As the agenda for CMEpalooza Spring continues to take shape (we’ve made some recent additions you can check out if you feel the urge), you’ll notice that the big picture concepts of CME are fairly well covered by our panels. These are some of the broader debates we all have when we are developing education: our educational design, our technology platforms, our outcomes plan…things like that. And don’t get me wrong — these are all critical to discuss and debate at length, which we’ll absolutely do on Wednesday, April 16.

But in this periodic feature that I rolled out earlier this year, we’ll look at some of the nooks and crannies of CME that don’t get discussed often enough but are nonetheless critical for the community to pick over and understand.

Today’s Topic: Who Makes the Final Call on Content?

One of the basic principles of CME activities is that there is going to be a clinician (or group of clinicians) who will be the “face” of our education. The level of their involvement in the content development process will, of course, vary depending upon the educational design. In some cases, they’ll serve more as planners and reviewers while our content team (typically, full-time or freelancer medical writers) takes on the brunt of the work; in other instances, the faculty will take a more hands on role (for instance, when creating a slide deck for a live presentation). In either scenario, things can get tricky when we disagree with the advice of our faculty experts either on a clinical matter in which they undoubtedly have more overall knowledge than we do or are something more nuanced like wording or slide design.

Let’s look at a couple of real-world scenarios with some Monday morning quarterbacking from me to give you an idea of what I’m talking about. And yes, these all really happened.

SCENARIO #1: This one happened about 18 years ago, when I was notably younger, had considerably more hair, and felt the need to assert myself a little more to carve out my space within my employer. We were in the slide review room prior to a satellite symposium (do people still do formal slide reviews onsite? I haven’t been part of one for many years) and going through the content of one faculty member in particular who had sent us his deck 2 days prior. I had been the one doing the content validation (ie, fact checking) for this specific activity, and I noted that he had made an error in his analysis of the trial data on one of his slides.

Since we were so close to the day of the symposium (and slide review), I didn’t mention anything until we were onsite and I had a chance to discuss things with this faculty member face to face. Perhaps not appreciating being told, “You are wrong,” by a relative newbie to the CME space, this faculty member pushed back and refused to change the wording on his slide. Eventually, we got the faculty chair to weigh in, and he agreed with my perspective. However, he was a bit more diplomatic than I was, and helped to broker a compromise solution.

MONDAY MORNING QUARTERBACK: While I was in the right from a factual perspective, I probably should have let this go once the presenting faculty member disagreed with my assessment. I don’t remember the precise substance of the issue, but I am fairly sure it was relative minor and not essential to the educational messages of his presentation. Now, if it was more substantive, I have no problem with someone on our end holding their ground and fighting hard for their position. Of course, it helps to have someone (ie, medical director, faculty chair) backing you up.

SCENARIO #2: I was working more recently on a case-based online activity where we had held an initial planning call with our two faculty members to hammer out the general direction of two patient scenarios. Our medical writer on the project took this direction, and I worked with her to craft sensible details for each case. During the initial review of the complete content, one of our faculty members inserted a comment that read as follows: “Why don’t we change this from an IgG case to an IgM case? It might be less common, but could be a more interesting case.”

A few important things to note here:

1. She had agreed on the planning call (or at least had not audibly disagreed) that we’d create an IgG case. It doesn’t matter if you know what IgG is by the way, just know that it’s a different subtype of one disease state.
2. She wasn’t saying that anything was factually incorrect in the case that had been created, just that we could have gone in a different direction
3. Making her suggested change would have had a lot of downstream effects on the details and progression of the case
4. We were already several weeks behind in our launch timeline and this would have pushed us back even further

So in my response to her, while we accepted the majority of her suggested edits, I politely explained that, while her suggestion was certainly valid, we did not have the time to make all of the changes that would have been necessary if we followed down this new path. I encouraged her to let us know if there was anything factually incorrect with the case we had created. Fortunately, our faculty member was fine with this explanation and agreed to leave the case’s direction alone.

MONDAY MORNING QUARTERBACK: One of the points I did not mention was that I initially approached our freelance writer to find out, “How much of a pain would it be to make this change?”

Her response, in a nutshell? “A big, big pain. I’ll do it if I have to, but this really would take a lot of time.”

That gave me all the information I needed. Faculty certainly may change their mind on specific items from time to time, and we often need to just “go with the flow.” But when they make a suggestion that significantly alters a decision they had already previously make on what seems like a whim, we can be confident in steering them gently back in the original direction.

