I know that many, many of you are worried that the current government shutdown will impact the delivery of the daily mail. Sorting through all of the valuable brochures, flyers, and random other knickknacks that arrive at our homes or apartments on a daily basis (except for Sunday) remains an exciting part of life. I, for one, have a Pavlovian response every time I hear the mail slot open and shut on our front door. It’s usually a race between the wife and I to see who gets there first.

OK, fine, this is all a bit of sarcasm. I receive maybe 2 or 3 items in a given month that don’t go straight into the trash. And you don’t even have to worry about interruptions to mail service once the government shutdown begins — the postal service operates independently of the feds, so you’ll still get your daily deliveries. Phew.

It didn’t use to be this way, of course. I am currently reading a biography focused on the scientific discoveries of Benjamin Franklin (Derek isn’t the only one who can bore you with tales of his latest literary adventures), and there is a short section of all of the ways that everyone’s favorite founding father revolutionized the mail service during his time as our Postmaster General. Two days to deliver a letter from Philadelphia to New York City? Preposterous!

Because so many of you miss the days of writing love letters to your beau overseas, the big brains at CMEpalooza started our Ask Us Anything advice column at the start of the year, giving our community a chance to regale us with their latest professional (or personal) challenges and invite Derek and I to chime in with our thoughts to help rectify the situation.

I can’t tell you how many times this month I have been on a call with a colleague and they said, “You know, this would make a great Ask Me Anything submission.” (OK, I can tell you. It’s 3. I’m terrible at keeping secrets.)

Of these 3 individuals, I can’t tell you how many actually went onto our online portal and wrote up their submission. (OK, I can tell you. It’s zero. I won’t shame the perpetrators publicly, but they know who they are.)

Because of their laziness, that means that our virtual mailbox is not exactly overflowing with advice seekers. In past months, we refereed accreditation oddities, funder conundrums, and other professional miscellany. Surprisingly, we are still awaiting the first person who wants us to chime in with parenting or dating advice or simply wants our opinion on the best Ben & Jerry’s ice cream flavor (I won’t tell you – you’ll just need to ask.) (note from Derek: I’ll tell you. It’s Peanut Butter Half Baked.)

So, c’mon everyone, don’t be shy. We won’t bite.

Click here to go to our Ask Us Anything submission portal

(The headline for this blog post mistakenly was emailed out with a big pile of nothing under it earlier this week — many people have told me it was some of my best work. Mea culpa.)

I got a bit carried away last week tying in Freytag’s pyramid with case-based CME in the blog, so I held over part of what I planned to share for this week. I know, I know, you have been waiting breathlessly with anticipation.

Among the other themes of the recent Alliance Industry Summit (AIS), as with basically every other conference ever developed, was “celebrating our successes.” This is where groups get up and talk about the wildly successful initiative they worked on last year, with innovative educational design frameworks, carefully planned partnerships, and outcomes that shine. Of course, it can inspire ideas of your own when you hear about other successful projects, but as one of the presenters (I think it was during the keynote, but I’m not sure) noted, “Why aren’t we talking about the projects that didn’t do so well? Isn’t there something we can learn from those?” (note from Derek: um…that was me. I said that. Thanks for coming to my session.)

But owning up to, and shining a spotlight on, our professional failures exposes us as something less than complete and utter successes. It can be embarrassing and humiliating to talk about projects that failed to live up to our lofty ambitions, even though we all have many, many of these to address. And so, we tuck these failures away into those little spaces that no one at civilized parties ever talks about, and we pretend they never happened.

Now, I’m not talking about those grand rounds or live webinars where no one (or almost no one) shows up — that happens a lot more than people are willing to admit. Or those recorded sessions where the audio feed cuts out for a minute or two — annoying but not catastrophic. I am talking about those crazy ideas that proved to be, well, crazy. But also, perhaps instructional for our community.

So, since I really don’t care if I am ridiculed or humiliated, I’ll go first (and, sigh, probably last. Wimps. Prove me wrong in the comments here or on our LinkedIn post.).

MY BIGGEST PROFESSIONAL FAILURE

This goes back about 18 or so years ago when I was working for a midsized medical education company. I had read something about the value of small group learning and indeed was coming off of a project where we had a lot of success educating teams of 15-20 learners in the live setting. So, I started noodling around with the concept of bringing small group learning to the satellite symposium — essentially, the antithesis of the small group setting.

Here was my idea: we’d divide up the big ballroom that held 150 learners into three separate rooms with those portable wall dividers you sometimes see in physical meeting spaces. We’d have three different stages and three faculty who would rotate through the rooms on a very specific time schedule (15 minutes in each room, with 5 minutes to move to the next room). All 150 learners would eventually get the same education, but each room would get that education in a different order — our faculty members would present their own content three times. The faculty would be asked to interact and engage with each “small group” of 50 learners, giving the education a more personal feel.

Yes, it was weird, but it was different and unique, which apparently was good enough to attract funding from multiple supporters. Perhaps my written description was just vague enough within our grant request so that the supporters couldn’t see how genuinely unwieldly this program was likely to be. I do distinctly remember one of the funders who told me onsite prior to our symposium, “I don’t understand what you are trying to do even a little bit.” That obviously filled me with confidence.

The physical setup of the room went OK. We had plenty of time to work with the hotel labor team to set up the physical walls between the rooms and equally divide up the tables. Our faculty seemed to understand the general concept — these were all people I had worked with before, so they trusted me (fools!) and didn’t try to question how or why this was going to work.

But then the learners started showing up. They didn’t understand why some people were asked to go into one room while some went into another. It took a long time to get everything situated — too long, of course — which meant we started the symposium 5 minutes late. I had to run between the 3 rooms to get everyone on the same schedule to make sure all of the presentations started more or less simultaneously.

