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Alliance for CME 2009 Presentation, Wake me Up Before it’s Over: Bringing out the “LIVE” in Large Live Meetings, Wendy Turell and Marissa Seligman

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    Notes on slide 1

    Please break room into two “competing” teams

    ANSWER = 3

    ANSWER – 3

    ANSWER = 1 Pedagogy = overarching term for the art/science of teaching

    Adult learners are autonomous and self-directed Impact for educators: Faculty must move from “expertise by eminence” to facilitators who actively involve adult participants in the learning process Adult learners are relevancy-oriented Impact for educators: Appeal to the learners need for “what’s in it for me” Adult learners are practical Impact for educators: Make the education EXPLICITLY relevant to clinical practice and not just “knowledge for knowledge sake”. Adults learners seek respect Impact for educators: Acknowledge and use the experiences that participants bring to the so that they will feel empowered to engage and be instructive to other participants as well as the faculty

    Educators must remember that learning occurs within each individual as a continual process throughout life. People learn at different speeds, so it is natural for them to be anxious or nervous when faced with a learning situation. Positive reinforcement by the instructor can enhance learning, as can proper timing of the instruction. Learning results from stimulation of the senses. In some people, one sense is used more than others to learn or recall information. Instructors should present materials that stimulates as many senses as possible in order to increase their chances of teaching success. There are four critical elements of learning that must be addressed to ensure that participants learn. These elements are motivation reinforcement retention Transference Motivation. If the participant does not recognize the need for the information (or has been offended or intimidated), all of the instructor's effort to assist the participant to learn will be in vain. The instructor must establish rapport with participants and prepare them for learning; this provides motivation. Instructors can motivate students via several means: Set a feeling or tone for the lesson. Instructors should try to establish a friendly, open atmosphere that shows the participants they will help them learn. Set an appropriate level of concern. The level of tension must be adjusted to meet the level of importance of the objective. If the material has a high level of importance, a higher level of tension/stress should be established in the class. However, people learn best under low to moderate stress; if the stress is too high, it becomes a barrier to learning. Set an appropriate level of difficulty. The degree of difficulty should be set high enough to challenge participants but not so high that they become frustrated by information overload. The instruction should predict and reward participation, culminating in success. In addition, participants need specific knowledge of their learning results ( feedback ). Feedback must be specific, not general. Participants must also see a reward for learning. The reward does not necessarily have to be monetary; it can be simply a demonstration of benefits to be realized from learning the material. Finally, the participant must be interested in the subject. Interest is directly related to reward. Adults must see the benefit of learning in order to motivate themselves to learn the subject. Reinforcement. Reinforcement is a very necessary part of the teaching/learning process; through it, instructors encourage correct modes of behavior and performance. Positive reinforcement is normally used by instructors who are teaching participants new skills. As the name implies, positive reinforcement is "good" and reinforces "good" (or positive) behavior. Negative reinforcement is normally used by instructors teaching a new skill or new information. It is useful in trying to change modes of behavior. The result of negative reinforcement is extinction -- that is, the instructor uses negative reinforcement until the "bad" behavior disappears, or it becomes extinct. (To read more about negative reinforcement, you can check out Maricopa Center for Learning & Instruction Negative Reinforcement Univeristy.) When instructors are trying to change behaviors (old practices), they should apply both positive and negative reinforcement. Reinforcement should be part of the teaching-learning process to ensure correct behavior. Instructors need to use it on a frequent and regular basis early in the process to help the students retain what they have learned. Then, they should use reinforcement only to maintain consistent, positive behavior. Retention. Students must retain information from classes in order to benefit from the learning. The instructors' jobs are not finished until they have assisted the learner in retaining the information. In order for participants to retain the information taught, they must see a meaning or purpose for that information. The must also understand and be able to interpret and apply the information. This understanding includes their ability to assign the correct degree of importance to the material. The amount of retention will be directly affected by the degree of original learning. Simply stated, if the participants did not learn the material well initially, they will not retain it well either. Retention by the participants is directly affected by their amount of practice during the learning. Instructors should emphasize retention and application. After the students demonstrate correct (desired) performance, they should be urged to practice to maintain the desired performance. Distributed practice is similar in effect to intermittent reinforcement. Transference. Transfer of learning is the result of training -- it is the ability to use the information taught in the course but in a new setting. As with reinforcement, there are two types of transfer: positive and negative . Positive transference, like positive reinforcement, occurs when the participants uses the behavior taught in the course. Negative transference, again like negative reinforcement, occurs when the participants do not do what they are told not to do. This results in a positive (desired) outcome. Transference is most likely to occur in the following situations: Association -- participants can associate the new information with something that they already know. Similarity -- the information is similar to material that participants already know; that is, it revisits a logical framework or pattern. Degree of original learning -- participant's degree of original learning was high. Critical attribute element -- the information learned contains elements that are extremely beneficial (critical) on the job. Although adult learning is relatively new as field of study, it is just as substantial as traditional education and carries and potential for greater success. Of course, the heightened success requires a greater responsibility on the part of the teacher. Additionally, the learners come to the course with precisely defined expectations. Unfortunately, there are barriers to their learning. The best motivators for adult learners are interest and selfish benefit. If they can be shown that the course benefits them pragmatically, they will perform better, and the benefits will be longer lasting.