SCENARIO #3: A few weeks ago, I got a slide deck from a faculty member that would be part of a live symposium happening later this year. It was generally well done — sensibly organized and thorough. But, as happens quite often, there was far too much information packed on some of the slides. The font size for some of the text was 18 pts. or less, which may be readable on the computer screen when you are sitting 5 feet away from the monitor, but is impossible for someone sitting in the back of the conference room to see on the monitors at the front of the room (the dreaded, “I know you probably can’t read this, but let me tell you what it says” moment from the podium that we’ve heard over and over).

When I went through the deck our faculty member submitted, I did the best I could to simplify some of the information on the busier slides so that they would be more likely to be viewable onsite.

My efforts were not well received.

“Can you put slides 6, 8, and 13 back the way they were?” our faculty member wrote. “I’m afraid they’ve lost the message I am trying to tell with your edits.”

Again, there was nothing factually wrong with the information on the initial (or revised) slides. Our faculty member simply wanting things the way she wanted them. Could I have pushed back again and said, “These are not going to be readable onsite”? I suppose so. But this was one of those situations where it doesn’t always help to unnecessarily cause friction. Yes, I’ll be cringing onsite when these “original” slides come up and everyone in the back of the room has to squint to read the small text, but I’ll trust our faculty to “tell her story” the way she wants.

MONDAY MORNING QUARTERBACK: This one is pretty fresh in my mind, so I don’t know if I would have done anything differently. We’ll see how things go onsite and if this comes up in our faculty postmortem.

But the takeaway for this one is to choose your battles. It’s always OK to make your best recommendation, but if you find points of disagreement, it’s also OK to give a little to avoid unnecessary confrontation.

Agree or disagree with anything/everything I’ve said here? I sure hope so. Feel free to share your thoughts in our comments here or through our LinkedIn posts.

 

As we roll into Spring and warmer weather, there are still people who are desperately asking for our advice (I know, we’re surprised as well). Must mean we’re doing something right.

Remember, if you have an issue (professional or personal) you want us to help with, you can click here to submit your question(s). We promise not to make fun of your issues and may actually offer useful advice.

Dear Derek and Scott,

Does Accreditation with Commendation provide more value to grant applications compared to regular Accreditation?

Succinctly,

Commendation Contemplator

SCOTT: The ACCME introduced the Accreditation with Commendation criteria in 2016 as a way for providers to “incentivise organisations to advance their educational strategy and recognise organisations that excel as continuing medical education (CME) providers” (this quote is taken from a 2022 article authored by ACCME President and CEO Graham McMahon – you can tell that Graham is from “across the pond” since he used British spelling of some terms in here).

I can’t tell you precisely how many organizations currently have the Accreditation with Commendation designation – it was apparently 49 between 2017-2022 according to said article, but a recent cursory examination of the ACCME website seems to indicate that it’s at least double that now. There are somewhere in the neighborhood of 1,600 total providers, so my guestimate is that about 6-7% have achieved the Accreditation with Commendation designation. I thought that the ACCME used to provide a free Excel spreadsheet with basic information about all accredited providers (am I wrong about this?) that I could have carved up to tell you the precise current numbers, but it costs $200 for a one-time download now, and that’s beyond our current CMEpalooza research budget.

From my perspective, I always assumed that the primary value of being an organization who achieved Accreditation with Commendation was that you had to be re-accredited every 6 years (vs. every 4 years for accredited organizations without this designation). For anyone who has been through the ACCME re-accreditation process, this is a fairly big deal as preparing paperwork for this takes lots of time. I never really considered the issue from the perspective of the supporter, so I’ll let Derek address the essence of what you are asking about.

DEREK: Oh boy. OK, first things first…my opinions are my opinions and do not represent the opinions of my employer, colleagues, anyone else who reviews grants, blah, blah, etc., etc.

Now that we have that out of the way, my short answer to your question is — and this is just my own opinion — maybe a little, but not really.

My slightly longer answer is that an organization’s accreditation status is not something I put much thought into when I am reviewing a grant application, other than noting whether or not the org is accredited. If they had probationary status, then yes, that could potentially detract from the value of the application. But as far as “regular” Accreditation vs Accreditation with Commendation goes, that is not a distinction I generally factor in as part of my grant decision-making process.

There is certainly value in achieving Accreditation with Commendation, as Scott notes above, and this is certainly not meant to take away from that. But if an organization’s primary motivation for obtaining a higher-level accreditation status is based on a theory that it will help win more grants, I’d suggest that’s an ill-conceived theory.

Dear Derek and Scott,

If you are a CME company that is new to pharma grant space, what are the best things you can do to win your first pharma grant besides the application? Does networking help? Marketing? Partnering with another company? Fill in the blank? What are the worst things you can do? I’ll take your best 101 and any jokes you can pepper in.

