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 (Derek)
As time continued its relentless march forward, the CMEslinger was forced to face the harsh reality that he was never going to catch the man in black at his current pace. He needed to take action, and he needed to do it now.

Reining the pony to a halt, he shielded his flinty grey eyes with the gnarled right hand whose pinkie finger was starting to have trouble reaching the shift button on his keyboard. Scanning the horizon, he caught a glint of sunlight bouncing off the tin roof of a farmhouse a quarter mile to the west. He gave the pony a gentle nudge with his heels and headed in the direction of the farmhouse at a trot.

As he neared the house, he noticed two things immediately. One was the mud spattered Jeep Wrangler in the dirt driveway that was so filthy it was impossible to determine the color of the paint job. The second was the silver haired woman clad in faded jeans and a chambray shirt, seated at what looked like an old school desk that someone had dragged onto the front porch of the farmhouse. She had a beat-up old Lenovo Thinkpad in front of her and was typing on it with such force that the clacking of the keys drowned out the angry curses emanating from her mouth.

The sound of hoofbeats eventually reached the ears of the furious typist, and she glanced up from the laptop with the surly look of a trapped wolverine. Her expression softened when she noticed the CMEslinger approaching, and she rose to greet him.

“Well, howdy there stranger. I apologize for the unkind words you might have heard just now. I don’t get too many visitors in this here neck of the woods.”

The CMEslinger nodded with a slight grin. “No apologies needed, ma’am. I didn’t mean to sneak up on you. If you don’t mind me asking, what’s got you typing madder than a bear with her paw stuck in a hornet’s nest?”

The woman gave a short laugh and a helpless shrug. “I appreciate your concern, mister, but it’s nothing you can help with. I work for the local health center, and I keep getting my dang CME grant proposals rejected. To make matters worse, won’t nobody give me a good reason why. It’s incredibly frustratin’!”

His grin growing even broader, the CMEslinger slid off his horse and gave the woman a brief nod of his head. “Ma’am, today just might be your lucky day. Let me take a look at one of those proposals. Perhaps we can work out some kind of a deal…”

(Three hours later)

“Las Vegas 300 miles,” read the road sign now rapidly shrinking in the Wrangler’s rearview mirror. The CMEslinger was making excellent time now that he was able to trade the pony and a few hours consulting for a temporary lease of the silver-haired woman’s muddy Jeep. It only took the CMEslinger a few minutes to scan one of her grant proposals to realize she was stuck in a CME time warp where non-referenced needs assessments and standalone live conferences without a tandem enduring program were the norm. It took him a bit longer to explain how she should update her approach to program planning and instructional design, but once he reviewed and gave a thumbs up to her freshly written executive summary, their deal was set.

The CMEslinger looked at the dashboard clock, grimaced, and gave the Wrangler more gas. He had to get moving.

If you missed Part 1 of the CMEslinger saga, you can click here to read it.

Part 2 (Scott)

It hadn’t always been like this, of course.

There was a time when the CMEslinger and the man in black were the industry’s dynamic duo, groomed by Phinneas not only to eventually take over his mantle, but to surpass his myriad accomplishments. They worked hand in hand on everything — project management, accreditation, outcomes, business development – there was nothing they couldn’t do. So feverishly did the CMEslinger and the man in black collaborate that they eventually knocked down the wall that separated their lavish offices so they could communicate through the mere expression on their faces.

Six satellite symposia in two days? No problem.

An unexpected visit from an ACCME site surveyor on Christmas Eve? Piece of cake.

That overzealous new employee who swore a P value of 0.08 was “good enough” for their company’s outcomes reports? They escorted her out the door arm in arm.

“Just remember boys,” Phinneas always told them. “The best of the good things are never great enough for you.”

But then came “The Incident,” and things were never the same. It was an unspeakable breach of trust that the CMEslayer refused to talk about with any of his four ex-wives. Even Ned, his favorite bartender at The Last Straw, got the cold shoulder when he asked, “Say there old timer, what happened to that friend of yours? Haven’t seen him ‘round these parts in a while.” The wounds were too deep, the damage too destructive.