Problem #1 averted (sort of).

Then the presentations start, and it becomes clear that these folding walls weren’t sufficiently muffling the noise between each room. You could clearly hear the presentation in the adjacent room, which not only annoyed attendees but also threw off faculty as well. There was no interaction between anyone. But no time to complain or try to fix anything, because it was time to switch rooms. DING!

Faculty 1 ran from room 1 to room 2, faculty 2 ran from room 2 to room 3, and faculty 3 circled from room 3 to room 1. For this first switch, the timing worked OK, but it was clearly a challenge to get mentally adjusted to the new room and the next presentation. Faculty were frazzled and learners were disjointed. The noise again carried throughout the rooms. Faculty covered maybe 50% of the planned content in this second segment because we were running behind and everything was confusing. Still no “small group” interaction that I had hoped for. But no time to complain or try to fix anything, because it was time to switch rooms. DING!

Faculty 3 ran from room 1 to room 2, faculty 1 ran from room 2 to room 3, and faculty 2 circled from room 3 to room 1. We were now 10 minutes behind, which meant that faculty had 5 minutes to give their final presentation. I was still putting up a good front (I think), but on the inside, I was working on my resume. Just in case.

When the time was finally up and the faculty had collapsed in a heap at the side of their stage, I congratulated them on doing such a great job under fairly trying circumstances. One of them said to me, “Let’s not do that again.” Good idea.

So, what did I learn from this experience (and perhaps what can you learn as well)? First, there is nothing wrong with thinking out of the box and coming up with creative ideas to liven up our education, but there are limits to what we can and should do. Second, be realistic in your educational plans. But most of all, don’t be afraid to fail. That is how we grow professionally. I am not embarrassed or ashamed to tell this story of my biggest failure — I tried my best and really did work with my team to plan for what we hoped was going to be something unique and successful. It was just a dumb idea that should never have gotten off the ground. It happens to all of us.

During last week’s Alliance Industry Summit, the primary theme of the keynote address was the power of storytelling as an educational tool. While there was far too much table interaction for my liking that really made me squirm (if you know Derek and I, you know how much we looove being forced to participate with strangers on any creative task), I did appreciate the general thrust of the session. Storytelling, you see, is one of the thing I am most passionate about both professionally and personally. If you are a faithful reader of this blog — and if you aren’t, shame on you — you hopefully have learned a lot about CMEpalooza and our personalities through our stories (or perhaps you have a poster of the CMEslinger on your wall and can’t wait for his return in 2026 for another adventure).

Think about a memorable conversation you recently had with a friend, family member, or colleague. Most of our “How were your day?” conversations may end with “Fine” or “Mid” (especially if you live with a teenager), but any time that question elicits anything memorable, it usually involves a “let me tell you a story about this interesting/funny/embarrassing thing that happened to me today.” We can’t often relate to being lectured about topics to which we have little or no personal connection, but it’s easy to relate to a well-told story from crazy Aunt Martha.

In the sessions we develop for CMEpalooza, the accredited education that I oversee as part of my “real” job, and even the historic tours I lead around Philadelphia every summer, storytelling plays a primary role. I am a big fan of using various forms of case studies within accredited education because of their storytelling capabilities and applicability to the real world. Really, the typical patient-provider encounter is just a story broken down into various elements.

I’ll illustrate how in a moment, but first, a quick story (of course)…

Last night, I was somewhat ironically helping my 14-year-old son prepare for an English quiz that focused on the five plot elements of Freytag’s pyramid. If you aren’t familiar with Freytag’s pyramid (and if you are, you must be a big English nerd), it essentially breaks down any story into five crucial elements. Allow me to align these with your typical patient-provider visit:

Element 1: The Exposition. This is basically the background of the story – who are the main characters, how do they relate to each other, where are things taking place, etc. Within a medical case study perspective, this introduces the patient and gives us some background into their family and medical history, their current medications, and so on — basically, everything within their initial chart presentation.

Element 2: Rising Action. This is the part of the story where the action starts to heat up. Often, it’s where our “hero” meets the “villain,” or in literary terms, where the protagonist meets the antagonist. While you may commonly picture the antagonist as a person or being (ie, The Joker or your mother-in-law), this isn’t always the case. In a medical case study, the antagonist is typically health, pain, or something like that. As the rising action phase emerges in our case studies, we find out what’s wrong with the patient (why are they here?) and perhaps get details from a physical exam, lab results, imaging, etc.

Element 3: Climax. This is the turning point of the story, where the protagonist and antagonist collide in a series of events that lead to either their success or downfall. In a medical case study, this is where the (hopefully) shared decision is made regarding what should be done to help cure the patient, alleviate their pain, and get them back to a healthier state.

Element 4: Falling Action. This is where the climax comes to an end and prepares us for the conclusion. It’s where the antagonist lays in a heap with their last breaths after being vanquished by our swashbuckling hero. Or, in our medical case study, the patient and clinician cement their agreement on the best plan of action and go their separate ways.

Element 5: Resolution/denouement. This is where we typically get our happy ending (or not). So for our medical case studies, the resolution is when the patient always, absolutely, positively gets better. Or maybe they don’t. Depending on the complexity of our case, the story arc may now bring us back to element 2 where the patient returns with a new complaint/issue that needs addressing. Life isn’t a fairy tale, after all.

I was going to write more today about a related theme from last week’s conference (celebrating our failures), but since this blog is already plenty long enough and you surely have work to do today, I’ll leave you in suspense for another day soon.

So for now, may you enjoy many happily ever afters…