Sweetly,

Bird New to This Place and Trying to Land

DEREK: Two muffins are sitting in an oven. The first muffin says “wow, it is hot in here!” The second muffin says “wow, a talking muffin!” (You said you would take any jokes, not our best jokes.)

The advice that I would give any company applying for grants, whether new or not, is to keep in mind that the majority of the time you are competing against other companies for a limited pool of funds. You need to present the best justification for why they should pick you for the grant (this is an oversimplification, but you get my point.)

If you are a new company, then you are starting at a lower baseline than the other companies you are competing with. You have no history with the grantor, they are not familiar with your services/products/applications/etc., and they don’t know if you are capable of doing what you say you are going to do. You need to convince the grantor you are the best company for the job, but they have no idea who you are. Not an easy task. Here are a few things you can do.

Networking: Networking helps, yes. Anything that gets people more familiar with your company is helpful. Some people are more willing to meet than others, and some have preferred methods for meeting (in-person vs virtual), so try to be as flexible as possible. Attending industry meetings such as the Alliance conference and AIS can be beneficial as many grantors reserve time there for 1:1 meetings.

Partnering: In this situation, partnering with another organization with defined expertise and a proven track record is an excellent idea. At the very least, having a known organization as part of the proposed program may ease some of the grantor’s concerns about working with an unknown organization. The partner org may also have more grant management experience than you do and may be able to prove some helpful tips.

Hire a Medical Editor: I don’t have the time or space to go through all the ins and outs of proposal development here, but one of the absolute best things you can do to help your chances of winning a grant is to put together a good, well written, concise proposal. One of the worst things you can do is to put together a poorly written, meandering, uninformative proposal. A good medical editor will help avoid that from happening. They’re worth the investment.

SCOTT: What did the belligerent birthday cake say to the party guests?

“You want a piece of me?!?!”

If Saturday Night Live is looking for new writers, you know where to find us…

Anyway, as to your question — back when I worked exclusively as a freelance medical writer, I was fortunate enough to receive a few grant awards each year for projects that I primarily designed and developed. But because I was a one-man show and, at least initially, an unknown quantity to a lot of supporters, I always partnered with associations and/or academic centers where they were the “named” lead  grantor and I served more in a secondary role within the proposal itself (even if I led the actual funded projects themselves from an execution perspective). I would highly recommend that newcomers go this route if possible. As Derek notes, the grant world is a highly competitive space, and funders are understandably hesitant about giving substantial funding to people and organizations they have never heard of, no matter how innovative their proposal may be.

Dear Derek and Scott,

When planning an RSS case conference, do you need disclosures from everyone in the room attending, or just the planning committee who serves as a moderator to ensure that the discussion is CME compliant? I am seeing different accredited providers doing it both ways. My issue is that our case conferences have large attendees/audiences, and getting disclosures from everyone isn’t always very feasible.

With Frustration,

Over Disclosed and Under Paid

SCOTT: As with most issues related to accreditation, I had no idea how to answer this question, so I turned to a few colleagues who are accreditation experts (who in turn passed this question along to other accreditation experts to make sure they were giving me the right information. Not surprisingly, this is a group that does things by the book).

Here is the gist of their advice – no matter how big or small your RSS case series, you do need disclosures from planners, managers, presenters, and moderators who are involved in the series, but not from everyone in the audience. This is pretty much covered in ACCME Standard 3.1.

I understand that most accredited providers prefer to err on the side of caution and will typically collect more paperwork than is needed to CYA. But in this case, where perhaps you have tens, or even hundreds, of learners participating in your RSS, collecting a disclosure from everyone in the room is both onerous and unnecessary.

DEREK:

Part 8 – The Finale (Scott)
Out in the hallway, it was chaos.

The CMEslinger could only sit in mute silence as he heard Alex, his vice president of education and longtime protegee, pacing up and down the halls calling out in a panic, “Has anyone seen the CMEslinger?”

The man in black snickered until he heard Rachel, his lead project manager who he had stolen from a competing organization just 5 months ago, pacing disgustedly down the hall muttering, “It figures the man in black would desert us now.”

For two men who were used to calling the shots, the wait was more agonizing than the end of Game 7 during the 2019 playoff series between the Toronto Raptors and their beloved Philadelphia 76ers, more nerve wracking than watching a souffle rise (or not) in the oven, more torturous than watching Love Actually for the third time. Both men had confidence in the teams that they had assembled to help them execute their satellite symposia, but for a showdown whose stakes were so high, it was nigh impossible to be this removed from the action.