Yet as the CMEslayer wiped his gritty hands on his black leather chaps, his soul couldn’t help but cry out as the memories of past glories flooded back. This was why he spurred on his palomino across the wind-swept plains, why he ignored the pangs of hunger in his ample belly, why he continued on for hours and hours getting closer…closer…closer to the final showdown.

The conference was in 36 hours and the man in black was far, far in the distance. He could no longer see the plumes of smoke from the 2014 Ford F250 rental, but he could see the scowl of the man in black on the horizon. He had to get moving.

Fresh off another Alliance conference, we open up the old mailbox to see who needs some advice.

If you have an issue (professional or personal) you want us to help with, you can click here to submit your question(s).

Dear Derek and Scott,

What do you do if you find out that an individual was not accurate on their disclosure (after the activity)? How do you think an accreditor would view the situation if you did everything by the book based on what was provided to you?

Warmly,

DisclosureMismatch

SCOTT: This sort of paperwork minutiae is not my area of expertise, but I was fortunate enough to get the perspective of others in our community who have more knowledge in this area to help me out.

Basically, it comes down to this: We are not the Disclosure Police. When we send faculty/planner/reviewers disclosure paperwork to complete, we should assume they are being truthful and forthright in the information they send back to us. It is not our responsibility to dig into their online profile, financial statements, and bank records to try to catch them in a lie (fun as this may be).

Now, let’s say that faculty X is presenting at a live symposium on the latest innovations in the treatment of disease Y. On her disclosure form, she does not list any relationship that would disqualify her from participation in the activity. However, upon a social post-activity conversation, she lets it slip that, oops, she has a financial relationship with a specific pharma company (who oh-by-the-way is developing a product she just spoke about at length) that would indeed have disqualified her from presenting at the symposium. While there are no steps you need to take from an accreditation standpoint to retroactively highlight this information, if there was significant bias noted by learners in their activity evaluations, you could potentially notify those learners via a follow-up communication (perhaps with additional educational reinforcement material) that it came to light after the live activity that faculty X had a relevant financial relationship with company Y that may have tainted the assumed unbiased nature of this segment of the activity. Again, you are not required to take this step under accreditation standards, but it could be an ethically appropriate step.

It goes without saying that you would likely not want to utilize this faculty member in future education.

DEREK: 100% agree with Scott here, which is an odd feeling. I’m not sure I like it. Anyway, my first boss at my first CME job used to tell me all the time that we are not the CME police. She even had an old police hat in her office that she would point to when she said this. Her point being, and one that I’ve come to appreciate more and more over time, is that we are all overworked and understaffed and don’t have the time to conduct an investigation on every disclosure form that comes our way. As much as I love Jake Powers, CME Detective, he’s a fictional character and should stay that way.

To answer the second part of the question — how do you think an accreditor would view the situation — I really don’t think it would be an issue. As long as you document the situation, how you managed it, and your plan for managing similar situations in the future, it should be fine.

Dear Derek and Scott,

Despite the wealth of knowledge and experience in our industry, why do we keep creating the same old educational formats? Why is the majority of the education created still following the “sage on the stage” format? I’ve heard it takes 17 years for research to become practice, but I’m pretty sure we’ve known for a much longer time that this passive type of teaching is not ideal.

Best,

Frustrated CME Crusader

DEREK: I’m having a little trouble answering this question because I am getting bogged down in determining the definition of “same old educational formats.” If we just look at very general categories of educational formats — live meetings, enduring materials, online programs, etc. — then fine, yes, we are still mostly producing the same old formats. But if we get a little more granular and look at the educational design of these activities, then I would push back on the idea that we are continuing to do the same old, same old.

Let’s look at satellite symposia as an example. I’m not going to get into the educational value of a satellite symposium, as that is another argument for another time, but I disagree with the idea that the majority of these symposia follow the “sage on the stage” format. Most of the medical symposia I have been to or seen proposed (I review a lot of proposals) over the past few years have had a mixture of educational elements beyond just didactic lectures. These include simple things like panel sessions and group breakout sessions; fun things like Jeopardy and quiz show formats; and cool things like VR headsets with video and patient simulations with holograms. I’ve seen Choose-Your-Own-Adventure and Escape Room style symposia. I’ve seen symposia with hands-on workshops and peer-to-peer interview training. The point being, there are a lot of creative and interesting things going on in the world of satellite symposia (and other formats, too. Remember, I’m just using symposia as an example.).