    Patient Case Presented: How Confident Would You Feel Treating This Patient CASE: Patient 32 yo female Presenting Complaint Increasingly depressed mood; current level of depression falls short of meeting criteria for MDD Past Medical History Past episodes of depression met criteria for MDD; experiences periods of expanded mood lasting up to 5 days every 2-3 weeks - not associated with any drugs or medication; S/P hysterectomy 2 yrs ago for endometriosis Physical Exam WNL Labs Obtained at this Visit TSH: WNL Current Medications Previous PCP treated her with fluoxetine 20 mg/day for the past year (increased lethargy, little improvement); Estrogen replacement therapy

    To add to learner and faculty engagement, involve them before and after a live event – Not necc. 1 point of interaction only!

    Share any Pri-Med examples (screen shots? Screening tool image) that fit this category 6 week post survey example Screen shot from Alisa Wilke on how we send out thank you’s with embedded links to associated online activities (continue education on this TA). Transcribing Q&A and sending out key elements into print document “pri-med dialogue” as f/u to attendees 6 week post mtg

    We’ll now take a deep dive into strategies to bring innovation into live meeting itself…..the “on site” portion of the learning continuum

    KF suggests a talking point: bring up how to finance it – as this is an issue for many small providers, hospitals, etc. This Slide message: Adults are @ different stages of learning, and may be ready for 1) general awareness raising; 2) asessing of own practice gaps, looking within and comparing with clin evidence; or 3) making changes This slide lists some examples of educational formats most appropriate for each stage of learning. Also suggested is that greater interactivity is most necessary at the later stage, when learner has assessed & acknowledged own gap and is ready to make changes.

    There is a continuum of interactivity – learners and faculty can play varying roles in how they approach an educational experience – passivity or along a set path; or highly interactive and behavior varying depending on the evolving situation The role of technology can be to assist with increasing the interactivity of learner or presenter……although not necessary to use technology, can be an added element

    ANSWER = 3

    ANSWER – 3

    ANSWER = 2

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    Alliance for CME 2009 Presentation, Wake me Up Before it’s Over: Bringing out the “LIVE” in Large Live Meetings, Wendy Turell and Marissa Seligman - Presentation Transcript

