The second reason is to negate any appearances of bias and impropriety. We all know the work of CME is heavily regulated on both the provider and supporter sides of the equation. Some individuals and organizations feel the best way (or easiest way) to reduce the odds of getting caught up in any potential conflicts of interest is to avoid provider/supporter meetings entirely.

[Quick shoutout to Pam Wagner, who discussed both of the issues above in a recent LinkedIn post.]

The third reason, and the reason I concur with more than the first two, is simply one of time. These meetings take a lot of time and can make it difficult to enjoy the full conference experience. I’ll use myself as an example. For this year’s Alliance meeting, I received 20+ requests for meetings and have 14 scheduled, not counting evening meals. Along with those meetings I also have a session to moderate, try to catch up with friends I only see at conferences, and hopefully attend a few sessions as well. I have no idea how this compares with other supporters, but I assume they receive a similar number of requests and some likely even more. I share this not to brag or anything like that–it’s just how it is. This is probably oversharing, but for me, face-to-face meetings sap my energy. I’ll be exhausted by the end of the conference and start to lose my voice partway through from all the talking. When I decline a meeting request, it’s because I’ve reached the saturation point in my schedule. It’s not you, it’s me.

SCOTT: I don’t have a lot more to add here as I have never been on the supporter side, though I can certainly understand the concept of “meeting fatigue” that Derek cites. While I have never been a big fan of provider capabilities presentations, I do understand the value of personal relationships in our field and have always appreciated the willingness of some supporters to provide me with a glimpse of how their specific organization is structured and the way it which their team determines which education they do/don’t support. In many ways, I prefer this to happen during casual interactions rather than forced discussions during scheduled meetings, but I understand this occurs by happenstance and simply luck in running into someone you were hoping to meet.

Dear Derek and Scott,

I am thinking about submitting an abstract for presentation at CMEpalooza Spring along with one of my colleagues, but I’m not sure if our idea is any good or if we even have a chance at being accepted. Plus, neither of us has really presented to an audience like this before, so we’re kind of nervous that we’re going to make fools of ourselves.

Do you have any advice so that can make me feel better?

Sheepishly,

Nervous Nelly

SCOTT: You’ve come to the right place, Nelly, because Derek and I have years upon years of experience in making fools of ourselves. In fact, that would be a great name for our band if either of us was musically inclined (sadly, my instrumental career ended back in 5th grade when I put down the viola for good).

We often hear from people who kinda sorta think they have a good idea for a CMEpalooza Spring abstract but either they are too shy, lack confidence, or just get too preoccupied with other things to remember to submit it for consideration.

(Quick aside: This is a good opportunity, of course, for us to remind everyone that there are less than 3 weeks until abstracts for our Spring event are due. You can get all of the details on the submission process by clicking here).

We always consider CMEpalooza to be a low pressure kind of presentation atmosphere for a number of reasons:

1. You are not physically “seeing” your audience so there is no intimidation into looking at a sea of faces staring at yours. With a virtual event like ours, there could be 1 people watching or 1,000 (in reality, it’s somewhere in the middle). It really doesn’t make any visible difference to the presenter.
2. We encourage fun and creative approaches to education. You won’t have the pressure to come up with a long slide deck, unless you really want to. You won’t have the pressure to develop pages and pages of notes to keep you on track, unless you really want to. While we don’t encourage “winging it” without some sort of plan, we also don’t require any specific plan of attack. You can figure out your own preparation preferences.
3. We love seeing new faces present. While I admittedly will attend some sessions presented by longtime friends and colleagues who I admire at live events, one of the benefits of CMEpalooza is that you get a time slot with no competing session AND your session can be viewed as soon as it’s completed in our online Archives. Which are there forever and forever. All for free.
4. I’ll let you in on a little secret – we don’t get hundreds of great submissions to consider every year. We never know exactly how many submissions will come in, but your odds of being accepting for a presentation slot are significantly better than last week’s Powerball, for which your bought 10 tickets.

Derek, you want to add anything? I know your top 10 lists, so I left you a few to fill in. You are welcome.

DEREK: How very generous of you. No, I think you have covered the main points pretty well. I do want to reiterate that CMEpalooza is about as low stress an environment for presenting as you can find while still reaching a decent sized audience. And if it helps, we’re happy to lie to you about how many people you are actually presenting to, since you won’t be able to tell (“What’s that Nervous Nelly? How many people are watching your session? Oh, it’s only a handful, and one of them is my mom. Nothing to worry about. No truth at all to the rumor that we had 250 people watching the previous session. OK, maybe there’s a little truth to that rumor, but only a little.”)

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.