That said, I don’t completely disagree with your point, Frustrated CME Crusader. I’ve certainly sat through my share of 2-hour lectures during this same time. The fact is that these more traditional education formats are generally easier and cheaper to produce, and there is still an audience for them. Plenty of people prefer this type of passive learning, though you are right to question whether we should still be giving it to them. But as long as “butts in seats” remains a primary metric for determining “success,” we will continue to have these types of programs around.

SCOTT: As Derek notes, there are a lot of providers who develop more innovative formats, but I won’t go so far as to say the majority of CME activities I see in our universe stray from the “sage on the stage model.” I don’t think the reasons for this are terribly complex – leaning on the tried-and-true slide deck and talking head model is both relatively inexpensive and easy, both for providers and faculty. More innovative models that involve newer technology can be costly and complex to develop. In some cases, faculty have a hard time “getting it” – basically, you are asking them to participate in a way that is unfamiliar to them. Some will love this sort of opportunity, some won’t. And in a world where supporter budgets are often squeezed, it shouldn’t be surprising that many providers continue to trot out traditional, cost-effective (and profitable) models.

Now, a personal perspective. I hate “sage on the stage” lectures. I hate keynote addresses where a supposed expert in whatever topic talks at me for 60 minutes without even trying to incorporate interactive or unique components. This is a big reason why you rarely see traditional lectures in CMEpalooza sessions, even though we don’t have a technology budget. We can all use our creativity to design education that puts a unique twist on our most traditional models. We are all definitely doing better than we were a decade ago (almost every program used your “sage on the stage” model back then), but there is still undoubtedly progress to be made.

Dear Derek and Scott,

I believe that patient advocacy organizations are significantly underutilized by the CE/CME/CPD industry. How can we better collaborate with these dedicated organizations to develop educational initiatives that truly encourage patient-centered care, moving beyond supplementary patient-education resources and testimonials that are often relegated to the end of the agenda?

Fondly,

Advocate Ally

SCOTT: I don’t know that you will find anyone in our community who will claim that patient advocacy organizations don’t add value to our education, and I have heard many people in our community echo your sentiments. So then why indeed are patient advocacy organizations still an afterthought for many of us?

Here is my two cents: It takes time to build relationships with any potential educational partner, and many of us already have to develop and cultivate partnerships with academic institutions, professional/state associations, joint accreditors, and/or other groups who, in many cases, are essential to the development of the education for a variety of reasons. Adding on patient advocacy organizations is simply deemed less of a priority, not because they aren’t seen as valuable partners but because they are seen as less valuable partners.

I’ll share a personal example to perhaps illustrate this point: I worked on a grant proposal last year where our team was planning both professional and patient-facing education (the potential funder had asked for both modalities in an RFP). We reached out to a patient advocacy group who we felt best fit our proposed education. After much back and forth, along with multiple conference calls, they agreed to be part of our proposal. We did the usual dance, talking about the potential role their organization would play in the education and finally hashed out the framework of an agreement. Great!

Grant was submitted. And denied.

So that time we spent building the relationship for that single relatively niche-oriented proposal was likely wasted. We parted on good terms, of course (“Hope we can work together in the future!” although the true likelihood of this happening is relatively slim), but this experience doesn’t exactly have us running to more new patient advocacy organizations for everything we are planning. You choose selectively and invest the time where you deem it to be appropriate.

DEREK: I’ll chime in just to add that if you do decide to work with a patient advocacy organization, loop them in from the very beginning. Don’t design the entire program and then reach out to them at the end. It makes the patient advocacy organization feel unimportant and tells them that you are only including them because it will look good in the proposal. From the supporter side, it’s fairly obvious when a patient advocacy organization (or any partner, really) has been included from the early stages or when their contribution has been relegated to a patient education handout tacked on at the end.

Remember, if you have an issue (professional or personal) you want us to help with in a future iteration of Ask Us Anything, you can click here to submit your question(s).