    1. Wake me Up Before it’s Over: Bringing out the “LIVE” in Large Live Meetings Wendy Turell, DrPH, CCMEP, Director, Strategic Relations and Educational Development, Pri-Med Marissa Seligman, PharmD, CCMEP, Senior Vice President, Pri-Med Institute Alliance for Continuing Medical Education Annual Conference San Francisco, California January 31, 2009
    2. Disclosures
      • Wendy Turell
      • does not have an interest in selling a technology, program, product and/or service to CME professionals.
      • Marissa Seligman
      • does not have an interest in selling a technology, program, product and/or service to CME professionals.
    3. Objectives for Session
      • Identify challenges Facing Educators and faculty in delivery of “Living Live” meetings
      • Discuss tools available to educators to use in their practice, increase education activity, productivity, and effectiveness, while not loosing the “best” of what live has to offer
      • Demonstrate the application of at least one of these tools
    4. How Adults Learn: Team Assignment You will be assigned in to one of two “learner teams”. Please chose the appropriate team for yourself below!
      • My last name begins with A – M
      • My last name begins with N - Z
    5. How Adults Learn: Question 1 According to Adult Learning Theorist Malcolm Knowles, adults are:
      • More Intelligent than children
      • Most responsive to didactic instruction
      • Autonomous and Self-Directed
      • All of the above
    6. How Adults Learn: Question 2 What is the most important factor that draws learners to specific CME activities?
      • Innovative learning formats
      • Prominence of thought leader faculty
      • Relevancy to learner’s practice/life
      • Focus on a “hot” topic
    7. How Adults Learn: Question 3 851 PCP’s were surveyed in 2008 regarding channels used to receive CME hours. Which answer best reflects their responses?
        • 60% Live, 5% Print, 17% Online
        • 51% Live, 19% Print, 12% Online
        • 30% Live, 10% Print, 42% Online
      (18% = other channels; mixed answers) Source: National PCP Insights & Behaviors Study, May, 2008 (N=851 Primary Care Physicians)
    8. Key Principles of Adult Learning- Malcolm Knowles
      • Adult learners are autonomous and self-directed
        • Impact for educators: Faculty must move from “expertise by eminence” to facilitators who actively involve adult participants in the learning process
      • Adult learners are relevancy-oriented
        • Impact for educators: Appeal to the learners need for “what’s in it for me”
      • Adult learners are practical
        • Impact for educators: Make the education EXPLICITLY relevant to clinical practice and not just “knowledge for knowledge sake”.
      • Adults learners seek respect
        • Impact for educators: Acknowledge and use the experiences that participants bring to the so that they will feel empowered to engage and be instructive to other participants as well as the faculty
      Refs: http://en.wikipedia.org/wiki/Malcolm_Knowles ; www.infed.org/thinkers/et-knowl.htm.
    9. Four Critical Elements of Learning-Application to Live
      • Motivation: Best motivators are “interest” and “selfish benefit”
        • Setting educational tone, appropriate level of concern (the clinical care gap), appropriate level of difficulty
      • Feedback: Critical to provide specific feedback so that participants leave the education with specific knowledge of their learning results. This is their “reward”
      • Reinforcement:
        • Ensuring learners “get” the education
      • Retention
        • Directly affected by learner baseline learning. If participant don’t learn the material well initially, “they will not retain it well either”
      • Transference:
        • Ability of learner to use information/skills outside the classroom setting
      “ Show that the course benefits the learner pragmatically, the learner WILL perform better and the benefits will be longer lasting.”
    10. Something to think about….
      • It is paradoxical that many educators and [faculty] still differentiate between a time for learning and a time for play without seeing the vital connections between them. 
        • Leo Buscaglia
      • One must learn by doing the thing; for though you think you know it, you have no certainty, until you try.
        • Sophocles
      • A physician buries his mistakes, a dentist pulls them out but a teacher has to live with them.
        • Anonymous
    11. Live Events Remain the Preferred Channel For CME Hours Question: We are interested in learning how you have received Continuing Medical Education (CME) over the past 12 months . For each CME source listed below, please indicate the approximate number of CME hours earned through this source. PERCENT OF CME HOURS EARNED BY CHANNEL Internal Medicine: 48% FMs/FPs/GPs: 55% Ped/OBGyn: 57% Base: 851 physicians