“Has anyone seen the CMEslinger?”

“What happened to the man in black?”

The exasperated yelps eventually died down as the clock hit 6 p.m., presumably meaning that the doors to both symposia had opened, and the competition was now, truly and finally, on.

6:13…6:14…6:15

Time slowly ticked by. The CMEslinger and man in black glared at each other from opposite sides of the worn couch, sneering with curled lips and furrowed eyebrows.

6:27…6:28…6:29

“How about we pass the time with the only true test of a man’s character?” the CMEslinger asked his rival.

“Yahtzee it is,” the man in black responded with a nod. “Marge?”

Of course, Marge was well aware of the peculiarities of the two combatants, and dug into her bag for her well-worn game box. As usual, it was an epic battle of wits. The CMEslinger was the more conservative player, racking up big scores with four “6s” and four “4s” to ensure the upper section bonus. The man in black went for the gusto time after time, hitting a lucky Yahtzee by rolling a pair of deuces on his final turn to join the other three “2s” already on the table and go along with the small and large straights he had already completed on his scorecard.

6:54…6:55…6:56

Both men were down to their last turn. The CMEslinger still had a void in his “Yahtzee” slot after patiently filling out the rest of his scorecard. The man in black’s sheet looked like a Picasso, with Xs through numerous squares, but big numbers in the “Yahtzee” slot. Were both men not mathematical savants, they might not have been able to tell who was winning and who was behind. But these men, with their acumen and experience, knew very well where things stood. The man in black needed at least two “3s” to take the lead and force the CMEslinger to roll a lucky, final Yahtzee.

The man in black grabbed the shaker. He got exactly what he needed, rolling a fateful, final “3” on his last turn to take the lead. Now it was up to the CMEslinger. The first roll was lucky – three “4s” to start with. He added a fourth “4” on his next turn, meaning that he needed just one die to turn his way on his last turn. Blowing on the shaker for luck before his fateful final throw, the CMEslinger wound up for the flick of the wrist before both men froze in place.

“Knock knock…knock knock…”

The men turned toward Marge.

“Accreditation with commendation,” she yelled in the direction of the door.

The lock clicked. The handle turned. The door opened.

“Hello Leon,” Marge said. “I assume you have news for us.”

“I do,” Leon said, strutting into the room, his eyes darting between the two combatants.

“This has been an interesting hour. At the beginning, attendees flooded to the CMEslinger’s symposium, lured in by the promise of new technology. Unfortunately, one fewer set of helping hands resulted in longer waits to help attendees figure out how to use the VR headsets, and despite the heroic efforts of your team, quite a few attendees became frustrated and left the room.”

The man in black stood up haughtily and extended a hand in the direction of the distraught CMEslinger. “It’s been nice knowing you, pal. Maybe this would be a good time to find that dappled palomino and sashay back into the desert.”

“Not so fast,” Leon said, turning toward the man in black. “You had a lot of catching up to do. The audience for your symposium was slow to trickle in. It was a restless bunch as your team waited for you to arrive, but once they finally kicked things off at 6:11, it was reasonably smooth sailing, although not particularly engaging. I saw a lot of learners crisscrossing the hallways going from one room to the other.”

“So who won?” asked the CMEslinger.

“Yeah, when do I need to order a Laz-e-boy recliner for the CMEslinger to celebrate his retirement?” questioned the man in black.

“The final tally was quite close,” Leon said. “We used high-tech infrared technology to count each and every individual that was in both rooms at 7 p.m. on the dot. Here are the totals…”

Leon cleared his throat.

“Man in black: 273”

“CMEslinger: 278”

The man in black slumped onto the couch, visibly crushed. In the back of his mind, of course he knew that this was a possibility, but no one had bettered him in competition since Larry Phillips won the Blueberry Pie Eating Contest in 10^th grade.

“I lost,” the man in black whispered into the thin air, shaking his head back and forth in disbelief. “I lost.”

The CMEslinger wanted desperately to celebrate, to give it back to the man in black with every ounce of snark that had been thrown his way over the last few months. But he saw the look of utter anguish on the face of his former friend, and he just couldn’t do it.

Instead, he grabbed the Yahtzee shaker and poured out that one final die. A “2.”

“Better luck next time,” the man in black said as he yanked on his trusty Stetson hat and headed for the door. “I’ll see you around…somewhere.”

***

Now that the CMEslinger saga is complete, you might want one document with the full story to read to your kids at bedtime (we promise that the man in black won’t cause them nightmares). It’s just a basic PDF of a Word document, but feel free to click here for all eight parts.