    12. Case Based-Lectures are Preferred Learning Format, Followed by Didactic Lectures and Diagnostic Challenges Case-based lectures w/ Q&A Didactic lectures w/ Q&A Diagnostic challenges w/ ARS Interactive workshops Point-counterpoint debate Other Patient simulation Which, if any, of the following learning formats would you be most interested in participating in? Question: Which, if any, of the following learning formats would you be most interested in participating? Please check all that apply. Ped/ Ob/Gyn: 61%* Ped/ Ob/Gyn: 57%* IMs: 60% FP/FM/GPs: 33% Base: 851 physicians
    13. Tools for Planners and Faculty
      • Non-Tech Options
        • Sequential/linked education
        • Activity Education Design
          • Group discussion
          • Group exercises
          • Individual exercises
          • Handouts
      • Technological Options
        • ARS
        • Laptops
        • Insert webcasts
    14. As CME Providers We Know Learning Erodes Over Time Without Further Intervention Baseline 6 WEEKS POST 3 MONTHS POST 6 MONTHS POST +51% -30% Source: Pri-Med Clinical Outcomes Study, 2006. Baseline N = 65, 6 wks post N = 74, 3 mths post N = 87, 6 mths post N = 91 Patient Case Vignette Presented: How Confident Would You Feel Treating This Patient? Topic Area: Bipolar
    15. Continuum of Education: Extension of Learning Cycle Pre and Post LIVE event
      • Participant surveys
      • Internet based engagement
        • Message Boards/Chat Rooms
        • Q&A Submission
        • Literature Downloads
      • Laminated Guidelines
      • Screening Tools
      • Fill-In-The-Blank Algorithms
      • Patient Diagnostic Questionnaires
      Take-Home Tools Pre-Meeting On-Site Hand Out Materials
      • Online education
      • Print education
      • Audio education (podcast, radio broadcasts)
      • Online Discussion Forums
      • Online Faculty Q&A Chat / Boards
      Post-Meeting- Enduring or Other Education
    16. Multi Channel Curriculums Help Reinforce Messaging to Facilitate Enhanced Outcomes (As Compared to Live Meeting Alone) (N = 1,816) (N = 1,340) Is Adherent in Treating Presented Patient (6 or 7 on the 7 pt. scale [ 7 is “ALWAYS incorporate this behavior”]) To measure performance, clinicians are asked: “How often do you incorporate the following into your practice when seeing patients with dyslipidemia?” [Scale: 1 (NEVER incorporate this behavior) to 7 (ALWAYS incorporate this behavior)] Relative change: +4% “ Assess and manage dyslipidemia according to ATP III guidelines” LIPIDS MANAGEMENT Base = clinicians seeing patients with dyslipidemia Relative change: +16 % Relative change: +26 % Post Educational Intervention
    18. On-Site Hand Out Materials
      • Hand Out Materials Can Include:
      Diagnostic tools/Algorithms Laminated guidelines Practice “Pearls” in summary form List of Resources, Online Links
    19. On-Site Handout Example: Treatment Algorithms
    20. Post-Meeting Reinforcement Example: Newsletter
      • Program Details
      • Follow-up Q&A based newsletter provides an opportunity to offer reinforcement and reference materials explicitly linked to the live experience to clinicians
      • 4 page reiteration of the Q&A dialogue (per session) at a live program
      • Targeted distributed of pre-registration and onsite attendees
      • Distributed 6 weeks after the live session
      • Not certified for credit
    21. Summary
      • Learning Continuum Includes a focus on:
      At the Live Meeting, innovative ideas can also be integrated with varying focuses: Structure of event, technology Focus on learner behavior at activity Focus of faculty behavior at activity Pre, on-site, and post meeting strategies
    22. Live Meeting: Strategies to Increase Learner Engagement
      • Live or Recorded Role Plays
      • Integration of Multimedia
      • Breakout Groups
      • Working sessions
      • Self-Reflection with group discussion
      Take-Home Tools More Engaging Presentations Learner - Learner Interaction
      • “ Town Hall” discussions
      • FAQs from Prior Meetings
      • ARS Techniques
      • Workshops
      Faculty – Learner Interaction
    23. Learning Framework Introduction Intermediary Deep-dive
      • Epidemiology/MOA
      • Diagnosis & Risks Assessment
      • Guidelines
      • Treatment management
      • Patient management
      LEARNING OBJECTIVES: Raise awareness & Build knowledge in P.C. Apply “real-life” cases in specialty GOAL: Self-evaluate gaps in clinical practice in P.C. LEVELS:
      • Lecture
      • Plenary sessions
      • Webcast
      • Panel of experts
      • Point/counter-points
      • Clinical debates
      • Small workshop
      • Very interactive
      • Lot of cases
      FORMAT:
      • Epidemiology/MOA
      • Diagnosis & Risks Assessment
      • Guidelines
      • Treatment management
      • Patient management
      • Epidemiology/MOA
      • Diagnosis & Risks Assessment
      • Guidelines
      • Treatment management
      • Patient management
    24. Faculty and Learner Interaction Examples Faculty interaction Learner interaction HIGH LOW didactic Case studies ARS Point-counterpoint simulations workshops Expert panel Role plays
    25. Live Meeting Innovation Strategies Principles of Adult Learning: Education should be interactive , problem-based , active and creative . FORMAT DESCRIPTION Diagnostic Challenge Use ARS to engage attendees in solving clinical problems. This formats works especially well for topics where diagnostic decision-making employs visual elements (dermatology, imaging studies) but has worked well for those that do not (kidney disease). Best of . . . Focus in one therapeutic area, but allowing faculty to frame real-life practice applications through discussion of recently published medical data or literature. Choose Your Own Path Using ARS, audience chooses the case they want to hear about Competition/Game Divide the audience into groups and use ARS to pit sides against each other Point-Counterpoint Two or more faculty members present different viewpoints on a clinical topic in a debate format, which can allow for Q&A throughout. Patient Simulation Actor “patient” attends session and engages with faculty to demonstrate symptom presentation, physical examination and/or interview techniques
    26. Innovative Format Example: Live Patient Cases at Pri-Med Meetings Demonstrate Real Practice Situations and Enhance Attendee Experience Conducted in Collaboration With
    27. Learner – Learner Interaction
      • Breakout Groups
      Working sessions Self-Reflection with group discussion Allow participants to exchange solutions to common practice barriers – get stock photo of docs in small groups
    28. Faculty-Learner Interaction
      • “ Town Hall” discussions
      • Roving Moderator with Microphone
      FAQs from Prior Meetings Bring in past program evaluation results and comments
      • ARS Techniques
        • Audience “teams” to foster involvement and/or debate discussion
        • Extended ARS response time to encourage table discussions prior to faculty comment
        • ARS “gaming” to enhance audience participation
      Workshops
      • Getting faculty to change their education styles and interaction with participants in the LIVE format is MISSION ONE in achieving success. So
      • Engage with faculty
      • Train faculty not just on COI but on “best practices” in education
    29. Activity: Breakout Groups – Case 1
      • A hospital-based CME office arranges for the chief of the rheumatology department to deliver a 40 minute rheumatoid arthritis lecture to the (generalist and specialist) physician attendees of the weekly grand rounds meeting.
      • In order to ‘liven things up’, she shows a 5 minute video on the disease in the middle of her talk. At the end of the lecture period, the chief is joined at the podium by two other rheumatologists who engage the audience in a very lively and well-received 20 minute question and answer period.
      • What was a strength of this strategy?
      • How could this have been better undertaken?
    30. Activity: Breakout Groups – Case 2
      • A medical education company organizes a 2.5 hour live CME satellite symposium activity on the topic of overactive bladder at a national association meeting for primary care physicians. In attempts to increase the interactivity of the event, they arrange for ARS keypads to be placed at every seat.
      • The 120 Learners, who are sitting in “rounds” of 8, are encouraged to chat as a group prior to keying in their ARS answers. As a follow-up, learners are sent a link to an online case-based activity on the same topic 3 weeks following the live event.
      • What was a strength of this strategy?
      • How could this have been better undertaken?
    31. Activity: Breakout Groups – Case 3
      • The Arkansas chapter of a national primary care medical association plans to host a CME lunch meeting during their annual chapter gathering on the topic of GERD. The 50 learners are served boxed lunches, and seated at long tables to listen to a 25 minute lecture.
      • Following the lecture period, participants separate into “breakout rooms” in groups of 7-8, where they discuss their own experiences treating patients with GERD. The learners become so caught up in their chats that the moderator is unable to reconvene the group to share key insights of group members.
      • What was a strength of this strategy?
      • How could this have been better undertaken?
    32. Examples/thoughts From Breakout Groups Shared as a Group
    33. How Adults Learn: Question 1
      • According to Adult Learning Theorist Malcolm Knowles, adults are:
      • More Intelligent than children
      • Most responsive to didactic instruction
      • Autonomous and Self-Directed
      • All of the above
    34. How Adults Learn: Question 2
      • What is the most important factor that draws learners to specific CME activities?
      • Innovative learning formats
      • Prominence of thought leader faculty
      • Relevancy to learner’s practice/life
      • Focus on a “hot” topic
    35. How Adults Learn: Question 3
      • 851 PCP’s were surveyed in 2008 regarding channels used to receive CME hours. Which answer best reflects their responses?
        • 60% Live, 5% Print, 17% Online
        • 51% Live, 19% Print, 12% Online
        • 30% Live, 10% Print, 42% Online
      (18% = other channels; mixed answers) Source: National PCP Insights & Behaviors Study, May, 2008 (N=851 Primary Care Physicians)
    36. Presenter Contact
      • For information on presentation please contact
      • [email_address]
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